Prevalence and associated factors of functional disability among middle-aged and older adults: evidence from 12 ethnic groups in Yunnan, China

Functional disability is a growing public health concern in aging populations worldwide, particularly in low- and middle-income countries. In China, rapid population aging and substantial ethnic and cultural diversity further complicate this issue, yet evidence focusing on functional disability among ethnic minority groups remains limited and overlooks intragroup heterogeneity. Thus, this study aims to investigate the prevalence and determinants of functional disability among middle-aged and older adults across different ethnic groups in a multi-ethnic setting. A cross-sectional study was conducted among 5,180 middle-aged and older adults from 12 ethnic groups in Yunnan. Sociodemographic characteristics and health conditions were collected through structured questionnaires. Functional disability was assessed using the functional assessment framework, comprising Physical Self-Maintenance Scale (PSMS) and Instrumental Activities of Daily Living (IADL) scale. Standardized prevalence rates for the 11 minority ethnic groups were calculated using the age distribution of the Han population as the standard. Multivariable logistic regression were applied to identify factors associated with functional disability, with results reported as odds ratios ( OR ) and 95% confidence intervals ( 95%CI ). The overall prevalence of functional disability was 36.41%, while the prevalence of basic ADL and IADL disability were 4.27% and 35.58%, respectively. After standardization, the Bulang (IADL 59.50%) and Nu (basic ADL 9.37%) showed the highest prevalence rates. The Lisu (51.33%), Nu (50.15%) and Bulang (49.58%) groups reported greater difficulty in mode of transportation, and Bulang (33.74%) showed the highest proportion of difficulty in ability to use telephone. Logistic regression showed that advanced age ( OR 2.56; OR 2.81; OR 2.52) and a BMI of less than 18.50 ( OR 1.41; OR 2.20; OR 1.35) were associated with an increased risk of functional disability and its two domains (basic ADL and IADL), while a higher level of education was associated with a lower risk ( OR 0.32; OR 0.49; OR 0.31). Women were more likely to experience functional disability ( OR 1.41) and IADL disability ( OR 1.40), while men were more likely to experience basic ADL disability ( OR 0.64). Functional disability remains disproportionately prevalent among ethnic minority populations, with substantial ethnic heterogeneity. Targeted and culturally sensitive interventions addressing health vulnerability are needed to reduce disparities and promote equitable healthy aging. Not applicable.