Racial Differences in Mortality in Older Adults: Factors Beyond Socioeconomic Status
- Roland J. Thorpe Jr PhD,
- Annemarie Koster PhD,
- Hans Bosma PhD,
- Tamara B. Harris MD,
- Eleanor M. Simonsick PhD,
- Jacques Th. M. van Eijk PhD,
- Gertrudis I. J. M. Kempen PhD,
- Anne B. Newman MD, MPH,
- Suzanne Satterfield PhD,
- Susan M. Rubin PhD,
- Stephen B. Kritchevsky PhD,
- for the Health ABC Study
- … show all 12 hide
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Little is known about the simultaneous effect of socioeconomic status (SES), psychosocial, and health-related factors on race differences in mortality in older adults.
This study examined the association between race and mortality and the role of SES, health insurance, psychosocial factors, behavioral factors, and health-related factors in explaining these differences.
Data consisted of 2,938 adults participating in the Health, Aging and Body Composition study. Mortality was assessed over 8 years.
SES differences accounted for 60% of the racial differences in all-cause mortality; behavioral factors and self-rated health further reduced the disparity. The racial differences in coronary heart disease mortality were completely explained by SES. Health insurance and behavioral factors accounted for some, but not all, of the race differences in cancer mortality.
Race-related risk factors for mortality may differ by the underlying cause of mortality.
- Crimmins EM, Saito Y. Trends in healthy life expectancy in the United States, 1970-1990: Gender, racial, and educational differences. Soc Sci Med. 2001; 52(11): 1629-1641. CrossRef
- Davey Smith G, Neaton JD, Wentworth D, Stamler R, Stamler J. Mortality differences between black and white men in the USA: Contribution of income and other risk factors among men screened for the MRFIT. MRFIT Research Group. Multiple Risk Factor Intervention Trial. Lancet. 1998; 351(9107): 934-939.
- Howard G, Anderson RT, Russell G, Howard VJ, Burke GL. Race, socioeconomic status, and cause-specific mortality. Ann Epidemiol. 2000; 10(4): 214-223. CrossRef
- Hummer R. Black-white difference in health and mortality: A review and conceptual model. Sociol Q. 1996; 37: 105-125. CrossRef
- Hummer R, Benjamins M, Rogers R. Racial and ethnic disparities in health and mortality among the U.S. elderly popuation. In: Anderson N, Bulatao R, Cohen B, eds. Critical perspectives on racial and ethnic differences in health in late life. Washington D.C.: National Academy Press; 2004: 69-110.
- Keil JE, Sutherland SE, Knapp RG, Tyroler HA. Does equal socioeconomic status in black and white men mean equal risk of mortality? Am J Public Health. 1992; 82(8): 1133-1136. CrossRef
- Levine RS, Foster JE, Fullilove RE, et al. Black-white inequalities in mortality and life expectancy, 1933-1999: Implications for healthy people 2010. Public Health Rep. 2001; 116(5): 474-483.
- Navarro, V. Race or class versus race and class: Mortality differentials in the United States. Lancet. 1990; 336(8725): 1238-1240. CrossRef
- Satcher D, Fryer GE, Jr., McCann J, Troutman A, Woolf SH, Rust G. What if we were equal? A comparison of the black-white mortality gap in 1960 and 2000. Health Aff. 2005; 24(2): 459-464. CrossRef
- Sudano JJ, Baker DW. Explaining US racial/ethnic disparities in health declines and mortality in late middle age: The roles of socioeconomic status, health behaviors, and health insurance. Soc Sci Med. 2006; 62(4): 909-922. CrossRef
- National Center for Health Statistics. Health United States, 2009: With Special Feature on Medical Technology. Hyattsville, MD; 2010.
