Skip to main content

Currently Skimming:

3 Racial and Ethnic Disparities in Health and Mortality Among the U.S. Elderly Population
Pages 53-94

The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.


From page 53...
... , and Native Americans. In several portions of the chapter, the health and mortality patterns of Mexican Americans, the nation's largest Hispanic subpopulation, are discussed.
From page 54...
... RACIAL/ETHNIC MORTALITY DISPARITIES AMONG THE ELDERLY Overall Mortality Disparities Using Vital Statistics and Census Data We begin by examining racial/ethnic disparities in older adult mortality. The National Center for Health Statistics (NCHS)
From page 55...
... ; Panel B presents rate ratios for the specific racial/ethnic, age, and sex groups vis-āvis non-Hispanic white elders. As the ratios in Panel B demonstrate, the reported mortality rates of most of the racial/ethnic minority groups (e.g., persons of Hispanic, API, and Native American origin)
From page 56...
... 56 1,515.0 2,372.3 3,802.6 6,492.2 2,433.4 3,780.8 5,712.0 9,286.8 Non-Hispanic White 15,284.6 17,539.1 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 Non-Hispanic with 1999 Native American 1,743.5 2,410.1 3,145.7 4,502.8 6,395.1 2,471.2 3,246.0 4,358.5 5,165.3 6,946.2 1.15 1.02 0.83 0.69 0.42 1.02 0.86 0.76 0.56 0.40 Compared Data, Ratios Rate Mortality U.S. 862.7 1,403.9 2,273.1 4,261.6 8,396.6 1,358.4 2,394.6 3,828.0 5,957.6 Death Asian/Pacific Islander 11,343.5 0.57 0.59 0.60 0.66 0.55 0.56 0.63 0.67 0.64 0.65 and Official States, Whites Hispanic Origin 1,125.8 1,662.1 2,591.2 4,300.9 8,838.7 1,841.1 2,704.7 3,913.0 5,696.6 9,842.3 0.74 0.70 0.68 0.66 0.58 0.76 0.72 0.69 0.61 0.56 Race/Ethnicity United by the of (2001)
From page 57...
... . Thus, the officially reported mortality disparities shown in Table 3-1 should be interpreted with great caution, with the low mortality levels for Native Americans, especially at the oldest ages, particularly suspect.
From page 58...
... , diseases of the heart, malignant neoplasms, and cerebrovascular diseases are the three leading causes of death for most racial/ethnic groups and account for 61 to 66 percent of deaths among all groups except Native Americans. For the two leading causes, non-Hispanic black rates are roughly twice as high as those reported for TABLE 3-2 Racial/Ethnic Disparities in Cause-Specific Mortality Rates (per 100,000 population)
From page 59...
... 59 death diseases of diseases causes neoplasms respiratory diseases leading Heart Malignant Cerebrovascular Chronic Diabetes five the for American Hispanic Native race/ethnicity Islander by black rates white Asian/Pacific Non-Hispanic Females mortality Non-Hispanic American 1999. Hispanic Native age-standardized Islander population, black U.S.
From page 60...
... As with women, the API male population is characterized by the lowest overall rates of mortality and lowest rates for several specific causes of death Overall Mortality Disparities Using a Survey-Based Data Set Large, population-based survey data sets, with links to follow-up mortality information, provide another important source of information regarding mortality disparities among the elderly. Using survey-based data sets linked to follow-up death records (i.e., the National Death Index)
From page 61...
... , return migration to the country of origin, after their original inclusion in the survey, may also bias survey-based follow-up estimates of mortality downward, although one recent study suggests that return migration effects cannot account for the relatively low adult mortality rates that have been demonstrated for the U.S. Hispanic population (Abraido-Lanza, Dohrenwend, Ng-Mak, and Turner, 1999)
From page 62...
