Skip to main content
SpringerLink
Log in

Racial Differences in Mortality in Older Adults: Factors Beyond Socioeconomic Status

  • Original Article
  • Published:
Annals of Behavioral Medicine

Abstract

Background

Little is known about the simultaneous effect of socioeconomic status (SES), psychosocial, and health-related factors on race differences in mortality in older adults.

Purpose

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.

Methods

Data consisted of 2,938 adults participating in the Health, Aging and Body Composition study. Mortality was assessed over 8 years.

Results

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.

Conclusions

Race-related risk factors for mortality may differ by the underlying cause of mortality.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. 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.

    Article  PubMed  CAS  Google Scholar 

  2. 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.

    PubMed  CAS  Google Scholar 

  3. Howard G, Anderson RT, Russell G, Howard VJ, Burke GL. Race, socioeconomic status, and cause-specific mortality. Ann Epidemiol. 2000; 10(4): 214-223.

    Article  PubMed  CAS  Google Scholar 

  4. Hummer R. Black-white difference in health and mortality: A review and conceptual model. Sociol Q. 1996; 37: 105-125.

    Article  Google Scholar 

  5. 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.

    Google Scholar 

  6. 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.

    Article  PubMed  CAS  Google Scholar 

  7. 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.

    PubMed  CAS  Google Scholar 

  8. Navarro, V. Race or class versus race and class: Mortality differentials in the United States. Lancet. 1990; 336(8725): 1238-1240.

    Article  PubMed  CAS  Google Scholar 

  9. 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.

    Article  Google Scholar 

  10. 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.

    Article  PubMed  Google Scholar 

  11. National Center for Health Statistics. Health United States, 2009: With Special Feature on Medical Technology. Hyattsville, MD; 2010.

  12. 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.

    Article  PubMed  CAS  Google Scholar 

  13. Hummer RA, Rogers RG, Eberstein IW. Sociodemographic differentials in adult mortality: A review of analytic Approaches. Popul Dev Rev. 1998; 24(3): 553-578.

    Article  Google Scholar 

  14. Williams DR, Collins C. U.S. socioeconomic and racial differences in health: Patterns and explanations. Annual Review of Sociology. 1995; 21: 349-386.

    Article  Google Scholar 

  15. 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.

    Article  Google Scholar 

  16. 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.

    Article  PubMed  CAS  Google Scholar 

  17. 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.

    Article  PubMed  Google Scholar 

  18. 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.

  19. 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.

    Article  PubMed  CAS  Google Scholar 

  20. McWilliams JM, Zaslavsky AM., Meara E, Ayanian JZ. Health insurance coverage and mortality among the near-elderly. Health Aff. 2004; 23(4): 223-233.

    Article  Google Scholar 

  21. 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.

    Article  PubMed  CAS  Google Scholar 

  22. 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

    PubMed  Google Scholar 

  23. Williams DR, Sternthal M. Understanding racial-ethnic disparities in health: Sociological contributions. J Health Soc Behav. 2010; 51 Suppl: S15-27.

    Article  PubMed  Google Scholar 

  24. 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

    Article  PubMed  Google Scholar 

  25. 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.

    Article  PubMed  CAS  Google Scholar 

  26. Monheit AC, Vistnes JP. Race/ethnicity and health insurance status: 1987 and 1996. Med Care Res Rev. 2000; 57(Suppl 1): 11-35.

    PubMed  Google Scholar 

  27. 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.

    PubMed  Google Scholar 

  28. National Center for Health Statistics. Health United States,2001, with urban and rural health chartbook. DHDD Publication No. (PHS) 01-1232. Hyattsville, MD; 2001.

  29. Rogers RG, Hummer RA, Nam CB. Living and Dying in the USA. New York: Academic Press; 2000.

    Google Scholar 

  30. 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.

    Article  Google Scholar 

  31. 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.

    PubMed  CAS  Google Scholar 

  32. 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.

    Article  PubMed  Google Scholar 

  33. Satcher D, Hull FL. The weight of an ounce. JAMA. 1995; 273(14): 1149-1150.

    Article  PubMed  CAS  Google Scholar 

  34. 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.

  35. U.S. Department of Health and Human Services. Tracking Healthy People 2010. Washington, DC: U.S. Government Printing Office; 2000.

  36. 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.

    Article  PubMed  CAS  Google Scholar 

  37. Fried LP, Borhani NO, Enright P, et al. The Cardiovascular Health Study: Design and rationale. Ann Epidemiol. 1991; 1(3): 263-276.

    Article  PubMed  CAS  Google Scholar 

  38. 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.

    Article  PubMed  Google Scholar 

  39. 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.

    Article  Google Scholar 

  40. Manly JJ. Deconstructing race and ethnicity: Implications for measurement of health outcomes. Med Care. 2006; 44(11(Suppl 3)): S10-S10-S16.

  41. 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.

    PubMed  CAS  Google Scholar 

  42. 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.

    Article  PubMed  Google Scholar 

  43. 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.

    PubMed  CAS  Google Scholar 

  44. 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.

    Article  PubMed  Google Scholar 

  45. 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.

    Article  PubMed  CAS  Google Scholar 

  46. 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.

    Article  PubMed  Google Scholar 

  47. 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.

    Article  PubMed  CAS  Google Scholar 

  48. 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.

    Google Scholar 

  49. Radloff LS. The CES-D scale: A self-reported depression scale for research in the general population. Appl Psychol Meas. 1977; 3: 385-401.

    Article  Google Scholar 

  50. 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.

    Google Scholar 

  51. 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.

    Article  PubMed  Google Scholar 

  52. 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.

    Article  PubMed  CAS  Google Scholar 

  53. McDavid K, Tucker TC, Sloggett A, Coleman MP. Cancer survival in Kentucky and health insurance coverage. Arch Intern Med. 2003; 163(18): 2135-2144.

    Article  PubMed  Google Scholar 

  54. 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.

    Article  PubMed  CAS  Google Scholar 

  55. 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.

    Article  PubMed  CAS  Google Scholar 

  56. Johnson NE. The racial crossover in comorbidity, disability, and mortality. Demography. 2000; 37(3): 267-283.

    Article  PubMed  CAS  Google Scholar 

  57. 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.

    Article  PubMed  CAS  Google Scholar 

  58. 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.

    Article  PubMed  Google Scholar 

  59. 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.

    Google Scholar 

  60. 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.

    Article  PubMed  Google Scholar 

  61. 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

    Article  PubMed  Google Scholar 

  62. 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.

    Google Scholar 

  63. 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.

    Chapter  Google Scholar 

  64. 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.

    PubMed  CAS  Google Scholar 

Download references

Acknowledgments

This study was supported by National Institute on Aging contracts N01-AG-6-2101, N01-AG-6-2103, and N01-AG-6-2106. This research was supported (in part) by the Intramural Research Program of the NIH, National Institute on Aging. Research conducted by the first author was supported by a grant from the National Center for Minority Health and Health Disparities (P60MD000214-01).

Conflict of Interest Statement

The authors have no conflict of interest to disclose.

Author information

Authors and 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

    Roland J. Thorpe Jr PhD

  2. Faculty of Health, Medicine and Life Sciences, Universiteit Maastricht, Maastricht, The Netherlands

    Annemarie Koster PhD, Hans Bosma PhD, Jacques Th. M. van Eijk PhD & Gertrudis I. J. M. Kempen PhD

  3. Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, MD, USA

    Annemarie Koster PhD & Tamara B. Harris MD

  4. Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA

    Eleanor M. Simonsick PhD

  5. Clinical Research Branch, National Institute on Aging, Baltimore, MD, USA

    Eleanor M. Simonsick PhD

  6. Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA

    Anne B. Newman MD, MPH

  7. Department of Preventive Medicine, University of Tennessee College of Medicine, Memphis, TN, USA

    Suzanne Satterfield PhD

  8. Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA

    Susan M. Rubin PhD

  9. Sticht Center on Aging, Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA

    Stephen B. Kritchevsky PhD

Authors
  1. Roland J. Thorpe Jr PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Annemarie Koster PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hans Bosma PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tamara B. Harris MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Eleanor M. Simonsick PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jacques Th. M. van Eijk PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Gertrudis I. J. M. Kempen PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Anne B. Newman MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Suzanne Satterfield PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Susan M. Rubin PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Stephen B. Kritchevsky PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

for the Health ABC Study

Corresponding author

Correspondence to Roland J. Thorpe Jr PhD.

About this article

Cite this article

Thorpe, R.J., Koster, A., Bosma, H. et al. Racial Differences in Mortality in Older Adults: Factors Beyond Socioeconomic Status. ann. behav. med. 43, 29–38 (2012). https://doi.org/10.1007/s12160-011-9335-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12160-011-9335-4

Keywords

Search

Navigation