- Hayward MD, Pienta A, McLaughlin D. Inequality in men's mortality: The socioeconomic status gradient and geographic context. J Health Soc Behav. 1997; 38(4): 313-330. CrossRef
- Hummer RA, Rogers RG, Eberstein IW. Sociodemographic differentials in adult mortality: A review of analytic Approaches. Popul Dev Rev. 1998; 24(3): 553-578. CrossRef
- Williams DR, Collins C. U.S. socioeconomic and racial differences in health: Patterns and explanations. Annual Review of Sociology. 1995; 21: 349-386. CrossRef
- Hayward MD, Gorman B. The long arm of childhood: The influence of early-life social conditions on men's mortality. Demography. 2004; 48: 87-107. CrossRef
- Lantz PM, House JS, Lepkowski JM, Williams DR, Mero RP, Chen J. Socioeconomic factors, health behaviors, and mortality: Results from a nationally representative prospective study of US adults. JAMA. 1998; 279(21): 1703-1708. CrossRef
- Lantz PM, Golberstein E, House JS, Morenoff J. Socioeconomic and behavioral risk factors for mortality in a national 19-year prospective study of U.S. adults. Soc Sci Med. 2010; 70:1558–1566. CrossRef
- Winkleby MA, Cubbin C. Chapter 12: Racial/ethnic disparities in health behaviors: A challenge to current assumption. In: Critical Perspectives on Racial and Ethnic Differences in Health in Late Life. Anderson NB, Bulatao RA, Cohen B, eds. Washington DC: National Academies Press; 2004.
- Baker DW, Sudano JJ, Albert JM, Borawski EA, Dor A. Lack of health insurance and decline in overall health in late middle age. N Engl J Med. 2001; 345(15): 1106-1112. CrossRef
- McWilliams JM, Zaslavsky AM., Meara E, Ayanian JZ. Health insurance coverage and mortality among the near-elderly. Health Aff. 2004; 23(4): 223-233. CrossRef
- Braveman PA, Cubbin C, Egerter S, et al. Socioeconomic status in health research: One size does not fit all. JAMA. 2005; 294(22): 2879-2888. CrossRef
- LaVeist TA. Disentangling race and socioeconomic status: A key to understanding health inequalities. J Urban Health. 2005; 82(2 Suppl 3): iii26-34. doi:10.1093/jurban/jti061
- Williams DR, Sternthal M. Understanding racial-ethnic disparities in health: Sociological contributions. J Health Soc Behav. 2010; 51 Suppl: S15-27. CrossRef
- Thorpe RJ, Jr, Brandon DT, LaVeist TA. Social context as an explanation for race disparities in hypertension: Findings from the exploring health disparities in integrated communities (EHDIC) study. Soc Sci Med. 2008; 67(10): 1604-1611. doi:10.1016/j.socscimed.2008.07.002 CrossRef
- Szanton SL, Seplaki CL, Thorpe RJ, Jr, Allen JK, Fried LP. Socioeconomic status is associated with frailty: The women's health and aging studies. J Epidemiol Community Health. 2010; 64(1): 63-67. CrossRef
- Monheit AC, Vistnes JP. Race/ethnicity and health insurance status: 1987 and 1996. Med Care Res Rev. 2000; 57(Suppl 1): 11-35.
- Wherry L, Finegold K. Changes in health insurance coverage and health status by race and ethnicity, 1997-2002. J Natl Med Assoc. 2004; 96(12): 1577-1582.
- National Center for Health Statistics. Health United States,2001, with urban and rural health chartbook. DHDD Publication No. (PHS) 01-1232. Hyattsville, MD; 2001.
- Rogers RG, Hummer RA, Nam CB. Living and Dying in the USA. New York: Academic Press; 2000.
- Sudquist J, Winkleby MA, Pudaric S. Cardiovascular disease risk factors among older black, Mexican-American, and white women and men: An analysis of NHANES III, 1988-1994. The National Health and Nutritional Examination Survey. J Am Geriatr Soc. 2001; 49(2): 109-116. CrossRef
- LaVeist TA, Bowie JV, Cooley-Quille M. Minority health status in adulthood: The middle years of life. Health Care Financ Rev. 2000; 21(4): 9-21.