... . The race/ ethnicity by age interaction effects proved to be statistically significant for non-Hispanic blacks, APIs, and Native Americans and, thus, the racial/ethnic disparities in comparison to non-Hispanic whites for these groups are shown to vary by age.
From page 63...
... In sum, the mortality results show that racial/ethnic disparities remain relatively unchanged in comparison to the results of Elo and Preston (1997) , who used data from approximately a decade earlier.
From page 64...
... RACIAL/ETHNIC DISPARITIES IN HEALTH AND ACTIVITY LIMITATIONS AMONG THE ELDERLY Disability and Active Life Expectancy While mortality studies provide one set of evidence regarding racial/ ethnic patterns of health, a number of other outcome variables help to round out the general picture of health disparities among the U.S. elderly population.
From page 65...
... . These results show substantial differences in TABLE 3-4 Disability Prevalence Rates and Estimates of Active Life Expectancy by Race/Ethnicity, Age, and Sex, United States, 1990 Indicator Non- Non- Asian/ and Age Hispanic Hispanic Pacific Native Group White Black Hispanic Islander American Panel A: Males Disability prevalence (%)
From page 66...
... On the other hand, API elderly men have the lowest disability prevalence at each age group and the highest level and percentage of active life remaining at each specific age. Finally, Hispanic males exhibit slightly lower levels of disability and higher percentages of remaining active life than non-Hispanic whites.
From page 67...
... . It is clear that API and non-Hispanic white individuals exhibit the most favorable levels of selfreported health, while non-Hispanic blacks, Native Americans, and Mexican Americans display the least favorable results.
From page 68...
... BENJAMINS, AND R.G. ROGERS TABLE 3-5 Self-Reported Health and Activity Limitations by Race/ Ethnicity, Sex, and Age Group, United States, 1989-1994a Indicator Non- Non- Asian/ and Age Hispanic Hispanic Mexican Other Pacific Native Group White Black American Hispanic Islander American Panel A: Males Self-rated health: % fair or poor 65-74 years 24.5 41.3 34.1 30.0 18.2 35.4 75-84 years 30.8 47.3 45.3 34.6 17.4 51.0 85+ years 32.0 51.4 56.6 40.3 -- b -Activity limitations: % with limitations 65-74 years 35.0 41.6 39.3 36.3 22.1 44.6 75-84 years 39.5 48.1 38.4 35.2 32.2 36.4 85+ years 49.6 59.5 70.8 51.6 30.8 -N 28,508 3,544 588 601 432 148 Panel B: Females Self-rated health: % fair or poor 65-74 years 23.0 41.0 36.0 32.0 20.9 34.2 75-84 years 29.1 45.8 44.7 41.7 35.0 40.5 85+ years 34.0 46.2 48.1 44.9 -- -Activity limitations: % with limitations 65-74 years 32.8 43.2 39.9 34.3 20.0 42.9 75-84 years 41.0 51.1 41.4 47.3 33.5 66.5 85+ years 60.8 65.7 57.2 68.6 43.5 63.2 N 40,749 5,753 783 973 561 228 aWeighted data.
From page 69...
... Hispanics, while displaying modestly lower elder mortality than non-Hispanic whites, exhibited higher levels of poor and fair health, slightly lower levels of active life expectancy, and a higher level of activity limitations than non-Hispanic whites. COMPARING RACIAL/ETHNIC DISPARITIES AMONG THE ELDERLY WITH THOSE EXHIBITED BY YOUNGER AGE GROUPS Mortality The mortality and health disparities described previously focus on the elderly (aged 65+, or in some cases, aged 60+)
From page 70...
... These results are consistent with TABLE 3-6 A Comparison of Racial/Ethnic Disparities in Mortality for Different U.S. Age Groups, 1999 Non- Non- Asian/ Hispanic Hispanic Pacific Native White Black Hispanic Islander American Infant Mortality Infant mortality rate 5.8 14.1 5.7 4.8 9.3 (per 1,000 live births)
From page 71...
... The exceptionally favorable pattern for the Native American elderly population, again, must be viewed as highly suspect; clearly, our survey-based results for older adult mortality do not show this same pattern. API mortality rates are the lowest of these racial/ethnic groups at each age group.
From page 72...
... 72 Different Native American 7.1 1.9 20.2 2.7 36.0 1.8 35.1 1.4 53.0 1.7 for Asian/ Pacific Islander 4.0 1.1 7.9 1.1 25.0 1.2 19.4 0.8 36.2 1.2 Limitations Activity Other Hispanic 6.0 1.6 12.9 1.7 31.0 1.5 34.3 1.4 45.0 1.4 and Health Mexican American 6.5 1.8 15.1 2.0 33.9 1.7 33.7 1.3 48.9 1.6 Self-Reported in 7.3 1.9 2.3 1.9 1.6 1.6 Non- Hispanic Black 17.1 39.3 41.0 50.6 Disparities 3.7 7.5 Non- Hispanic White -- -- 20.5 -- 25.3 -- 31.3 - Racial/Ethnic of 1989-1994 whites whites whites whites whites health health health health health States, Health Comparison self-rated self-rated self-rated self-rated self-rated A United non-Hispanic non-Hispanic non-Hispanic non-Hispanic non-Hispanic poor poor poor poor poor 3-7 Self-Reported or versus or versus or versus or versus or versus Groups, A: Group Indicator fair fair fair fair fair % Ratio % Ratio % Ratio % Ratio % Ratio TABLE Age Age and Panel 20-24 40-44 60-64 70-74 80-84
From page 73...
... 73 6.6 1.0 27.8 2.0 37.8 1.2 38.3 1.2 57.9 1.3 3.9 0.6 7.1 0.5 20.4 0.7 16.9 0.5 35.5 0.8 6.6 1.0 14.9 1.1 34.2 1.1 31.8 1.0 55.1 1.2 4.8 0.7 13.1 0.9 34.7 1.1 36.0 1.1 46.2 1.0 6.8 1.0 1.3 1.4 1.2 1.0 17.7 42.3 38.5 46.2 6.9 -- 14.1 -- 30.8 -- 31.5 -- 45.2 -- 1989-1994. Surveys, whites whites whites whites whites Interview Health data.
From page 74...
... . Interestingly, Mexican Americans are characterized by their most favorable level of activity limitations compared to non-Hispanic whites at ages 20 to 24, when their mortality rates are highest compared to non-Hispanic whites.
From page 75...
... , with most non-Hispanic white foreign-born elders residing in the United States for 10 or more years. Note that for Native Americans, foreign-born individuals are presumably those who have migrated from Canada or Latin America.
From page 76...
... BENJAMINS, AND R.G. ROGERS TABLE 3-8 Percentage Distributions for Selected Demographic and Socioeconomic Variables by Race/Ethnicity for Individuals 65 Years and Above, 1989-1994 Non Non- Asian/ Hispanic Hispanic Mexican Other Pacific Native White Black American Hispanic Islander American Male Overall 41.7 40.1 44.3 39.4 44.1 39.0 65-74 years 44.8 42.5 45.2 41.1 43.2 41.9 75+ years 37.1 36.0 42.0 36.4 45.8 33.7 Nativity/duration U.S.
From page 77...
... U.S.-born Foreign born < 10 years Foreign born 10+ years 100 90 80 70 60 50 40 Percentage 30 20 10 0 white black American Hispanic Islander American Other Native Non-Hispanic Non-Hispanic Mexican Asian/Pacific FIGURE 3-4 Nativity and duration by race/ethnicity for individuals 65 and older, U.S. noninstitutionalized population, 1989-1994.
From page 78...
... For the most part, immigrants to the United States have been shown to exhibit favorable levels of adult health and mortality in comparison to the native-born population (with cause-specific mortality exceptions; see, e.g., Singh and Siahpush, 2001; Toussaint and Hummer, 1999) , with foreign-native born disparities usually reported to be wider for health outcomes than for mortality risk.
