Critical Perspectives on Racial and Ethnic Differences in Health in Late Life (2004) / Chapter Skim
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19 An Exploratory Investigation into Racial Disparities in the Health of Older South Africans
19 An Exploratory Investigation into Racial Disparities in the Health of Older South Africans
Pages 703-736
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From page 703... ...
Structured around a population register of racial classification, the economy, social, and political spheres were mutually reinforcing in building a society steeped in racism and economically favoring the white minority elite. A legacy that South Africa now has to grapple with is an income distribution that is among the most unequal in the world and that more than half of the South African people, mostly black, live in conditions of poverty, with 11.5 percent in conditions of extreme poverty (United Nations Development Programme, 2002)
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From page 704... ...
103) that were far from being based on physical characteristics and concluded that South Africans cannot be categorized easily into the population groups, races, tribes, or cultures.
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From page 705... ...
The figures hint at the conflation of race, class, and gender in South African society.
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From page 706... ...
The extent to which such racial differences can be accounted for by socioeconomic factors are then considered, allowing contrasts and comparisons with the situation in the United States. HEALTH IN SOUTH AFRICA Efforts to investigate racial disparities in health have been thwarted by the lack of reliable statistics, particularly mortality data.
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From page 707... ...
. They have revealed clear racial disparities in health status; for example, the infant mortality rate for Africans was found to be 47 per 1,000, compared to 11 per 1,000 for white South Africans.
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From page 708... ...
. Assuming no antiAIDS treatment interventions and calibrated to match the levels of HIV observed among pregnant women attending antenatal services in the public sector during the 1990s, the model is used to project a possible trend in premature adult mortality (45Q15)
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From page 709... ...
While cohort estimates would reflect an individual's risk more accurately, it is nonetheless standard to use period estimates of life expectancy and mortality. INVESTIGATING DISPARITIES IN THE HEALTH OF OLDER SOUTH AFRICANS Clearly, the South African setting provides extensive scope for investigating racial disparities in the health and health determinants in aging.
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From page 710... ...
SOURCE: Actuarial Society of South Africa (2001)
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From page 711... ...
RACIAL DISPARITIES IN THE HEALTH OF OLDER SOUTH AFRICANS 711 TABLE 19-1 Death Rates per 100,000 by Population Group and Death Rate Ratios Relative to White South Africans, 1985, Based on ASSA 2000 Panel A: Death Rates Per 100,000 MALE Age Group African Coloured White Asian 45-49 7,481 7,076 3,128 5,347 50-54 10,527 10,138 5,112 10,728 55-59 13,357 13,968 8,281 13,556 60-64 17,072 18,772 12,783 17,430 65-69 23,055 24,758 18,719 23,589 70-74 30,622 31,932 26,466 31,331 75-79 40,523 39,040 36,457 41,619 FEMALE Age group African Coloured White Asian 45-49 4,095 4,520 1,823 2,507 50-54 6,200 6,217 2,807 6,277 55-59 8,686 8,576 4,318 8,808 60-64 12,027 11,644 6,812 12,329 65-69 17,166 15,534 10,065 17,722 70-74 24,272 22,276 14,985 25,043 75-79 33,927 28,593 23,319 35,734 Panel B: Death Rate Ratios Compared to White South Africans MALE Age Group African Coloured White Asian 45-49 2.39 2.26 1.00 1.71 50-54 2.06 1.98 1.00 2.10 55-59 1.61 1.69 1.00 1.64 60-64 1.34 1.47 1.00 1.36 65-69 1.23 1.32 1.00 1.26 70-74 1.16 1.21 1.00 1.18 75-79 1.11 1.07 1.00 1.14 FEMALE Age Group African Coloured White Asian 45-49 2.25 2.48 1.00 1.38 50-54 2.21 2.22 1.00 2.24 55-59 2.01 1.99 1.00 2.04 60-64 1.77 1.71 1.00 1.81 65-69 1.71 1.54 1.00 1.76 70-74 1.62 1.49 1.00 1.67 75-79 1.45 1.23 1.00 1.53 SOURCE: Actuarial Society of South Africa (2001)
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From page 712... ...
had no details and could not be included in this analysis. The second important data source is that of the adult health questionnaire in the South African Demographic and Health Survey conducted in 1998.
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From page 713... ...
Logistic regression analysis was used to calculate adjusted odds ratios (ORs) and 95 percent confidence intervals (95 percent CIs)
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From page 714... ...
