Aging with dual burdens: Cross-national evidence on mortality among older Hispanic adults with diabetes and dementia

OBJECTIVES: Older Hispanic adults in the United States (U.S.) and Mexico face a high burden of diabetes and dementia, yet cross-national differences in absolute survival associated with these conditions remain unclear. This study compared five-year survival among Mexican-origin adults aged 74 and older by condition profile and assessed gender differences. METHODS: Two representative longitudinal surveys were harmonized: the Hispanic Established Populations for Epidemiologic Study of the Elderly-Centers for Medicare & Medicaid Services (H-EPESE-CMS) linked data for the U.S. and the Mexican Health and Aging Study (MHAS) for Mexico. Flexible parametric survival models and g-computation estimated standardized five-year survival, risk differences, and risk ratios across four groups: no condition, diabetes only, dementia only, and dual conditions. RESULTS: Survival declined steadily with condition burden in both countries. In the U.S., standardized five-year survival was 73.3% (no condition), 57.9% (diabetes only), 49.2% (dementia only), and 36.6% (dual conditions). In Mexico, absolute survival was higher across all groups: 77.5%, 67.9%, 56.8%, and 40.9%, respectively. Hazard ratios confirmed elevated mortality risks, particularly when both were present. Women had lower mortality than men in the U.S. but higher mortality in Mexico. However, gender did not significantly modify the association between condition burden and survival in either country. DISCUSSION: Five-year survival declines with condition burden in both countries, with lower absolute survival and steeper relative penalties in the U.S. Divergent gender patterns across countries reflect overall mortality differences rather than condition-specific modification, highlighting the need for tailored and integrated approaches to chronic disease and dementia care.