Elsevier

Social Science & Medicine

Volume 70, Issue 2, January 2010, Pages 240-250
Social Science & Medicine

Life course determinants of racial and ethnic disparities in functional health trajectories

https://doi.org/10.1016/j.socscimed.2009.10.003Get rights and content

Abstract

Previous research has documented racial/ethnic disparities in functional health trajectories in old age, though little work has investigated the relative contribution of early and later life insults in their genesis. This paper uses two-part latent curve models to investigate the life course determinants of racial/ethnic disparities in functional health trajectories in the USA. We find that blacks and Hispanics have both a greater probability of having any limitation at baseline and more limitations on average among those who have any. Over time, there is convergence in trajectories between Hispanics and non-Hispanic whites, though the black-white gap remains constant. In addition, we find that disparities result from differential exposure to poor childhood health, early life socioeconomic deprivation, as well as adult health and socioeconomic attainment. However, the impact of childhood insults is largely mediated by more contemporaneous factors. We also find little evidence that the impact of life course factors varies across groups.

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)

  • D.O. Clark et al.

    Racial and social correlates of age-related changes in functioning

    Journals of Gerontology: Social Sciences

    (1992)
  • D.O. Clark et al.

    Race, aging, and functional health

    Journal of Aging and Health

    (1993)
  • J.R. Colley et al.

    Respiratory disease in young adults: influence of early childhood lower respiratory tract illness, social class, air pollution, and smoking

    British Medical Journal

    (1973)
  • G. Davey Smith et al.

    Lifetime socioeconomic position and mortality: prospective observational study

    British Medical Journal

    (1997)
  • G. Davey Smith et al.

    Adverse socioeconomic conditions in childhood and cause specific adult mortality: prospective observational study

    British Medical Journal

    (1998)
  • N. Duan et al.

    A comparison of alternative models for the demand for medical care

    Journal of Business and Economic Statistics

    (1983)
  • D.D. Dunlop et al.

    Racial/ethnic differences in the development of disability among older adults

    American Journal of Public Health

    (2007)
  • D.J. Eggebeen et al.

    Race, family structure, and changing poverty among American children

    American Sociological Review

    (1991)
  • I.T. Elo

    Childhood conditions and adult health: Evidence from the Health and Retirement Study

    (1998)
  • K.F. Ferraro et al.

    Health trajectories: long-term dynamics among black and white adults

    Journal of Health and Social Behavior

    (1997)
  • K.F. Ferraro et al.

    Cumulative disadvantage and health: long term consequences of obesity

    American Sociological Review

    (2003)
  • L.A. Fingerhut et al.

    Mortality among minority populations in the United States

    American Journal of Public Health

    (1992)
  • S. Fonda et al.

    Documentation of physical functioning measures in the Health and Retirement Study and the Asset and Health Dynamics among the Oldest Old

    (2004)
  • L. Franzini et al.

    Understanding the Hispanic paradox

  • A. Geronimus et al.

    Inequality in life expectancy, functional status, and active life expectancy across selected black/white populations in the United States

    Demography

    (2001)
  • A. Geronimus et al.

    ‘Weathering’ and age patterns of allostatic load scores among blacks and whites in the United States

    American Journal of Public Health

    (2006)
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      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).

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    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.

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