714 BRADSHAW ET AL. 45+ Years, Men 100 80 60 Percent 40 20 African Coloured White 45+ Years, Women 100 80 60 Percent 40 20 African Coloured White Infectious/parasitic Respiratory infections Neoplasms Diabetes mellitus Other cardiovascular Stroke Respiratory conditions Other Ill defined Injuries FIGURE 19-4 The age-weighted cause of death profile of the 1998 sample by population group and gender.
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From page 716... ...
The risk of dying from stroke was significantly lower among white women than African women. When compared to Africans, the risk profile for coloured South Africans was similar to that of whites.
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From page 717... ...
* 0.6 0.4 ect Eff 0.2 Main White White African Africa adjusted -0.2 adjusted ColouredColoured Asian Asian adjusted adjusted -0.4 -0.6 Mean Standardized Peak Flow (95% CI)
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From page 718... ...
The results based on the self-reported information about ever having had TB diagnosed by a doctor or a nurse are shown in Figure 19-7. These suggest that white and Asian South Africans have been protected from having this disease, but when the other socioeconomic factors are taken into account, they are not significantly different.
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From page 719... ...
Intercept 0.9292 0.0468 0.1053 0.6566 1.80 Population group <0.0001 African 0.0000 Coloured 0.0176 0.0775 0.8208 2.18 White 0.4385 0.0928 <0.0001 1.96 Asian 0.0868 0.1279 0.4974 1.99 Age 0.0404 15-24 0.0000 25-34 0.0909 0.0501 0.0701 1.37 35-44 0.1731 0.0545 0.0016 1.49 45-54 0.1040 0.0702 0.1385 1.81 55-64 0.1577 0.0855 0.0655 2.07 65+ 0.1085 0.0814 0.1827 1.68 Asset index (quintiles) 0.4220 Poorest group 0.0000 Second poorest 0.0419 0.0643 0.5149 1.32 Middle group 0.0491 0.0692 0.4787 1.47 Fourth poorest 0.0491 0.0849 0.5627 1.83 Richest group 0.1250 0.0916 0.1728 1.57 Education <0.0001 None 0.0000 1-7 years 0.0551 0.0741 0.4570 1.61 8-12 years 0.1018 0.0764 0.1835 1.62 >12 years 0.3075 0.1006 0.0023 1.49 Geographic setting 0.0342 Urban 0.0000 Rural 0.1207 0.0567 0.0342 2.13 SOURCE: Norman et al.
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From page 720... ...
0.8556 Poorest group 0.0000 Second poorest 0.0063 0.0480 0.8957 1.06 Middle group 0.0188 0.0535 0.7258 1.23 Fourth poorest 0.0356 0.0785 0.6507 2.06 Richest group 0.0261 0.0842 0.7564 1.75 Education 0.011 None 0.0000 1-7 years 0.0700 0.0552 0.2055 1.54 8-12 years 0.2012 0.0663 0.0025 1.98 >12 years 0.3058 0.0914 0.0009 1.57 Geographic setting 0.0021 Urban 0.0000 Rural 0.1821 0.0589 0.0021 2.82 SOURCE: Norman et al.
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From page 721... ...
Poorest group 1.00 -- 1.00 - Second poorest 1.14 0.78- 1.68 1.00 0.74- 1.35 Middle group 1.11 0.75- 1.67 1.00 0.73- 1.36 Fourth poorest 1.77 1.15- 2.73 1.33 0.94- 1.87 Richest group 2.20 1.35- 3.59 1.13 0.75- 1.72 Education None 1.00 -- 1.00 - 1-7 years 0.99 0.70- 1.39 1.19 0.94- 1.50 8-12 years 1.19 0.84- 1.68 1.11 0.84- 1.46 > 12 years 0.75 0.43- 1.31 0.58 0.36- 0.92 Geographic setting Urban 1.00 -- 1.00 - Rural 1.06 0.82- 1.37 0.63 0.50- 0.80 SOURCE: Norman et al.
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From page 722... ...
Poorest group 1.00 -- 1.00 - Second poorest 0.82 0.43- 1.56 0.53 0.33-0.83 Middle group 0.50 0.30- 0.84 0.43 0.26-0.71 Fourth poorest 056 0.28- 1.12 0.39 0.20-0.74 Richest group 0.38 0.17- 0.83 0.16 0.07-0.36 Education None 1.00 -- 1.00 - 1-7 years 0.96 0.62- 1.49 1.35 0.85-2.15 8-12 years 0.70 0.40- 1.22 1.03 0.60-1.78 > 12 years 0.14 0.03- 0.64 0.59 0.15-2.30 Geographic setting Urban 1.00 -- 1.00 - Rural 0.80 0.47- 1.39 1.07 0.68-1.68 SOURCE: Norman et al.