From page 79...
... Levels of family income by race/ethnicity correspond quite well with the health and mortality patterns of the elderly. Non-Hispanic black and Native American elders are characterized by very high percentages of individuals who live in the lowest family income category ($0-15,999)
From page 80...
... Widely differing nativity/duration profiles, even among the heavily immigrant populations, also point to the substantial complexity of understanding health and mortality patterns across these groups. BASIC RACIAL/ETHNIC MODELS OF OLDER ADULT HEALTH, ACTIVITY LIMITATIONS, AND MORTALITY The last major section of this chapter presents basic models of racial/ ethnic disparities in older adult health, activity limitations, and mortality, using data taken from pooled samples of the National Health Interview Survey from 1989 to 1994.
From page 81...
... Furthermore, the addition of education results in a measurable reduction in the racial/ethnic disparities in selfreported health, particularly for non-Hispanic blacks, Mexican Americans, and Native Americans compared to non-Hispanic whites. However, even with the addition of this powerful socioeconomic variable, sizable racial/ethnic disparities remain in self-reported health, particularly between non-Hispanic blacks and whites.
From page 82...
... black Odds [NH Islander American <10 10+ Hispanic 3-9 American Hispanic American born, born, [female] non-Hispanic Mexican other Asian/Pacific Native race/ethnicity continuous *
From page 84...
... Racial/ethnic disparities in self-reported health are further reduced with the addition of income, although significant differences remain between non-Hispanic blacks and non-Hispanic whites and between Mexican Americans and non-Hispanic whites. Nevertheless, it is clear that socioeconomic factors are instrumental in helping to account for the relatively poor self-reported health for nonHispanic black, Mexican American, other Hispanic, and Native American elders in comparison to non-Hispanic whites.
From page 85...
... hibit lower elderly mortality than non-Hispanic whites. The age by racial/ ethnicity interactions shown in Model 2 reconfirm the converging blackwhite and API-white mortality disparities with age and demonstrate the substantial mortality disadvantage for blacks and mortality advantage for APIs, relative to non-Hispanic whites, at age 65.
From page 86...
... Ratios black Islander years Hazard black in American [non-Hispanic Islander Hispanic 3-11 American Hispanic American [female] non-Hispanic Mexican other Asian/Pacific race/ethnicity continuous *
From page 88...
... Moreover, the relative mortality disparities between the other racial/ethnic populations and whites change only slightly with the introduction of the socioeconomic factors. CONCLUSION Despite the national-level priority on understanding and eliminating health disparities, we know far less about racial/ethnic differences in older adult health, activity limitations, and mortality than is the case among infants, children, and younger adults.
From page 89...
... adults, although levels of poor health, activity limitations, and mortality risks increase for all racial/ethnic groups with age. This chapter also documented wide socioeconomic differences between racial/ethnic groups in old age.
From page 90...
... Understanding Hispanic and API older adult health and mortality will be a substantial future challenge, particularly with continued large-scale migration and the possibility of circular and/or return migration to Mexico, other countries of Latin America, and Asia. The diverse ethnic, cultural, and geographic factors that characterize all of these broad racial/ethnic groups, but perhaps especially the Hispanic and API populations, will pose a real challenge to the understanding of elderly health and mortality patterns in the United States.
From page 91...
... In conclusion, the United States experienced a remarkable mortality decline and great improvements in health across the 20th century. All racial/ethnic groups participated in and contributed to these substantial changes, although some important health and mortality disparities remain.
From page 92...
... . Mortality rates of elderly Asian American populations.
From page 93...
... . Socioeconomic differences in adult mortality and health status.
From page 94...
... . Differential mortality risks from violent causes for foreign- and native-born residents of the United States.


This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More information on Chapter Skim is available.