Risk factors for intracerebral and subarachnoid hemorrhage among Hispanics and non-Hispanic whites in a New Mexico community

BACKGROUND AND OBJECTIVE: A higher incidence of spontaneous intracerebral and subarachnoid hemorrhage among Hispanics than non-Hispanic whites has been measured in Bernalillo County, New Mexico. In an attempt to explain these differences, we compared historical vascular risk factors between Hispanics and non-Hispanic whites living in this community. METHODS: An ongoing telephone survey, the Behavioral Risk Factor Surveillance System, collected annual data about vascular risk factors among non-institutionalized, randomly selected adults. Data covering 6 years, 1988-1993, were analyzed. RESULTS: There were 843 Hispanic and 1,635 non-Hispanic white residents of Bernalillo County, New Mexico, who participated in this survey. Because Hispanics were significantly younger than non-Hispanic whites (37.7 vs. 43.4 years, p < 0.001), all other comparisons were adjusted for age. Prevalence of hypertension was similar between these ethnic groups (15-17%). Prevalence of alcohol drinking considered risky for abuse was similar between these ethnic groups (5-6%), but was significantly higher among Hispanic men than women (8.5 vs. 1.6%, p < 0.001). The quantity of alcohol consumption among those at risk for abuse was similar between these ethnic groups. Prevalence of current cigarette smoking was similar between these ethnic groups (22-23%), but Hispanics smoked significantly less than non-Hispanic whites (11.4 vs. 15.2 cigarettes per day, p < 0.001) and among non-Hispanic whites, men smoked significantly more than women (17.0 vs. 13.4 cigarettes per day, p = 0.001). CONCLUSION: The vascular risk factors which we compared between Hispanics and non-Hispanic whites do not help to explain the higher incidence of hemorrhagic strokes among the Hispanics in Bernalillo County, New Mexico. Additional risk factors for hemorrhagic strokes in these two ethnic groups should be studied.     

Ethnicity, stress, and cortisol function in Hispanic and non-Hispanic white women: A preliminary study of family dementia caregivers and noncaregivers.

OBJECTIVE: This study examined differences in psychologic and physiological responses to caregiving stress in Hispanic and non-Hispanic white women dementia caregivers and noncaregivers. Dependent variables were perceived stress, depression, and salivary cortisol. METHOD: Eighty-three women caregivers (20 Hispanic and 24 non-Hispanic white) and noncaregivers (19 Hispanic and 20 non-Hispanic white) completed the Perceived Stress Scale (PSS), Center for Epidemiological Studies-Depression Scale (CES-D), and collected three saliva samples daily for 3 consecutive days. A subsample of 17 Hispanic and 28 non-Hispanic white participants matched on age and education was used for the main analyses. RESULTS: Caregivers had higher levels of 8 am, 5 pm, and 9 pm log cortisol as well as higher perceived stress than noncaregivers. Non-Hispanic whites had higher depression scores than noncaregivers, but there was no significant difference for Hispanics. Hispanics, regardless of caregiving status had flatter daytime cortisol slopes than the non-Hispanic whites. Multivariate regression analyses showed that both ethnicity and depressive symptoms independently predicted daytime cortisol slope. CONCLUSIONS: Results support the relationship between chronic stress and hypothalamic-pituitary-adrenal axis dysregulation among women dementia caregivers and highlight the need to examine further the role of ethnicity and depressive symptoms in their physiological responses.     

Differential item responses on CES-D inventory: A comparison of elderly Hispanics and non-Hispanic Whites in the United States and item usage by elderly Hispanics across time

Objectives: This study examines the differential item functioning (DIF) on both the standard 20-item scale and 10-item and 12-item subsets of the Center for Epidemiological Studies Depression (CES-D) inventory.

Method: Two elderly groups in the United States are compared: one composed of Hispanics and the other of non-Hispanic Whites. We also compare item use among the elderly Hispanics over time. Survey data was analyzed from participants (N = 4499) in the Established Populations for Epidemiologic Studies of the Elderly (EPESE) with complete data on the CES-D. Partial correlation analysis was applied to test hypotheses regarding the DIF on the basis of ethnic background and among the elderly Hispanics across time points.