- Miller DK, Wolinsky FD, Malmstrom TK, et al. Inner city, middle-aged African Americans have excess frank and subclinical disability. J Gerontol A Biol Sci Med Sci. 2005; 60(2): 207-212. CrossRef
- Satcher D, Hull FL. The weight of an ounce. JAMA. 1995; 273(14): 1149-1150. CrossRef
- U.S. Department of Health and Human Services. Healthy people 2000: National health promotion and disease prevention objectives. (Report No. PHS 91-50213). Washington, DC: Public Health Service; 1991.
- U.S. Department of Health and Human Services. Tracking Healthy People 2010. Washington, DC: U.S. Government Printing Office; 2000.
- Lynch JW, Kaplan GA, Salonen JT. Why do poor people behave poorly? Variation in adult health behaviours and psychosocial characteristics by stages of the socioeconomic lifecourse. Soc Sci Med. 1997; 44: 809-819. CrossRef
- Fried LP, Borhani NO, Enright P, et al. The Cardiovascular Health Study: Design and rationale. Ann Epidemiol. 1991; 1(3): 263-276. CrossRef
- Koster A, Penninx, BW, Bosma H, et al. Is there a biomedical explanation for socioeconomic differences in incident mobility limitation? J Gerontol A Biol Sci Med Sci. 2005; 60(8): 1022-1027. CrossRef
- Rooks RN, Simonsick EM, Miles T, et al. The association of race and socioeconomic status with cardiovascular disease indicators among older adults in the health, aging, and body composition study. J Gerontol B Psychol Sci Soc Sci. 2002; 57(4): 247-256. CrossRef
- Manly JJ. Deconstructing race and ethnicity: Implications for measurement of health outcomes. Med Care. 2006; 44(11(Suppl 3)): S10-S10-S16.
- Davis TC, Long SW, Jackson RH, et al. Rapid estimate of adult literacy in medicine: A shortened screening instrument. Fam Med. 1993; 25(6): 391-395.
- Mehta KM, Simonsick EM, Rooks R, et al. Black and white differences in cognitive function test scores: What explains the difference? J Am Geriatr Soc. 2004; 52(12): 2120-2127. CrossRef
- Ainsworth BE, Haskell WL, Whitt MC, et al. Compendium of physical activities: An update of activity codes and MET intensities. Med Sci Sports Exerc. 2000; 32(9 Suppl): S498-504.
- Brach JS, Simonsick EM, Kritchevsky S, Yaffe K, Newman AB. The association between physical function and lifestyle activity and exercise in the health, aging and body composition study. J AM Geriatr Soc. 2004; 52(4): 502-509. CrossRef
- Taylor HL, Jacobs DR, Jr, Schucker B, Knudsen J, Leon AS, Debacker G. A questionnaire for the assessment of leisure time physical activities. J Chronic Dis. 1978; 31(12): 741-755. CrossRef
- Visser M, Simonsick EM, Colbert LH, et al. Type and intensity of activity and risk of mobility limitation: The mediating role of muscle parameters. J Am Geriatr Soc. 2005; 53(5): 762-770. CrossRef
- McDowell I, Kristjansson B, Hill GB, Herbert R. Community screening for dementia: The Mini Mental State Exam (MMSE) and Modified Mini-Mental State Exam (3MS) compared. J Clin Epidemiol. 1997; 50(4): 377-383. CrossRef
- Andersen E, Malmgren J, Carter WB, Patrick DL. Screening for depression in well older adults: Evaluation of a short form of the CES-D. AM J Prev Med. 1994; 10: 77-84.
- Radloff LS. The CES-D scale: A self-reported depression scale for research in the general population. Appl Psychol Meas. 1977; 3: 385-401. CrossRef
- Preston SH, Taubman P. Socioeconomic differences in adult mortality and health status. In: Martin LG, Preston SH, eds. Demography of Aging. Washington, DC: National Academy Press; 1994: 279-318.
