U.S.-born Asian Americans no longer the healthiest group among older adults

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For the first time in two decades, older Asian Americans are no longer the healthiest U.S.-born aging racial group with the lowest rates of disability, according to a study published last month in the Journals of Gerontology.
The report focused on adults aged 50 and older, and used disability prevalence as an indicator for overall health.
The paper shows that while disability rates have decreased among aging adults in every racial group, it's remained unchanged among U.S.-born Asian Americans. The findings suggest that one contributor to the stagnating disability rate is income inequality, which has impacted Asian Americans more than any other group in recent years.
Previous research had shown that both foreign-born and U.S.-born Asian older adults had lower mortality and disability rates than their counterparts in other racial groups. According to the new report, non-Hispanic white Americans have overtaken Asians Americans as the healthiest U.S.-born population, with the lowest disability prevalence.
'This study shows that the 'model minority' stereotype is wrong about the overall experience of U.S.-born older Asians in terms of health,' said lead author Leafia Ye, an assistant sociology professor at the University of Toronto.
The report is the first to focus solely on the health of U.S.-born Asians, a group that experts say has been understudied due to its limited population size. The study drew on data from the American Community Survey, which has a sample size of more than 18 million U.S.-born adults aged 50 and older. The sample size for U.S.-born Asians is roughly 116,000, Ye said.
The study authors defined disability as any chronic physical or mental health condition that limits an older adult's self-care or independent living capacity, which includes carrying out tasks like eating, bathing and grocery-shopping without assistance.
Two decades ago, just 5.5% of U.S.-born Asian elders had trouble living independently — compared with 7% of white and 14% of Black elders.
From 2005 to 2022, the report found, disability rates fell by at least 2% among U.S.-born non-Hispanic white, Black, Hispanic and Indigenous populations, as well as all foreign-born groups. (Black older adults experienced the largest drop from 14% to 10%.) Among native-born older Asian Americans, however, the rate has stayed at 5.5%.
Ye said the trends preceded the Covid-19 pandemic, so it's unlikely that rising anti-Asian racism was a key risk factor.
'What's striking about this study is that U.S.-born Asians are the only group that hasn't experienced improved outcomes,' said Mansha Mirza, principal investigator at the Aging Services Inclusive of Asian American Networks, a national technical assistance and resource development center focused on Asian Americans older adults. Mirza was not involved with the new study.
The trend could be attributed to the fact that U.S.-born Asians 'are more assimilated into the American way of life,' Mirza said, while foreign-born Asians were more likely to 'retain practices from their home countries related to nutrition and diet.'
Disability prevalence varies across the racial group. Cognitive disability is more prevalent in Vietnamese, Filipino and Japanese older adults, according to a 2024 paper in Innovation in Aging. For self-care disability, on the other hand, Vietnamese, Chinese, Filipino and Indian older adults have a higher prevalence.
In the past, older Asian Americans have had better health outcomes than other groups because the large majority were foreign-born, Ye said. People with poorer health and lower socioeconomic status were less likely to resettle in another country, she said, so Asian immigrants became a 'very positively selected' group that's 'healthier and more successful economically compared with both the source and the destination populations.'
By contrast, Ye said, U.S.-born Asians were immediately exposed to the country's cultural and political realities. Socioeconomic status has a particularly strong influence on health outcomes, as college-educated older Asian Americans saw a slight decline in disability, while those without a degree saw an increase.
While the data didn't contain mental health measures, like loneliness and anxiety, Ye said it's possible that these conditions could have also contributed to stagnating health outcomes.
'In a way,' Ye said, 'U.S.-born Asians are both less selected and more exposed throughout their lifetime.'
Mirza said a point of further study could be desegregated research on the impact of migration history on health outcomes. First-generation Vietnamese and Cambodian refugees, for example, survived war, famine and genocide. Research has shown that exposure to these adverse conditions could contribute to 'altered diets and physiological capacity' in their U.S.-born children, who are now advancing in age, Mirza said.
Mirza also emphasized a need to study the impact of social isolation on Asian seniors, which she said is gradually emerging as a social determinant of health as much as smoking and alcohol use.
'We need to see what social isolation looks like for foreign-born Asians Americans and U.S.-born Asians Americans,' she said, 'and the extent to which social ties are preserved within these groups.'
This article was originally published on NBCNews.com