Results: Hispanics appear to express positive affect differently than non-Hispanic Whites. On the 20-item scale, Hispanics under responded to items measuring positive affect. Item bias was also found for one positive affect question in the 10-item subset. Among the Hispanic sub-population, we also observed item response bias for the positive affect items across time. A 12-item subset tested for DIF displays an acceptable amount of item bias across ethnic groups and across time for the Hispanic sample.

Conclusions: Attempts to make substantive comparisons about the relative prevalence of depression symptoms in elderly Hispanic and non-Hispanic sub-populations appears to be limited by the lack of measurement invariance in the full CES-D. Comparisons across time for elderly Hispanics also appear problematic.     

Differences in life satisfaction among older community-dwelling Hispanics and non-Hispanic Whites

Objectives: Hispanics are the fastest growing ethnic/racial group of the older adult population in the United States, yet little is known about positive mental health in this group. We examined differences in life satisfaction between demographically matched groups of older Hispanics and non-Hispanic Whites, and sought to identify specific factors associated with these differences

Methods: Participants included 126 community-dwelling English-speaking Hispanics aged 50 and older, and 126 age-, gender-, and education-matched non-Hispanic Whites. Participants completed standardized measures of life satisfaction and postulated correlates, including physical, cognitive, emotional and social functioning, as well as positive psychological traits and religiosity/spirituality.

Results: Hispanics reported greater life satisfaction than non-Hispanic Whites (p < 0.001). Ethnic groups were comparable on most postulated correlates of life satisfaction, except that Hispanics had lower levels of cognitive performance, and higher levels of daily spiritual experiences, private religious practices and compassion (ps < 0.001). Among these factors, spiritual experiences, religious practices, and compassion were significantly associated with life satisfaction in the overall sample. Multivariable analyses testing the influence of these three factors on the association between ethnicity and life satisfaction showed that higher spirituality among Hispanics accounted for ethnic differences in life satisfaction.

Conclusion: English-speaking Hispanics aged 50 and older appeared to be more satisfied with their lives than their non-Hispanic White counterparts, and these differences were primarily driven by higher spirituality among Hispanics. Future studies should examine positive mental health among various Hispanic subgroups, including Spanish speakers, as an important step toward development of culturally sensitive prevention and intervention programs aimed at promoting positive mental health.     

Alcohol abstinence and binge drinking: the intersections of language and gender among Hispanic adults in a national sample, 2002–2018

Purpose

Prior research examining alcohol use using national data has often overlooked vital heterogeneity among Hispanics, especially that related to language dominance and gender. We examine the prevalence of alcohol abstinence and—given prior research suggesting that many Spanish dominant Hispanics do not drink—examine rates of binge drinking among past-year alcohol users with a focus on the intersections of language and gender among Hispanics, while drawing comparisons with non-Hispanic (NH) White and NH Black adults.

Methods

Drawing from the National Survey on Drug Use and Health—a nationally representative survey between 2002 and 2018—we examine the year-by-year prevalence of alcohol abstinence and binge drinking among adults ages 18 and older in the United States.

Results

A disproportionate number of Spanish-dominant Hispanics abstain from alcohol use (54%), with particularly high levels of alcohol abstinence observed among Spanish dominant women (men: 39%, women: 67%). The prevalence of alcohol abstinence among English-dominant Hispanic men (24%) and women (32%) is far lower, approximating that of NH Whites (men: 23%, women: 32%). Importantly, however, among Spanish-dominant drinkers, the prevalence of binge drinking (men: 52%, women: 33%) is comparable to or greater than NH Whites (men: 42%, women: 32%). Binge drinking levels among English-dominant Hispanic men (50%) and women (37%) are greater than among their NH White counterparts.

Conclusion

Findings paint a complex picture; consistent with prior research, we see that many Hispanics abstain from alcohol, but we also see new evidence underscoring that—among Hispanic drinkers—the prevalence of binge drinking is disconcertingly elevated.

