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Black–white differences in health-related quality of life among older adults

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Abstract

Very little information exists on racial differences in quality of life among older adults. In this paper, we examine black–white differences in health-related quality of life (HRQOL) and identify factors that may account for these differences. The participants were 5,986 community-dwelling persons age 65+ (62% black at baseline) from the Chicago Health and Aging Project. Poor HRQOL was defined as having 14 or more self-reported physically or mentally unhealthy days over the past 30 days. A higher proportion of blacks (11.0%) than whites (9.7%) reported poor HRQOL. After adjusting for age and sex, blacks had increased odds of reporting poor HRQOL compared with whites (odds ratio [OR] = 1.72; 95% CI: 1.50–1.98). The black–white differences in HRQOL tended to increase with age (p < 0.05) and were greater among females (p < 0.05). Lifetime socioeconomic status, summary measures of medical conditions, and cognitive function accounted for most of the black–white difference (OR = 1.06; 95% CI: 0.89–1.27). Our results suggest that racial differences in HRQOL are associated with the combined effects of social disadvantage, poor physical health, and lower cognitive function.

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Abbreviations

CDC:

Centers for Disease Control & Prevention

CHAP:

Chicago Health and Aging Project

HRQOL:

Health-related quality of life

MUD:

Mentally unhealthy days

PUD:

Physically unhealthy days

QOL:

Quality of life

SES:

Socioeconomic status

U.S.:

United States

References

  1. Centers for Disease Control and Prevention (CDC) (2000) Measuring healthy days. CDC, Atlanta, Georgia

    Google Scholar 

  2. Smith KW, Avis NE, Assmann SF (1999) Distinguishing between quality of life and health status in quality of life research: A meta-analysis. Qual Life Res 8:447–459

    Article  PubMed  CAS  Google Scholar 

  3. Wolinsky FD, Miller DK, Andresen EM, Malmstrom TK, Miller JP (2004) Health-related quality of life in middle-aged African Americans. J Gerontol 2:S118-S123

    Google Scholar 

  4. U.S. Department of Health and Human Services (DHHS) (2000) Healthy People 2010: Understanding and Improving Health. 2nd ed. U.S. Government Printing Office, Washington, DC

    Google Scholar 

  5. Centers for Medicare and Medicaid Services. Medicare Health Outcomes Survey. 2003. Retrieved June 22, 2005, from http://www.cmms.gov/surveys/hos/survey.asp

  6. Mowad L (2004) Correlates of quality of life in older veterans. West J Nurs Res 26:293–306

    Article  PubMed  Google Scholar 

  7. Power M, Bullinger M, Harper A (1999) The World Health Organization WHOQOL-100: Tests of the universality of quality of life in 15 different cultural groups worldwide. Health Psychol 18:495–505

    Article  PubMed  CAS  Google Scholar 

  8. World Health Organization (1946) Definition of Health (Preparatory Committee of the International Health Conference). Author, Geneva

    Google Scholar 

  9. World Health Organization. The first ten years. The health organization. WHO, Geneva, 1958. WHO. Planning and organization of geriatric services. Technical report, Series 548. Geneva: Author, 1974

  10. Farquhar M (1995) Elderly people’s definitions of quality of life. Soc Sci Med 10:1439–1446

    Article  Google Scholar 

  11. McHorney CA (1999) Health status assessment methods for adults: Past accomplishments and future challenges. Annu Rev Public Health 20:309–335

    Article  PubMed  CAS  Google Scholar 

  12. Moriarty DG, Zack MM, Kobau R. The Centers for Disease Control and Prevention’s Healthy Days Measures – Population tracking of perceived physical and mental health over time. Health and Qual Life Outcomes 2003; 1(37):1–8. Retrieved November 11, 2005, from http://www.hqlo.com/content/1/1/37

  13. Albert SM (2004) Public health and aging: An introduction to maximizing function and well-being. Springer, New York

    Google Scholar 

  14. Dominick KL, Ahern FM, Gold CH, Heller DA (2003) Health-related quality of life among older adults with activity-limiting health conditions. J Ment Health Aging 9:43–53

