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Explaining US racial/ethnic disparities in health declines and mortality in late middle age: The roles of socioeconomic status, health behaviors, and health insurance

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  • Sudano, Joseph J.
  • Baker, David W.

Abstract

Pervasive health disparities continue to exist among racial/ethnic minority groups, but the factors related to these disparities have not been fully elucidated. We undertook this prospective cohort study to determine the independent contributions of socioeconomic status (SES), health behaviors, and health insurance in explaining racial/ethnic disparities in mortality and health declines. Our study period was 1992-1998, and our study population consists of a US nationally representative sample of 6286 non-Hispanic whites (W), 1391 non-Hispanic blacks (B), 405 Hispanics interviewed in English (H/E), and 318 Hispanics interviewed in Spanish (H/S), ages 51-61 in 1992 in the Health and Retirement Study. The main outcome measures were death; major decline in self-reported overall health (SROH); and combined outcome of death or major decline in SROH. Crude mortality rates over the 6-year study period for W, B, H/E and H/S were 5.8%, 10.6%, 5.8%, and 4.4%, respectively. Rates of major decline in SROH were 14.6%, 23.2%, 22.1% and 39.4%, for W, B, H/E and H/S, respectively. Higher mortality rates for B versus W were mostly explained by worse baseline health. For major decline in SROH, education, income, and net worth independently explained more of the disparities for all three minority groups as compared to health behaviors and insurance, reducing the effect for B and H/E to non-significance, while leaving a significant elevated odds ratio for H/S. Without addressing the as-yet undetermined and pernicious effects of lower SES, public health initiatives that promote changing individual health behaviors and increasing rates of insurance coverage among blacks and Hispanics will not eliminate racial/ethnic health disparities.

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  • Sudano, Joseph J. & Baker, David W., 2006. "Explaining US racial/ethnic disparities in health declines and mortality in late middle age: The roles of socioeconomic status, health behaviors, and health insurance," Social Science & Medicine, Elsevier, vol. 62(4), pages 909-922, February.
    • Handle: RePEc:eee:socmed:v:62:y:2006:i:4:p:909-922
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    6. Bjornstrom, Eileen E.S. & Kuhl, Danielle C., 2014. "A different look at the epidemiological paradox: Self-rated health, perceived social cohesion, and neighborhood immigrant context," Social Science & Medicine, Elsevier, vol. 120(C), pages 118-125.
    7. Kathrin Roll & Tom Stargardt & Jonas Schreyögg, 2012. "Effect of Type of Insurance and Income on Waiting Time for Outpatient Care," The Geneva Papers on Risk and Insurance - Issues and Practice, Palgrave Macmillan;The Geneva Association, vol. 37(4), pages 609-632, October.
    8. Irma Elo & Hiram Beltrán-Sánchez & James Macinko, 2014. "The Contribution of Health Care and Other Interventions to Black–White Disparities in Life Expectancy, 1980–2007," Population Research and Policy Review, Springer;Southern Demographic Association (SDA), vol. 33(1), pages 97-126, February.
    9. Krueger, Patrick M. & Saint Onge, Jarron M. & Chang, Virginia W., 2011. "Race/ethnic differences in adult mortality: The role of perceived stress and health behaviors," Social Science & Medicine, Elsevier, vol. 73(9), pages 1312-1322.
    10. Shireen Assaf & Stefano Campostrini & Cinzia Di Novi & Fang Xu & Carol Gotway Crawford, 2017. "Analyzing disparity trends for health care insurance coverage among non-elderly adults in the US: evidence from the Behavioral Risk Factor Surveillance System, 1993–2009," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 18(3), pages 387-398, April.
    11. Joshua C. Hall & Brad R. Humphreys & Jane E. Ruseski, 2015. "Economic Freedom, Race, and Health Disparities: Evidence from US States," Working Papers 15-43, Department of Economics, West Virginia University.
    12. Hankyung Jun & Emma Aguila, 2021. "Private Insurance and Mental Health among Older Adults with Multiple Chronic Conditions: A Longitudinal Analysis by Race and Ethnicity," IJERPH, MDPI, vol. 18(5), pages 1-15, March.
    13. Kim, Seijeoung & Dolecek, Therese A. & Davis, Faith G., 2010. "Racial differences in stage at diagnosis and survival from epithelial ovarian cancer: A fundamental cause of disease approach," Social Science & Medicine, Elsevier, vol. 71(2), pages 274-281, July.
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