     

Performance of Hispanics and Non-Hispanic Whites on the NIH Toolbox Cognition Battery: the roles of ethnicity and language backgrounds

Objective: This study examined the influence of Hispanic ethnicity and language/cultural background on performance on the NIH Toolbox Cognition Battery (NIHTB-CB). Method: Participants included healthy, primarily English-speaking Hispanic (n = 93; Hispanic-English), primarily Spanish-speaking Hispanic (n = 93; Hispanic-Spanish), and English speaking Non-Hispanic white (n = 93; NH white) adults matched on age, sex, and education levels. All participants were in the NIH Toolbox national norming project and completed the Fluid and Crystallized components of the NIHTB-CB. T-scores (demographically-unadjusted) were developed based on the current sample and were used in analyses. Results: Spanish-speaking Hispanics performed worse than English-speaking Hispanics and NH whites on demographically unadjusted NIHTB-CB Fluid Composite scores (ps < .01). Results on individual measures comprising the Fluid Composite showed significant group differences on tests of executive inhibitory control (p = .001), processing speed (p = .003), and working memory (p < .001), but not on tests of cognitive flexibility or episodic memory. Test performances were associated with language/cultural backgrounds in the Hispanic-Spanish group: better vocabularies and reading were predicted by being born outside the U.S., having Spanish as a first language, attending school outside the U.S., and speaking more Spanish at home. However, many of these same background factors were associated with worse Fluid Composites within the Hispanic-Spanish group. Conclusions: On tests of Fluid cognition, the Hispanic-Spanish group performed the poorest of all groups. Socio-demographic and linguistic factors were associated with those differences. These findings highlight the importance of considering language/cultural backgrounds when interpreting neuropsychological test performances. Importantly, after applying previously published NIHTB-CB norms with demographic corrections, these language/ethnic group differences are eliminated.     

Acculturation and the lifetime risk of psychiatric and substance use disorders among Hispanics

Between 1981 and 1995, approximately 5 million people from either Mexico, Cuba, Central America, or South America immigrated to the United States. Some regional studies have suggested that as Hispanic immigrants become acculturated to American society, their risk of mental illness increases sharply. This study examined the lifetime risk of psychiatric and substance use disorders among U.S. Hispanic subgroups and the specific role of nativity, parental nativity, language preferences, and other sociodemographic characteristics as risk factors for these disorders. The study used the National Comorbidity Survey (NCS), a national probability sample of 8098 U.S. adults aged 15 to 54. Selected DSM-III-R psychiatric diagnoses were collapsed into eight categories. When compared with non-Hispanic whites, Mexican-Americans were less likely to have any psychiatric disorder. After multivariate adjustment, acculturation items predicted greater risk of having any DSM-III-R disorders for Mexican-Americans and "other" Hispanics and greater risk of having a substance abuse disorder for Puerto Ricans, among other significant relationships. The results suggest that there is likely to be an increasing prevalence of psychiatric and substance use disorders among Hispanics that may be attributable to increasing levels of acculturation among the more than 5 million recent immigrants from Latin America.     

Racial and Ethnic Disparities in Serious Psychological Distress Among Those With Alzheimer's Disease and Related Dementias

BackgroundAlzheimer's disease and related dementias (ADRD) is a growing public health challenge. Prior research suggests that non-Hispanic whites (whites), non-Hispanic African Americans (African Americans), and Hispanics have differing risks for ADRD.ObjectiveTo examine the existence of serious psychological distress (SPD) among whites, African Americans, and Hispanics; to calculate the predicted probability of ADRD in whites, African Americans, and Hispanics, and to decompose the differences among ADRD populations, quantifying the burden of higher SPD among African Americans and Hispanics, compared to whites.Data and MethodThe authors use nationally representative data from the Medical Expenditure Panel Survey (2007–2015) to estimate the association between ADRD and race, ethnicity, and SPD. Using Blinder-Oaxaca decomposition analysis, the authors estimate to what extent higher SPD among Hispanics and African Americans was associated with higher ADRD rates compared to whites.ResultsAfter controlling for individuals’ demographic and socioeconomic characteristics and co-existing medical conditions, the presence of SPD was still significantly associated with a higher likelihood of having ADRD. The model predicted significantly higher likelihood of having ADRD among African Americans (7.1%) and Hispanics (5.7%) compared to whites (4.5%). Higher rates of having SPD among African Americans explained 15% of white-black difference and 40% of the white-Hispanic difference in ADRD rates, respectively.Discussion and ConclusionOur findings suggest a significant relationship between SPD and ADRD and that the burden of SPD was greater among African Americans and Hispanics with ADRD. Efficient screening using self-reported SPD, compared to simply using diagnoses codes of mental illness, may be more helpful to reduce racial and ethnic disparities in ADRD.     

English use/proficiency,ethnic discrimination,and alcohol use disorder in Hispanic immigrants

Purpose

Acculturation-related measures, often based on language, have traditionally been identified as predictors of drinking outcomes for US Hispanics. However, a sole focus on acculturation may obscure the role of societal factors such as discrimination. The present study evaluated ethnic discrimination as a mediator in the relationship between English use/proficiency and alcohol use disorder in US Hispanic immigrants.

Methods

The study examined data from the 2222 self-identified Hispanic immigrant adults in the National Epidemiologic Survey on Alcohol and Related Conditions-III who reported alcohol use within the past year. The study utilized multivariable binomial logistic regression analyses to test relationships between English use/proficiency and perceived ethnic discrimination; English use/proficiency and DSM-5 alcohol use disorder; ethnic discrimination and DSM-5 alcohol use disorder. Statistical mediation examined ethnic discrimination as a mediator in the relationship between English use/proficiency and alcohol use disorder.

Results

Perceived ethnic discrimination was significantly associated with alcohol use disorder in men (adjusted odds ratio [AOR] 1.99; 95% CI [confidence interval], 1.40–2.83), yet not women (AOR 1.32; 95% CI, 0.71–2.44), in a regression model that also included English use/proficiency. Perceived ethnic discrimination also acted as a partial mediator between English use/proficiency and DSM-5 alcohol use disorder for male, yet not female, Hispanic immigrants.

Conclusion

Findings show some support for the notion that experiences of ethnic discrimination, which may accompany the process of acculturation, partially explain deteriorating drinking outcomes in Hispanic immigrant men adapting to life in the US.

     

Examining Latino Differences in Mental Healthcare Use: The Roles of Acculturation and Attitudes Towards Healthcare

Latinos are less likely to use mental health services compared to non-Latino whites, but little research has examined the relative contribution of acculturation and attitudes towards healthcare. In the current study, we analyze data from a nationally representative sample of Mexicans, Cubans, Puerto Ricans and non-Latino whites from the 2002–2003 Medical Expenditure Panel Survey (n = 30,234). Findings show different utilization patterns in use of specialty, non-specialty, and any type of mental healthcare across the three Latino subgroups. The predictive efficacy of acculturation variables on ethnic group differences varies by subgroup. Self-reliant attitudes towards healthcare are associated with lower use, but these attitudes do not explain the ethnic gaps in use.     

Relationship of race/ethnicity to caregivers' coping, appraisals, and distress after traumatic brain injury

The objective of the current study was to determine the relationship between race/ethnicity and caregivers' coping, appraisals of the caregiving role, and distress after traumatic brain injury (TBI). Participants were 195 caregivers (75% white; 25% black/Hispanic) of persons with TBI who were admitted to comprehensive inpatient rehabilitation at one of three participating centers and were followed up at 1 year after injury. Caregivers completed interview and self-report questionnaires, including the Ways of Coping Questionnaire, Caregiver Appraisal Scale, and Brief Symptom Inventory. Compared to whites, blacks/Hispanics reported lower levels of education, lower annual household income, and were more likely to be caring for an extended family member. After adjusting for relationship to the person with injury, age, education and income, race/ethnicity significantly predicted caregivers' use of the coping strategies distancing and accepting responsibility. Blacks/Hispanics made greater use of these strategies compared to whites. Blacks/Hispanics also showed more traditional beliefs regarding the caregiving role. Race/ethnicity was not predictive of distress. However, an interaction was noted between race/ethnicity and caregiver ideology. For Blacks/Hispanics, more traditional ideology was associated with increased distress. Future research using a larger sample of non-whites and including measures of acculturation is warranted.     

The relation between acculturation and alcohol consumption patterns among older Asian and Hispanic immigrants

This study examines the relation between acculturation and alcohol consumption patterns among older Asian and Hispanic immigrants in the state of California. Data were obtained from the 2009 California Health Interview Survey and included Asian (n?=?1264) and Hispanic (n?=?571) adults aged 60 and older who were born outside of the US. Outcome variables included presence of past year alcohol consumption, past year binge drinking, and number of binge drinking days. Acculturation was measured with items pertaining to English use and proficiency. Hierarchical multiple or logistic regression analyses were conducted separately for each racial/ethnic group and each dependent variable. Alcohol consumption was found in less than half of the sample for both Asians (43.2%) and Hispanics (39.2%). Binge drinking was found in 3.1% of Asians and 8.4% of Hispanics. Acculturation was significantly related to past year alcohol consumption for Hispanics, past year binge drinking for Asians, and binge drinking days for Asians, such that higher level of acculturation predicted a greater likelihood of alcohol consumption but decreased likelihood of binge drinking and fewer binge drinking days. The results indicate that acculturation may be related to alcohol consumption patterns for older immigrants. This suggests future needs to develop an in-depth understanding of the health behaviors of these immigrant elderly groups.     