    Google Scholar 

  15. Hughes M, Thomas ME (1998) The continuing significance of race revisited: A study of race, class, and quality of life in America, 1972 to 1996. Am Soc Rev 63:785–795

    Article  Google Scholar 

  16. Ibrahim SA, Burant CJ, Siminoff LA, Stoller EP, Kwoh CK (2002) Self-assessed global quality of life: A comparison between African-American and white older patients with arthritis. J Clin Epidemiol 55:512–517

    Article  PubMed  Google Scholar 

  17. Jackson-Triche ME, Greer Sullivan J, Wells KB, Rogers W, Camp P, Mazel R (2000) Depression and health-related quality of life in ethnic minorities seeking care in general medical settings. J Affect Disord 58:89–97

    Article  PubMed  CAS  Google Scholar 

  18. Kim JS, Bramlett MH, Wright LK, Poon LW (1998) Racial differences in health status and health behaviors of older adults. Nurs Res 47:243–250

    Article  PubMed  CAS  Google Scholar 

  19. Ren XS, Amick BC (1996) Race and self assessed health status: The role of socioeconomic factors in the USA. J Epidemiol Community Health 50:269–273

    PubMed  CAS  Google Scholar 

  20. Mutchler JE, Burr JA (1991) Racial differences in health and health care service utilization in later life: The effect of socioeconomic status. J Health Soc Behav 32:342–356

    Article  PubMed  CAS  Google Scholar 

  21. Kelley-Moore JA, Ferraro KF (2004) The Black/White disability gap: Persistent inequality in later life?. J Gerontol Soc Sci 59:34–43

    Google Scholar 

  22. Harper M, Alexander C. Profile of the black elderly. In Harper MS (ed), Minority Aging. US DHHS No. HRS (P-DV-90–4). Washington, DC: U.S. Government Printing Office, 1990.

  23. Manton KG, Stallard E (1997) Health and disability differences among racial and ethnic groups. In Martin LG, Soldo BJ (eds) Racial and Ethnic Differences in the Health of Older Americans. National Academy Press, Washington, DC, pp. 43–105

    Google Scholar 

  24. Richardson AD, Piepho RW (2000) Effect of race on hypertension and antihypertensive therapy. Int J Clin Pharmacol Ther 38:75–79

    PubMed  CAS  Google Scholar 

  25. Sacco RL, Boden-Albala B, Gan R, Chen X, Kargman DE, Shea S, et al. (1998) Stroke incidence among White, Black, and Hispanic residents of an urban community: The Northern Manhattan Stroke Study. Am J Epidemiol 147:259–268

    PubMed  CAS  Google Scholar 

  26. Dries DL, Exner DV, Gersh BJ, Cooper HA, Carson PE, Domanski MJ (1999) Racial differences in the outcome of left ventricular dysfunction. N Engl J Med 340:609–616

    Article  PubMed  CAS  Google Scholar 

  27. Resnick HE, Valsania P, Halter JB, Lin X (1998) Differential effects of BMI on diabetes risk among Black and White Americans. Diabetes Care 21:1828–1835

    Article  PubMed  CAS  Google Scholar 

  28. Adler NE, Boyce WT, Chesney MA, Folkman S, Syme SL (1993) Socioeconomic inequalities in health: No easy solution. JAMA 269:3140–3145

    Article  PubMed  CAS  Google Scholar 

  29. Adler NE, Boyce T, Chesney MA, et al. (1994) Socioeconomic status and health. The challenge of the gradient. Am Psychol 49:15–24

    Article  PubMed  CAS  Google Scholar 

  30. Williams DR, Collins C (1995) U.S. socioeconomic and racial differences in health: Patterns and explanations. Annu Rev Sociol 21:349–386

    Article  Google Scholar 

  31. House JS (2002) Understanding social factors and inequalities in health: 20th century progress and 21st century prospects. J Health Soc Behav 43:125–142

    Article  PubMed  Google Scholar 

  32. Mirowsky J, Ross CE (2003) Education, Social Status, and Health. Aldine de Gruyter, New York

    Google Scholar 

  33. Williams DR (1998) African-American health: The role of the social environment. J Urban Health 75:300–321

    Article  PubMed  CAS  Google Scholar 

  34. Bienias JL, Beckett LA, Bennett DA, Wilson RS, Evans DA (2003) Design of the Chicago Health and Aging Project (CHAP). J Alzheimers Dis 5:349–355

    PubMed  Google Scholar 

  35. Evans DA, Bennett DA, Wilson RS, et al. (2003) Incidence of Alzheimer’s disease in a biracial urban community: Relation to Apolipoprotein E allele status. Arch Neurol 60:185–189

    Article  PubMed  Google Scholar 

  36. Wilson RS, Bennett DA, Beckett LA, et al. (1999) Cognitive activity in older persons from a geographically defined population. J Gerontol Psychol Sci 54:P155–160

    CAS  Google Scholar 

  37. Hennessy CH, Moriarty DG, Zack MM, Scherr PA, Brackbill R (1994) Measuring health-related quality of life for public health surveillance. Public Health Rep 109:665–672

    PubMed  CAS  Google Scholar 

  38. Andresen EM, Catlin T, Wyrwich K, Jackson-Thompson J (2001) Retest reliability and validity of a surveillance measure of health-related quality of life. Qual Life Res 10:199

    Article  Google Scholar 

  39. Andresen EM, Catlin T, Wyrwich K, Jackson-Thompson J (2003) Retest reliability of surveillance questions of health related quality of life. J Epidemiol Commun Health 57:339–343

    Article  PubMed  CAS  Google Scholar 

  40. Dominick KL, Ahern FM, Gold CH, Heller DA (2002) Relationship of health-related quality of life to health care utilization and mortality among older adults. Aging Clin Exp Res 14:499–508

    PubMed  Google Scholar 

  41. Moriarty DG, Zack MM. Validation of the Centers for Disease Control and Prevention’s healthy days measures (abstract). Quality of life research, Abstracts issue, 6th Annual Conference of the International Society for Quality of Life Research, Barcelona, Spain, 1999; 8(7):617

  42. Newschaffer CJ (1998) Validation of Behavioral Risk Factor Surveillance System (BRFSS) HRQOL measures in a statewide sample. CDC, Atlanta

    Google Scholar 

  43. Ôunpuu S, Chambers LW, Patterson C, Chan D, Yusuf S (2001) Validity of the US Behavioral Risk Factor Surveillance System’s Health Related Quality of Life Survey Tool in a Group of Older Canadians. Chronic Dis Can 22(3–4):93–101

    PubMed  Google Scholar 

  44. Ford ES, Moriarty DG, Zack MM, Mokdad AH, Chapman DP (2001) Self-reported body mass index and health-related quality of life: Findings from the Behavioral Risk Factor Surveillance System. Obes Res 9:21–31

    PubMed  CAS  Google Scholar 

  45. Ford ES, Mannino DM, Homa DM, et al. (2003) Self-reported asthma and health-related quality of life: Findings from the Behavioral Risk Factor Surveillance System. Chest 123:119–127

    Article  PubMed  Google Scholar 

  46. Heo M, Allison DB, Faith MS, Zhu S, Fontaine KR (2003) Obesity and quality of life: Mediating effects of pain and comorbidities. Obes Res 11:209–216

    PubMed  Google Scholar 

  47. Borawski E, Wu G, Jia H (1998) Substance Abuse and Mental Health Services Administration, Centers for disease control and prevention. Self-reported frequent mental distress among adults—United States, 1993–1996. MMWR 47:325–331

    Google Scholar 

  48. Everson-Rose SA, Mendes de Leon C, Bienias JL, Wilson RE, Evans DA (2003) Early life conditions and cognitive functioning in later life. Am J Epidemiol 158:1083–1089

    Article  PubMed  Google Scholar 

  49. Hauser RM, Warren JR. Socioeconomic Indexes for Occupations: A Review, Update, and Critique. (CDE working paper no. 96–01). Madison, WI: Center for Demography and Ecology, University of Wisconsin, 1996.

  50. Cornoni-Huntley J, Brock DB, Ostfeld AM, Taylor JO, Wallace RB. Established Populations for Epidemiologic Studies of the Elderly. Resource Data Book. Washington, DC: U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health, 1986.

