Older People From Minority Ethnic Groups: Poorer Health, Lower Incomes

In several countries with good data, older people from minority ethnic groups live with more illness, lower incomes and later dementia diagnoses than older people from the majority population. The evidence links these gaps not to ethnicity itself but to a lifetime of unequal work, housing and treatment, including racism, and to services that were not designed with them in mind.

Later life is becoming more diverse. In Canada, 14% of people aged 65 and over belonged to racialized groups in the 2021 Census, and that older racialized population grew by 38% between 2016 and 2021, against 18% for other older people^[1]. Many of today's older people from minority ethnic groups arrived as migrants earlier in life and are now growing old in the country they made their home; across Europe, many have a direct migration background^[2]. Others were born where they live and have spent a lifetime as a minority there. This study brings together evidence from the United States, the United Kingdom, Canada and Europe on what aging looks like for them. It uses each country's own categories, which are not the same, and does not add them up.

Ill health arrives earlier, and the gaps are widest in later life

The clearest long-run evidence comes from England. Researchers combined six nationally representative surveys covering 1993 to 2017 and people aged 40 and over. Their central finding was "the persistence of stark and significant ethnic inequalities in limiting long-term illness and self-rated health" over more than two decades, and these inequalities "tend to be greater in older ages"^[4]. After allowing for age and sex, Pakistani people had higher odds of a limiting long-term illness than White British people in every survey year, ranging from 1.66 times the odds in 2007 to 4.42 times in 2015-17; Bangladeshi people also had consistently higher odds^[4].

The same pattern shows up in other data. Analysis of Census 2021 by the Centre for Ageing Better found that 22% of Bangladeshi women aged 50 to 64 reported poor health, the same proportion as White British women aged 85 and over, "a gap of 30 to 35 years"^[6]. In Scotland's 2011 Census, Pakistani people aged 45 and over had the highest rates of poor self-rated health of any ethnic group, and the authors warned that "the better health of the younger minority population should not be taken as evidence of better health outcomes in later life"^[7]. A UK systematic review found indicative evidence that minoritised ethnic groups develop multiple long-term conditions at higher rates "and do so earlier than the majority white population"^[8].

The picture is not uniform. In the 2015-17 survey, Chinese people aged 40 and over reported the lowest rate of limiting illness of any group, and Irish, Black African and Black Caribbean people were much closer to the White British figure than Pakistani and Bangladeshi people were^[4]. Broad labels such as "BAME" or "Asian" hide exactly the differences that matter.

Racism is part of the explanation, not a side issue

Why do these gaps exist? The English study tested this directly. The inequalities it found were "partially explained by contemporaneous measures of socio-economic position, racism, and discrimination"^[4]. Pakistani and Bangladeshi people aged 40 and over were consistently under-represented in the highest income group and in managerial and professional jobs across every survey year, and Black African and Indian people were under-represented in the highest income group despite much higher rates of degree-level education^[4]. In the 2007 Citizenship Survey used in that study, 77.8% of Pakistani, 79.0% of Bangladeshi, 77.9% of Indian and 61.1% of Black Caribbean people aged 40 and over said they feared racial harassment, against 36.9% of White British people^[4].

Evidence that discrimination precedes poorer health comes from longitudinal data. In the UK Household Longitudinal Study, 20.4% of 4,883 ethnic minority adults of all ages reported racial discrimination. Two years later, those who had reported it had 1.31 times the odds of a limiting longstanding illness, after allowing for their earlier health, income, education and other factors^[9]. That study covered adults of every age, not older people alone, but it points to a mechanism that the later-life studies suggest builds up over decades.

This matters for how the problem is described. The data do not show that being from a particular ethnic group makes a person ill. They suggest that people who have spent years in worse-paid work and on the receiving end of racism tend to arrive at later life in worse health, and that the gaps are greater at older ages^[4]. Those are conditions that policy can change.

Dementia is more common in some groups, and diagnosed later

The largest direct comparison comes from the United States. Among 274,283 members of one Northern California health plan aged 64 and over, followed from 2000 to 2013, recorded dementia incidence was highest for African-American members, at 26.6 per 1,000 person-years, and lowest for Asian-American members, at 15.2; rates for Latino, Pacific Islander and white members sat in between^[10]. The estimated 25-year risk of dementia from age 65 was 38% for African-Americans against 30% for white members, and overall "dementia rates varied over 60% between groups"^[10].

In the UK, the concern is as much about diagnosis as about risk. Using primary care records for more than 2.5 million people aged 50 to 105 between 2007 and 2015, researchers found that the recorded rate of new dementia diagnoses was 25% higher among Black women than white women and 28% higher among Black men than white men, but 18% lower among Asian women^[5]. Comparing those records with community studies of how often dementia actually occurs, they estimated that only 42% of Black men who developed dementia in 2015 received a diagnosis, against 53% of white men^[5]. A later English study of people aged 65 and over (health records, 1997-2018) found that South Asian and Black people with dementia died on average about three years younger than White people with dementia (2.97 and 2.66 years younger respectively)^[11].

Qualitative research in an ethnically diverse UK area helps explain the delay. People from minoritised ethnic groups "are diagnosed with dementia later in the disease"; the word dementia itself was stigmatised and understood differently across cultures, and translating symptoms faithfully was hard for professionals and interpreters alike^[12]. An Alzheimer Europe expert group concluded that across Europe there is "a lack of equity in relation to dementia diagnoses and care because equal opportunities do not necessarily translate into equal outcomes"^[2]. The dementia library covers this in more depth in dementia and ethnic inequalities.

Lower incomes after a lifetime of unequal pay

Income in later life is shaped by working lives, and the data suggest that inequality at work follows people into old age. In the United States, three-year averages for 2020 to 2022 show that 17.3% of Black, 17.4% of Hispanic and 12.5% of Asian adults aged 65 and over had incomes below the official poverty line, against 7.7% of White older adults^[3]. On the alternative Supplemental Poverty Measure, 20.0% of older Hispanic adults were in poverty, against 9.2% of older White adults. On the official measure, close to half of older Black (43.9%) and Hispanic (44.7%) adults lived on less than twice the poverty line, against 25.1% of White older adults^[3]. On the official measure, poverty rates among older Black and Hispanic women were twice those of older White women^[3].

Canada's official statistics show the same pattern through the sources of income. In 2020, 72% of racialized people aged 65 and over received Canada or Quebec Pension Plan benefits, with a median of C$5,280, against 94% of other older people, with a median of C$8,600^[1]. In England, the Centre for Ageing Better found that around a quarter of people aged 50 and over from Bangladeshi and Pakistani backgrounds live in deep poverty, and that 36% of Bangladeshi, 29% of Black African and 27% of Pakistani people in that age group live in housing that is overcrowded, has no central heating or is shared, against 3.5% of White British people^[6]. For poverty in later life more broadly, see older people on low incomes.

Language, care and services not built around them

Language is a barrier that grows more important as health needs rise. In a nationally representative US survey of community-dwelling adults aged 65 and over (2013-2018), 4.6% had limited English proficiency. They were less likely than English-proficient older adults to be taking multiple prescription medicines (polypharmacy; 51.7% against 58.1%), which the authors caution "may reflect barriers to care rather than better prescribing practices"^[13]. In the UK dementia research above, professionals and interpreters described how hard it was to translate meanings faithfully and to balance the voices of older people and their relatives^[12].

When care is needed, it is not always of equal quality. A US analysis found a two-tier pattern in nursing home care: the nearly 15% of US non-hospital nursing homes serving mainly Medicaid residents had fewer nurses and more health-related deficiencies, were concentrated in the poorest counties, and were more likely to serve African-American residents than other homes^[14]. That study is from 2004; it is still widely cited, but care markets have changed since and newer national data would be needed to say how far the pattern holds today.

Older people from minority ethnic groups also give a great deal of care. In England, older women from Bangladeshi and Pakistani backgrounds, the groups reporting the worst health, are "particularly likely to provide high levels of unpaid care"^[6]. Caring at high intensity while in poor health is its own risk; see older unpaid carers. Older people whose ethnicity is bound up with migration face further barriers, covered in older migrants and refugees.