Providing Health Services for Hispanic Americans

Hispanics—consisting of Mexican-Americans, Puerto Ricans, Cubans, and Central and South Americans—are among the fastest growing population segments in the U.S. today. In order to provide effective health services, physicians must become familiar with demographic, epidemiologic, and cultural differences that affect Hispanics. Although recent literature suggests that Hispanics may have a lower adjusted mortality rate for all causes of death than non-Hispanic whites, certain conditions have particular importance. These include diabetes mellitus, cirrhosis, and homicide. Cultural issues in working with Hispanics are reviewed, as are guidelines for the use of interpreters in clinical practice. Twelve recommendations are made to assist psychiatrists and other health professionals who treat Hispanic patients.     

Prevalence of disorders of executive cognitive functioning among the elderly: findings from the San Luis Valley Health and Aging Study

The San Luis Valley Health and Aging Study is a population-based epidemiologic study of chronic illness and disability among Hispanic and non-Hispanic white persons over the age of 60 in two counties in rural southern Colorado, USA. Between 1993 and 1995, we examined the prevalence of impaired executive cognitive functioning in a sample of 1,313 individuals living both in the community and in nursing homes. Overall, 1 person in 3 was found to have at least mild impairment, while 1 in 6 had moderate to severe deficits. Increasing levels of executive functioning impairment were associated with lower education, advancing age, and Hispanic ethnicity. After controlling for education and acculturation, the differences by ethnic group were no longer significant.     

Posttraumatic stress disorder among Hispanic Vietnam veterans

OBJECTIVE: The purpose of this study was to examine posttraumatic stress disorder (PTSD) among Hispanics who served in the Vietnam War. METHOD: The authors conducted secondary data analyses of the National Vietnam Veterans Readjustment Study, a national epidemiologic study completed in 1988 of a representative sample of veterans who served during the Vietnam era (N=1,195). RESULTS: After adjustment for premilitary and military experiences, the authors found that Hispanic, particularly Puerto Rican, Vietnam veterans had significantly more severe PTSD symptoms and a higher probability of experiencing PTSD than nonminority veterans. However, they had no greater risk for other mental disorders, and their greater risk for PTSD was not explained by acculturation. Despite their more severe symptoms, Hispanic veterans, especially Puerto Rican veterans, showed no greater functional impairment than non-Hispanic white veterans. CONCLUSIONS: Hispanic Vietnam veterans, especially Puerto Rican Vietnam veterans, have a higher risk for PTSD and experience more severe PTSD symptoms than non-Hispanic white Vietnam veterans, and these differences are not explained by exposure to stressors or acculturation. This high level of symptoms was not accompanied by substantial reduction in functioning, suggesting that the observed differences in symptom reporting may reflect features of expressive style rather than different levels of illness.     

Sex/gender differences in cognitive trajectories vary as a function of race/ethnicity

IntroductionThe present study sought to determine whether cognitive trajectories differ between men and women across and within racial/ethnic groups.MethodsParticipants were 5258 non-Hispanic White (NHW), Black, and Hispanic men and women in the Washington/Hamilton Heights-Inwood Columbia Aging Project who were administered neuropsychological tests of memory, language, and visuospatial abilities at 18- to 24-month intervals for up to 25 years. Multiple-group latent growth curve modeling examined trajectories across sex/gender by race/ethnicity.ResultsAfter adjusting for age and education, the largest baseline differences were between NHW men and Hispanic women on visuospatial and language, and between NHW women and Black men on memory. Memory and visuospatial decline was steeper for Black women compared with Hispanic men and NHW women, respectively.DiscussionThis study takes an important first step in understanding interactions between race/ethnicity and sex/gender on cognitive trajectories by demonstrating variability in sex/gender differences across race/ethnicity.     