  51. Albert MS, Smith LA, Scherr PA, Taylor JO, Evans DA, Funkenstein HH (1991) Use of brief cognitive tests to identify individuals in the community with clinically diagnosed Alzheimer’s disease. Int J Neurosci 57:167–178

    Article  PubMed  CAS  Google Scholar 

  52. Smith A (1984) Symbol Digit Modalities Test Manual – Revised. Western Psychological, Los Angeles, CA

    Google Scholar 

  53. Folstein M, Folstein S, McHugh P (1975) Mini-Mental State: A practical method for grading the mental state of patients for the clinician. J Psychiatr Res 12:189–198

    Article  PubMed  CAS  Google Scholar 

  54. SAS Institute Inc (2000). SAS/STAT® User’s Guide, Version 8. SAS Institute Inc, Cary, NC

    Google Scholar 

  55. Barnes LL, Mendes de Leon CF, Wilson RS, Bienias JL, Bennett DA, Evans DA (2004a) Racial differences in perceived discrimination in a community population of older blacks and whites. J Aging Health 16:315–337

    Article  PubMed  Google Scholar 

  56. Williams D, Lawler KA (2001) Stress and illness in low-income women: The roles of hardiness, John Henryism, and race. Women Health 32:61–75

    Article  PubMed  CAS  Google Scholar 

  57. Anderson NB, Armstead CA (1995) Toward understanding the association of socioeconomic status and health: A new challenge for the biopsychosocial approach. Psychosom Med 57:213–225

    PubMed  CAS  Google Scholar 

  58. Cagney KA, Browning CR, Wen M (2005) Racial disparities in self-rated health at older ages: What differences does the neighborhood make? Journal of Gerontology: Social Sciences 60B:S181–190

    Google Scholar 

  59. Gallo LC, Matthews KA (1999) Do negative emotions mediate the association between socioeconomic status and health?. Ann N Y Acad Sci 896:226–245

    Article  PubMed  CAS  Google Scholar 

  60. Macintyre S, Maciver S, Sooman A (1993) Area, class and health: Should we be focusing on places or on people?. J Soc Policy 22:213–234

    Article  Google Scholar 

  61. Barnes LL, Mendes de Leon CF, Bienias JL, Evans DA (2004b) A longitudinal study of black–white differences in social resources. J Gerontol Soc Sci 59B:S146–S153

    Google Scholar 

  62. Collins KS, Tenney K, Hughes DL. Quality of health care for African Americans: Findings from The Commonwealth Fund 2001 Health Care Quality Survey. Publication #524. New York: NY, 2002.

  63. The Commonwealth Fund. Minority Americans Lag Behind Whites on Nearly Every Measure of Health Care Quality. New York: NY, 2002.

  64. Mendes de Leon CF, Barnes LL, Bienias JL, Skarupski KA, Evans DA (2005) Racial disparities in disability: Recent evidence from self-reported and performance-based disability measures in a population-based study of older adults. J Gerontol Soc Sci 60(B):S263–271

    Google Scholar 

  65. Flegal KM, Carroll MD, Ogden CL, Johnson CL (2002) Prevalence and trends in obesity among U.S. adults, 1999–2000. JAMA 288:1723–1727

    Article  PubMed  Google Scholar 

  66. Freedman DS, Khan LK, Serdula MK, Galuska DA, Dietz WH (2002) Trends and correlates of class 3 obesity in the United States from 1990 through 2000. JAMA 288:1758–1761

    Article  PubMed  Google Scholar 

  67. Geronimus AT, Bound J, Waidmann TA, Hillemeier MM, Burns PB (1996) Excess mortality among blacks and whites in the United States. N Engl J Med 335:1552–1558

    Article  PubMed  CAS  Google Scholar 

  68. Gillum RF (1996) Epidemiology of hypertension in African American women. Am Heart J 131:385–395

    Article  PubMed  CAS  Google Scholar 

  69. Ng-Mak DS, Dohrenwend BP, Abraido-Lanza AF, Turner JB (1999) A further analysis of race differences in the National Longitudinal Mortality Study. Am J Public Health 89:1748–1751