What the evidence asks of us

The figures point in a consistent direction, and they imply action on four fronts.

• Count people properly. The English researchers identify "a large empirical gap focusing on older ethnic minority people" and call for future data collection to "better represent older ethnic minority populations"^[4]. The Centre for Ageing Better recommends making ethnicity reporting mandatory in official and statutory statistics and "reporting on specific ethnic groups rather than broad categories like BAME"^[6]. Health and care systems that cannot see who they are failing cannot fix it.
• Treat racism as a determinant of health in later life. The evidence that discrimination is followed by poorer health^[9], and that it helps explain gaps at older ages^[4], makes it a legitimate target for health policy, not only for equality law.
• Close the diagnosis gap. Later dementia diagnosis in some groups^[5][12] calls for services that work with community organisations, use professional interpreters and reflect the communities they serve; the UK study authors point to "closer collaboration with interpreters and workforce diversity"^[12], and Alzheimer Europe's group set out recommendations for timely, culturally appropriate diagnosis and care^[2].
• Build equity into the global agenda. The UN Decade of Healthy Ageing (2021-2030) commits to reducing inequity through action on age-friendly environments, ageism, integrated care and long-term care^[15]. For older people from minority ethnic groups, that means measuring progress separately for them, in each country's own terms.

Language: this piece says "older people" rather than "the elderly", and uses "older people from minority ethnic groups" or "minoritised ethnic groups", as many race equality and older people's organisations do. Where a source uses its own terms ("racialized" in Canada, "Black", "Hispanic" or "Latino" in the United States, named groups such as "Pakistani" or "Black Caribbean" in the UK), we keep them, and we avoid catch-all labels such as "BAME" that hide differences between groups.

Why we're publishing this

Older people from minority ethnic groups are too often missing twice over: from research on aging, which rarely has samples large enough to see them, and from research on race and health, which tends to stop before later life. The organisations that work with them need the evidence in one place, cleanly sourced and ready to put in front of a commissioner, a funder, a regulator or a journalist. The case here is theirs; our part is to set out what the data show and to be honest about where they run out.

How to read this data

The figures come from different countries, years and methods and are not directly comparable. Ethnic categories differ by country: Canada's "racialized" groups, the US Census race and Hispanic-origin categories and the UK's census groups do not map onto each other. The English health figures are self-reported limiting illness and self-rated health from household surveys of people aged 40 and over; the percentages in the first chart are unadjusted, while the odds ratios allow for age and sex. The US dementia figures are recorded diagnoses among members of one health plan, not national estimates; the UK estimate of how many people with dementia are diagnosed compares recorded diagnoses with rates from community studies and is modelled. Poverty figures depend on the measure used. Associations between discrimination and health do not, on their own, prove cause. Evidence for this intersection is thinnest outside North America and the UK, for smaller groups, and for people living in care homes; much of the strongest data is now several years old.

Use this data

Free to cite with attribution to Understanding Aging. Race equality organisations, older people's groups, campaigners and journalists are welcome to reuse these figures and charts. For the underlying figures as a spreadsheet, get in touch.

Important: This article summarises published research and statistics for general information. It is not medical, care or financial advice and cannot be used to diagnose, treat or predict anything about an individual. If you have concerns about your own or someone else's memory or health, please speak to a GP or another qualified health professional.

Sources

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2. Gove D, Nielsen TR, Smits C, et al. The challenges of achieving timely diagnosis and culturally appropriate care of people with dementia from minority ethnic groups in Europe. International Journal of Geriatric Psychiatry, 2021. europepmc.org/article/MED/34378237
3. KFF. How Many Older Adults Live in Poverty? KFF, 2024. kff.org/medicare/how-many-older-adults-live-in-poverty
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15. World Health Organization. UN Decade of Healthy Ageing 2021-2030. WHO. who.int/initiatives/decade-of-healthy-ageing