Sex Differences in Cognitive Impairment in Multiple Sclerosis

Multiple sclerosis (MS) is twice as prevalent in females as in males, but the possibility of sex differences in the cognitive sequellae of the disease has not been considered. In this study male patients with MS performed more poorly than female patients on tests of verbal and nonverbal memory, visuospatial construction, and on the Mini Mental State Exam (MMSE) and the Wisconsin Card Sorting Test (WCST). The groups of male and female patients were similar in age, education, and on several measures of neurologic and emotional disturbance. Among normals there are no sex differences on the MMSE and WCST. Sex differences on the memory and visuospatial construction tests were larger in magnitude for the patients than for normal controls, implying that male patients are somehow especially vulnerable to cognitive deficits. Reanalysis of existing databases could clarify questions about the existence and source of cognitive sex differences in MS.     

Sex differences in cognitive impairment in multiple sclerosis

Multiple sclerosis (MS) is twice as prevalent in females as in males, but the possibility of sex differences in the cognitive sequellae of the disease has not been considered. In this study male patients with MS performed more poorly than female patients on tests of verbal and nonverbal memory, visuospatial construction, and on the Mini Mental State Exam (MMSE) and the Wisconsin Card Sorting Test (WCST). The groups of male and female patients were similar in age, education, and on several measures of neurologic and emotional disturbance. Among normals there are no sex differences on the MMSE and WCST. Sex differences on the memory and visuospatial construction tests were larger in magnitude for the patients than for normal controls, implying that male patients are somehow especially vulnerable to cognitive deficits. Reanalysis of existing databases could clarify questions about the existence and source of cognitive sex differences in MS.     

Racial/ethnic differences in perception of need for mental health treatment in a US national sample

Purpose

To resolve contradictory evidence regarding racial/ethnic differences in perceived need for mental health treatment in the USA using a large and diverse epidemiologic sample.

Methods

Samples from 6 years of a repeated cross-sectional survey of the US civilian non-institutionalized population were combined (N = 232,723). Perceived need was compared across three non-Hispanic groups (whites, blacks and Asian-Americans) and two Hispanic groups (English interviewees and Spanish interviewees). Logistic regression models were used to test for variation across groups in the relationship between severity of mental illness and perceived need for treatment.

Results

Adjusting statistically for demographic and socioeconomic characteristics and for severity of mental illness, perceived need was less common in all racial/ethnic minority groups compared to whites. The prevalence difference (relative to whites) was smallest among Hispanics interviewed in English, ?5.8% (95% CI ?6.5, ?5.2%), and largest among Hispanics interviewed in Spanish, ?11.2% (95% CI ?12.4, ?10.0%). Perceived need was significantly less common among all minority racial/ethnic groups at each level of severity. In particular, among those with serious mental illness, the largest prevalence differences (relative to whites) were among Asian-Americans, ?23.3% (95% CI ?34.9, ?11.7%) and Hispanics interviewed in Spanish, 32.6% (95% CI ?48.0, ?17.2%).

Conclusions

This study resolves the contradiction in empirical evidence regarding the existence of racial/ethnic differences in perception of need for mental health treatment; differences exist across the range of severity of mental illness and among those with no mental illness. These differences should be taken into account in an effort to reduce mental health-care disparities.

     

Normative performance of healthy older individuals on the Modified Mini-Mental State (3MS) examination according to ethno-racial group,gender, age,and education level

Objective: To present normative performance data on the Modified Mini-Mental State (3MS) examination for healthy community-dwelling older individuals according to gender, age, education level, and ethno-racial group. Method: More than 19,000 generally healthy older men and women without a diagnosis of dementia were recruited from the general population in Australia and the U.S. for the ASPirin in Reducing Events in the Elderly (ASPREE) study. The 3MS exam was administered as part of the baseline screening and individuals scoring above 77 were eligible to participate. Results: The sample comprised 16,360 Australian whites, 1080 U.S. whites, 895 African-Americans and 316 Hispanic/Latinos. The median age of participants was 74 years (range 65–98), with an average of 12 years of education and 56% were female. Increasing age and fewer years of completed education were associated with lower scores on the 3MS. Women scored higher than men in most age and education categories. Differences across ethno-racial groups were found. With factor analysis, four factors were identified which accounted for 35% of the between-person variance in 3MS scores for white Australians. Conclusions: This large cohort of older individuals provides some of the most comprehensive 3MS normative data to be generated for whites (Australian and U.S.), Hispanic/Latinos and African-Americans, by age, gender, and educational attainment. These findings will serve as important reference standards for monitoring cognitive function in generally healthy older individuals, becoming increasingly important as this fraction of the population increases.