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From page 723... ...
/day) , SADHS 1998 Men: Light Smokers = 2,051 Women: Light Smokers = 780 Nonsmokers = 2,678 Nonsmokers = 6,276 Sociodemographic Characteristics Odds Ratio 95% CI Odds Ratio 95% CI Model I Population group African 1.00 -- 1.00 - Coloured 1.80 1.46-2.22 11.77 9.08-14.26 White 0.41 0.46-0.67 3.50 2.33- 5.25 Asian 1.30 0.88-1.93 1.52 0.88- 2.61 Age 15-24 1.00 -- 1.00 - 25-34 3.70 3.01-4.55 1.66 1.15- 2.37 35-44 4.92 3.94-6.14 3.31 2.30- 4.76 45-54 3.14 2.41-4.10 3.63 2.50- 5.27 55-64 3.68 2.78-4.85 1.97 1.29- 3.00 65+ 3.30 2.50-4.34 1.72 1.11- 2.64 Model II Population group African 1.00 -- 1.00 - Coloured 2.28 1.75-2.97 18.34 13.34-25.23 White 0.84 0.48-1.45 12.96 7.55-22.24 Asian 2.19 1.38-3.49 3.20 1.68- 6.11 Age 15-24 1.00 -- 1.00 - 25-34 3.84 3.11-4.75 1.47 1.01- 2.13 35-44 4.94 3.92-6.21 2.61 1.79- 3.80 45-54 2.91 2.19-3.87 2.54 1.71- 3.78 55-64 3.16 2.36-4.24 1.22 0.77- 1.95 65+ 2.76 2.04-3.73 0.96 0.59- 1.56 Asset index (quintiles)
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From page 724... ...
/day) , SADHS 1998 Men: Heavy Smokers = 477 Women: Heavy Smokers = 153 Normatensives = 2,678 Normatensives = 6,276 Sociodemographic Characteristics Odds Ratio 95% CI Odds Ratio 95% CI Model I Population group African 1.00 -- 1.00 - Coloured 3.84 2.71- 5.43 49.67 25.02- 98.61 White 7.68 5.57-10.58 86.17 41.54-178.78 Asian 5.93 3.79- 9.28 2.73 0.76- 9.79 Age 15-24 1.00 -- 1.00 - 25-34 5.44 3.64- 8.12 2.70 1.23- 5.91 35-44 6.89 4.57-10.39 4.78 2.34- 9.78 45-54 6.42 4.14- 9.94 3.39 1.53- 7.50 55-64 4.77 2.94- 7.75 3.27 1.52- 7.05 65+ 4.48 2.68- 7.50 0.93 0.26- 3.31 Model II Population group African 1.00 -- 1.00 - Coloured 3.81 2.57- 5.61 49.32 21.59-112.67 White 10.04 5.95-16.93 161.46 62.82-414.97 Asian 6.17 3.64-10.48 3.09 0.81- 11.79 Age 15-24 1.00 -- 1.00 - 25-34 5.80 3.85- 8.76 2.71 1.22- 6.05 35-44 7.21 4.78-10.87 4.66 2.19- 9.92 45-54 6.33 4.07- 9.85 2.95 1.36- 6.41 55-64 4.57 2.71- 7.69 2.57 1.15- 5.75 65+ 4.29 2.45- 7.54 0.68 0.19- 2.53 Asset index (quintiles)
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From page 725... ...