    PubMed  CAS  Google Scholar 

  70. Robbins JM, Vaccarino V, Zhang H, Kasl SV (2000) Excess type 2 diabetes in African-American women and men aged 40–74 and socioeconomic status: Evidence from the Third National Health and Nutrition Examination Survey. J Epidemiol Community Health 54:839–845

    Article  PubMed  CAS  Google Scholar 

  71. Ferraro KF, Farmer MM (1996) Double jeopardy, aging as leveler, or persistent health inequality? A longitudinal analysis of white and black Americans. Journal of Gerontology: Social Sciences 51:S319–328

    CAS  Google Scholar 

  72. Clark DO, Gibson RC (1997) Race, age, chronic disease, and disability. In Markides KS, Miranda MR (eds) Minorities, aging, and health. Sage Publications, Thousand Oaks, CA

    Google Scholar 

  73. Centers for Disease Control and Prevention (CDC). Health-related quality of life measures – United States, 1993. Morbidity & Mortality Weekly Report 1995; 44:195–200.

    Google Scholar 

  74. Dominick KL, Ahern FM, Gold CH, Heller DA (2004) Health-related quality of life and health service use among older adults with osteoarthritis. Arthritis Rheum 51:326–331

    Article  PubMed  Google Scholar 

  75. Lam CL, Fong DY, Lauder IJ, Lam TP (2002) The effect of health-related quality of life (HRQOL) on health service utilization of a Chinese population. Soc Sci Med 55:1635–1646

    Article  PubMed  Google Scholar 

  76. Singh JA, Borowsky SJ, Nugent S, et al. (2005) Health-related quality of life, functional impairment, and healthcare utilization by veterans: Veterans’ quality of life study. JAGS 53:108–113

    Article  Google Scholar 

  77. Sprenkle MD, Niewoehner DE, Nelson DB, Nichol KL (2004) The veterans short form 36 questionnaire is predictive of mortality and health-care utilization in a population of veterans with a self-reported diagnosis of asthma or COPD. Chest 126:81–89

    Article  PubMed  Google Scholar 

  78. Aksoy S (2000) Can the “quality of life” be used as a criterion in health care services?. Bull Med Ethics 162:19–22

    PubMed  Google Scholar 

  79. Binstock RH, George LK (eds) (2001) Handbook of Aging and the Social Sciences, Fifth Edition. Academic Press, San Diego

    Google Scholar 

  80. U. S. Bureau of the Census. Current population reports, special studies, P23-190, 65+ in the United States. U.S. Government Printing Office, Washington, DC., 1996.

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Acknowledgments

This research was supported by grants from the National Institutes of Health: National Institute on Aging (AG11101) and the National Institute of Environmental Health Sciences (ES10902). We␣thank Ms Michelle Bos, Ms Holly Hadden, Mr Flavio LaMorticella, and Ms Jennifer Tarpey for coordination of the study. We also thank Mr␣Todd Beck, M.S., for statistical programming.

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Authors and Affiliations

  1. Rush Institute for Healthy Aging, Rush University Medical Center, 1645 W. Jackson, Suite 675, Chicago, IL, 60612-3227, USA

    Kimberly A. Skarupski, Carlos F. Mendes de Leon, Julia L. Bienias & Denis A. Evans

  2. Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA

    Kimberly A. Skarupski, Carlos F. Mendes de Leon, Julia L. Bienias & Denis A. Evans

  3. Department of Preventive Medicine, Rush University Medical Center, Chicago, IL, USA

    Carlos F. Mendes de Leon

  4. National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA

    Paul A. Scherr, Matthew M. Zack & David G. Moriarty

  5. Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, USA

    Denis A. Evans

  6. Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA

    Denis A. Evans

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  1. Kimberly A. Skarupski
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  2. Carlos F. Mendes de Leon
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  3. Julia L. Bienias
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  4. Paul A. Scherr
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  5. Matthew M. Zack
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  6. David G. Moriarty
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  7. Denis A. Evans
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Correspondence to Kimberly A. Skarupski.

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Skarupski, K.A., de Leon, C.F.M., Bienias, J.L. et al. Black–white differences in health-related quality of life among older adults. Qual Life Res 16, 287–296 (2007). https://doi.org/10.1007/s11136-006-9115-y

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