Introduction: Since 1997, US guidelines for collecting race/ethnicity in the US included White, Black, Hispanic/Latinx, Asian, American Indian/Alaskan Native (AI/AN), and Native Hawaiian/Other Pacific Islander (NH/OPI) as minimum reporting categories. Middle Eastern and North African (MENA) Americans were included in the White race group, until March 28, 2024, when the US government approved adding a checkbox for MENA individuals. Little is known whether having a checkbox for MENA Americans will provide a truer assessment of health disparities for other groups. We evaluated whether removing MENA Americans from the White race group altered comparisons of cognitive difficulty between racial/ethnic minoritized populations and Whites.

Methods: We analyzed data from the American Community Survey (ages >=65 years; N= 3,159,136), we identified 24,798 adults with MENA ancestry/birthplace. Multivariable regression models were conducted to compare the odds of cognitive difficulty among racial/ethnic minority groups and Whites before and after removing MENA Americans from the sample.

Results: Cognitive difficulty was higher among Black, Asian, AI/AN, and NH/OPI compared to White adults before and after removing adults with a MENA ancestry or birthplace from the sample. Marginal changes were observed. For example, for Black older adults, odds decreased only slightly from 1.40 (95%CI=1.37-1.42) to 1.39 (95%CI=1.36-1.42). Among Hispanic/Latinx older adults, odds decreased slightly from 1.23 (95%CI=1.20-1.26) to 1.21 (95%CI=1.18-1.24).

Conclusions: While we only found marginal differences in cognitive difficulty when we removed MENA adults from the national sample, further research is needed to determine whether this differs in smaller samples (e.g., states) and for other health outcomes.