Heterogeneity in healthy aging among U.S. Latinos: a dual functionality perspective

This study examines heterogeneity in healthy aging among U.S. Latinos using a dual functionality perspective-the absence of both cognitive and physical limitations. We aim to quantify age-related changes and subgroup disparities by heritage and nativity, disaggregated by sex.

We analyzed 16 years of nationally representative data from the American Community Survey (2008-2023), including 1,902,870 Latino adults. Logistic regression models estimated age-specific probabilities of dual functionality across heritage and nativity subgroups, adjusting for sociodemographic covariates. Analyses were stratified by sex, and subgroup deviations from pan-ethnic Latino averages were calculated.

Dual functionality declines with age, but subgroup differences are pronounced. At age 45, South American male and female respondents had the highest dual functionality (≥97%), whereas island-born Puerto Ricans had the lowest (≤89%). By age 85, South Americans maintained a relative advantage, while Puerto Ricans remained disadvantaged. Foreign-born Latinos generally exhibited higher dual functionality than U.S.-born peers; this advantage narrowed or reversed with age, particularly among women. Notably, U.S.-born South American men showed steep declines after age 75, in contrast to sustained advantages among foreign-born Central Americans.

These findings reveal deep inequities in functional aging that emerge well before old age. Dual functionality offers a culturally grounded and policy-relevant metric for assessing aging equity. The persistent disadvantage among Puerto Ricans-particularly island-born-signals the enduring impact of structural inequality. Addressing these disparities requires life-course informed interventions that prioritize functional health, autonomy, and dignity in aging.