RACIAL DISPARITIES IN THE HEALTH OF OLDER SOUTH AFRICANS 725 TABLE 19-5 Racial Disparities in Self-Report Injury in Past Month, SADHS 1998 Men: Injured = 80 Women: Injured = 95 Not Injured = 5,673 Not Injured = 7,978 Sociodemographic Characteristics Odds Ratio 95% CI Odds Ratio 95% CI Model I Population group African 1.00 -- 1.00 - Coloured 0.69 0.28- 1.66 1.67 0.76- 3.67 White 1.58 0.54- 4.63 2.49 0.85- 7.33 Asian 0.53 0.11- 2.48 0.79 0.11- 5.82 Age 15-24 1.00 -- 1.00 - 25-34 1.55 0.51- 4.71 0.76 0.33- 1.76 35-44 2.10 0.88- 5.02 0.90 0.51- 1.57 45-54 2.22 0.87- 5.66 1.07 0.58- 1.98 55-64 1.81 0.65- 5.03 0.79 0.30- 2.08 65+ 0.97 0.24- 3.89 1.04 0.50- 2.17 Medical Aid Yes 1.00 1.00 No 0.91 0.42- 2.00 0.96 0.43- 2.15 Model II Population group African 1.00 -- 1.00 - Coloured 0.92 0.37- 2.29 1.97 0.85- 4.58 White 3.24 1.08- 9.78 5.17 1.71-15.64 Asian 0.84 0.18- 3.96 1.33 0.18- 9.54 Age 15-24 1.00 -- 1.00 - 25-34 1.56 0.53- 4.60 0.73 0.31- 1.70 35-44 2.31 0.96- 5.54 0.83 0.46- 1.51 45-54 2.71 0.99- 7.40 1.00 0.49- 2.05 55-64 2.36 0.73- 7.67 0.79 0.32- 1.98 65+ 1.49 0.31- 7.02 1.02 0.43- 2.41 Medical aid Yes 1.00 1.00 No 0.74 0.31- 1.76 0.82 0.35- 1.94 Asset index (quintiles) Poorest group 1.00 -- 1.00 - Second poorest 1.12 0.35- 3.57 2.63 0.85- 8.13 Middle group 0.69 0.20- 2.37 2.09 0.59- 7.44 Fourth poorest 0.55 0.18- 1.64 1.62 0.44- 5.93 Richest group 0.22 0.06- 0.81 0.63 0.16- 2.45 Education None 1.00 -- 1.00 - 1-7 years 2.89 0.86- 9.69 1.31 0.54- 3.16 8-12 years 3.65 1.04-12.88 0.90 0.31- 2.63 > 12 years 1.20 0.20- 7.07 0.75 0.16- 3.40 Geographic setting Urban 1.00 -- 1.00 - Rural 0.40 0.18- 0.88 0.37 0.14- 0.99 SOURCE: Norman et al.
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From page 726... ...
Age 1.5 Age and SES Odds 1.0 0.5 0.0 African Coloured White Asian FIGURE 19-6 Comparison of odds ratio for hypertension, adjusted for age only (Model I) and other socioeconomic factors and age (Model II)
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From page 727... ...
5 4 Ratio Age Age and SES 3 Odds * 2 1 0 African Coloured White Asian FIGURE 19-7 Comparison of odds ratio for "ever had TB" adjusted for age only (Model I)
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From page 728... ...
* 4 2 0 African Coloured White Asian FIGURE 19-8 Comparison of odds ratio for light and heavy smoking, adjusted for age only (Model I)
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From page 729... ...
* 0 African Coloured White Asian Heavy Smoking Women 20 18 16 *
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From page 730... ...
Age Age and SES Odds 8 6 4 2 0 African Coloured White Asian Injury in Past Month Women 18 16 * 14 12 Ratio 10 Age Odds 8 Age and SES 6 4 2 0 African Coloured White Asia FIGURE 19-9 Comparison of odds ratio for self-reported injury in the past month, adjusted for age only (Model I)
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From page 731... ...
However, the current cause of death profile suggests that the population groups remain at different stages of the health transition with Africans affected more by the infectious diseases and coloured and white South Africans affected more by noncommunicable diseases. This pattern would tend to suggest that the differences in mortality rates have persisted.
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From page 732... ...
The internal physiology includes biological systems that regulate blood pressure as well as the genes involved in controlling blood pressure. Genetic factors have been determined to account for 25 to 40 percent of the variability in blood pressure among people, and as many as 10 to 15 genes can play a role in this variation.
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From page 733... ...
. However, this does not necessarily confirm the observation from the Demographic and Health Survey because it provides no information about the injury death rate, and it may be possible that the rate for white South Africans is lower than it is for Africans.
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From page 734... ...
Once the death statistics, post-1998, containing the population group of the deceased become available, there will be more scope to describe the differentials and examine the relationships among population group, socioeconomic factors, and mortality. However, the mortality data will have limitations, making it timely to reflect on the issues that need to be investigated with a view to conducting more directed data collection for investigating racial disparities in health.
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From page 735... ...
. Chronic diseases, risk factors and lifestyles based on the South Africa Adult Demographic and Health Survey.
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