- DeSalvo KB, Bloser N, Reynolds K, He J, Muntner P. Mortality prediction with a single general self-rated health question. A meta-analysis. J Gen Intern Med. 2006; 21(3): 267-275. CrossRef
- Idler EL, Benyamini Y. Self-rated health and mortality: A review of twenty-seven community studies. J Health Soc Behav. 1997; 38(1): 21-37. CrossRef
- McDavid K, Tucker TC, Sloggett A, Coleman MP. Cancer survival in Kentucky and health insurance coverage. Arch Intern Med. 2003; 163(18): 2135-2144. CrossRef
- Roetzheim RG, Pal N, Gonzalez EC, Ferrante JM, Van Durme DJ, Krischer JP. Effects of health insurance and race on colorectal cancer treatments and outcomes. Am J Public Health. 2000; 90(11): 1746-1754. CrossRef
- Corti MC, Guralnik JM, Ferrucci L, et al. Evidence for a black-white crossover in all-cause and coronary heart disease mortality in an older population: The North Carolina EPESE. Am J Public Health. 1999; 89(3): 308-314. CrossRef
- Johnson NE. The racial crossover in comorbidity, disability, and mortality. Demography. 2000; 37(3): 267-283. CrossRef
- Manton KG, Poss SS, Wing S. The black/white mortality crossover: Investigation from the perspective of the components of aging. Gerontologist. 1979; 19(3): 291-300. CrossRef
- Kasper JD, Ensminger ME, Green KM, et al. Effects of poverty and family stress over three decades on the functional status of older African American women. J Gerontol B Psychol Sci Soc Sci. 2008; 63(4): S201-S210. CrossRef
- Guralnik JM, Butterworth S, Wadsworth, ME, Kuh, D. Childhood socioeconomic status predicts physical functioning a half century later. J Gerontol B Psychol Sci Soc Sci. 2006; 61(7): 694-701.
- Thorpe RJ, Jr, Kasper JD, Szanton SL, Frick KD, Fried LP, Simonsick EM. Relationship of race and poverty to lower extremity function and decline: Findings from the women's health and aging study. Soc Sci Med. 2008; 66(4): 811-821. CrossRef
- Glass, T. A., & McAtee, M. J. Behavioral science at the crossroads in public health: Extending horizons, envisioning the future. Soc Sci Med. 2006; 62(7): 1650-1671. doi:10.1016/j.socscimed.2005.08.044 CrossRef
- LaVeist TA. Beyond dummy variables and sample selection: What health services researchers ought to know about race as a variable. In: LaVeist TA, ed. Race, ethnicity, and health: A public health reader. 1st ed. San Francisco: Jossey-Bass; 2002.
- Whitfield KE, Thorpe RJ, Szanton SL. Health disparities, social class, and aging. In: Schaie KW, Willis SL, eds. The Handbook of the Psychology of Aging. 7th ed. Oxford: Elsevier; 2011: 207-218. CrossRef
- Kaufman JS, Cooper RS, McGee DL. Socioeconomic status and health in blacks and whites: The problem of residual confounding and the resiliency of race. Epidemiology. 1997; 8(6): 621-628.
- Racial Differences in Mortality in Older Adults: Factors Beyond Socioeconomic Status
Annals of Behavioral Medicine
Volume 43, Issue 1 , pp 29-38
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Older adults
- Industry Sectors
- Roland J. Thorpe Jr PhD (1)
- Annemarie Koster PhD (2) (3)
- Hans Bosma PhD (2)
- Tamara B. Harris MD (3)
- Eleanor M. Simonsick PhD (4) (5)
- Jacques Th. M. van Eijk PhD (2)
- Gertrudis I. J. M. Kempen PhD (2)
- Anne B. Newman MD, MPH (6)
- Suzanne Satterfield PhD (7)
- Susan M. Rubin PhD (8)
- Stephen B. Kritchevsky PhD (9)
- Author Affiliations
- 1. Hopkins Center for Health Disparities Solutions, Department of Health Policy and Management, The Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Ste 309, Baltimore, MD, USA
- 2. Faculty of Health, Medicine and Life Sciences, Universiteit Maastricht, Maastricht, The Netherlands
- 3. Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, MD, USA
- 4. Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
- 5. Clinical Research Branch, National Institute on Aging, Baltimore, MD, USA
- 6. Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- 7. Department of Preventive Medicine, University of Tennessee College of Medicine, Memphis, TN, USA
- 8. Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
- 9. Sticht Center on Aging, Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA