Life course determinants of racial and ethnic disparities in functional health trajectories☆
Introduction
In this paper, we examine the life course determinants of racial/ethnic disparities in functional health trajectories among older Americans. An enduring aspect of population health in the USA is that African Americans suffer disproportionately from disease, illness, and premature mortality at all ages compared to non-Hispanic whites (Fingerhut and Makuc, 1992, Rogers, 1992). The black/white health gap must be juxtaposed against the broader landscape of substantial racial/ethnic heterogeneity in health (Franzini, Ribble, & Keddie, 2002). Specifically, racial/ethnic disparities in functional health measured by disability or its antecedent functional/mobility limitation are well documented (Cho et al., 2004, Ferraro et al., 1997, Hayward and Herron, 1999, Jette et al., 1996, Kington and Smith, 1997, Ostchega et al., 2000). Significant differences in functional health trajectories have been noted both in terms of aggregate age-related patterns (Clark and Maddox, 1992, Clark et al., 1993) and individual-level trajectories (Dunlop et al., 2007, Taylor, 2008). Increasingly, social scientists are interested in the degree to which this racial/ethnic heterogeneity may be rooted in developmental processes and exposures that occur over the life course.
Section snippets
Explanations for racial/ethnic disparities in functional health
Several explanations have been offered for racial/ethnic inequalities in functional health status. First, group differences in the prevalence of chronic disease may lead to elevated functional impairment among racial/ethnic minorities given the important role of conditions like diabetes and stroke in the disablement process (Ferraro et al., 1997). However, rather than explain disparities, this simply shifts the focus to earlier points in the disablement process. Others have highlighted racial
Data
This analysis utilizes the RAND version of the Health and Retirement Study (HRS) (RAND, 2007). The HRS is an ongoing panel study of Americans begun in 1992 and designed to investigate economic and health transitions associated with retirement (Juster & Suzman, 1995). The original HRS cohort was composed of 12,652 individuals selected from a sample of housing units generated using a multi-stage, clustered area probability sample. In-home interviews were conducted at baseline and follow-up
Observed functional health trajectories
Before turning to the statistical models, Fig. 2 presents race-specific trends in the mean number of functional limitations between 1994 and 2004. From this simple plotting of means, there are clear racial/ethnic differences in functional health trajectories over the 10 years of observation. For non-Hispanic whites, the mean number of limitations increased by 30% from 1.9 in 1994 to 2.48 in 2004. Non-Hispanic blacks had a larger number of limitations at baseline though they experienced a much
Discussion
The above analysis investigated the extent to which racial/ethnic disparities in functional health trajectories result from childhood versus more contemporaneous factors, the relative impact of limitation onset versus accumulation, and whether disparities result from differential exposure to various life course factors (mediation) or from the differential impact of those factors across groups (differential vulnerability/moderation). Our results reveal large racial/ethnic disparities in
References (53)
- et al.
Does childhood health affect chronic morbidity in later life?
Social Science & Medicine
(2001) - et al.
Life course social conditions and racial disparities in incidence of first stroke
Annals of Epidemiology
(2008) Trajectories of functional health: the ‘long arm’ of childhood health and socioeconomic factors
Social Science & Medicine
(2008)- et al.
Recall of childhood illnesses
Journal of Clinical Epidemiology
(1988) - et al.
Physical health status at 36 years in a British national birth cohort
Social Science & Medicine
(1993) - et al.
On the choice between sample selection and two-part models
Journal of Econometrics
(1996) Mothers, Babies and Health in Later Life
(1994)- et al.
Latent curve models: A structural equation perspective
(2006) - et al.
Economic status and health in childhood: the origins of the gradient
The American Economic Review
(2002) - et al.
Nativity, duration of residence, and the health of Hispanic adults in the United States
International Migration Review
(2004)
Racial and social correlates of age-related changes in functioning
Journals of Gerontology: Social Sciences
Race, aging, and functional health
Journal of Aging and Health
Respiratory disease in young adults: influence of early childhood lower respiratory tract illness, social class, air pollution, and smoking
British Medical Journal
Lifetime socioeconomic position and mortality: prospective observational study
British Medical Journal
Adverse socioeconomic conditions in childhood and cause specific adult mortality: prospective observational study
British Medical Journal
A comparison of alternative models for the demand for medical care
Journal of Business and Economic Statistics
Racial/ethnic differences in the development of disability among older adults
American Journal of Public Health
Race, family structure, and changing poverty among American children
American Sociological Review
Childhood conditions and adult health: Evidence from the Health and Retirement Study
Health trajectories: long-term dynamics among black and white adults
Journal of Health and Social Behavior
Cumulative disadvantage and health: long term consequences of obesity
American Sociological Review
Mortality among minority populations in the United States
American Journal of Public Health
Documentation of physical functioning measures in the Health and Retirement Study and the Asset and Health Dynamics among the Oldest Old
Understanding the Hispanic paradox
Inequality in life expectancy, functional status, and active life expectancy across selected black/white populations in the United States
Demography
‘Weathering’ and age patterns of allostatic load scores among blacks and whites in the United States
American Journal of Public Health
Cited by (95)
Disability and Place of Death in Older Americans: The Moderating Role of Household Wealth
2024, Journal of Pain and Symptom ManagementA Scoping Review of Personal, Financial, and Environmental Determinants of Mobility Among Older Adults
2023, Archives of Physical Medicine and RehabilitationPhysical work conditions and disparities in later life functioning: Potential pathways
2021, SSM - Population HealthPhysical functioning and survival: Is the link weaker among Latino and black older adults?
2020, Social Science and MedicineCitation Excerpt :What is surprising, however, is that the association is likely to vary by race/ethnicity. Most research indicates that Latinos, both immigrants and US-born, have higher rates of disability and functional limitations than non-Latino whites (Boen and Hummer, 2019; Angel et al., 2014; Haas and Rohlfsen, 2010; Hayward et al., 2014). This Latino disadvantage occurs even though this group has a distinct survival advantage over whites: Latinos have life expectancies at least as high as, and often higher than, whites, despite their lower average socioeconomic status and poorer access to health care, a pattern referred to as the Latino or Hispanic mortality paradox (Abraido-Lanza et al., 1999; Markides and Eschbach, 2005).
- ☆
We would like to thank Doug Ewbank and participants of the University of Pennsylvania Population Studies Center colloquium series for helpful comments. A prior version of this paper presented at the 2008 Annual Meeting of the Population Association of America.