Future Directions for the Demography of Aging Proceedings of a Workshop (2018) / Chapter Skim
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2 Racial/Ethnic and Nativity Disparities in the Health of Older U.S. Men and Women - Robert A. Hummer and Iliya Gutin
2 Racial/Ethnic and Nativity Disparities in the Health of Older U.S. Men and Women - Robert A. Hummer and Iliya Gutin
Pages 31-66
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From page 31... ...
awarded to the Carolina Population Center at the University of North Carolina at Chapel Hill by the Eunice Kennedy Shriver National Institute of Child Health and Human Development. We are grateful to the National Center for Health Statistics and Minnesota Population Center for making the public-use data available for this paper.
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From page 32... ...
. Moreover, a large body of research has demonstrated that foreign-born individuals in most racial/ethnic groups tend to have more favorable health patterns than their U.S.-born counterparts (Hummer et al., 2015)
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The Native American population has also experienced a tragic history of racism, resulting in their near genocide and continued social and economic marginalization. At present, the Native American population exhibits patterns of low SES and poor health that are similar to African Americans (Jones, 2006)
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Most national-level population health work, including the present effort, cannot address such heterogeneity, given relatively small sample sizes of specific groups within national datasets. Nonetheless, the Chinese, Japanese, and Korean national origin subgroups have been shown to exhibit more favorable health profiles when compared to the South and Southeast Asian origin subgroups (Frisbie et al., 2001)
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Although positive health and educational selectivity has long characterized Hispanic immigration and has helped to account for the favorable health patterns among the immigrant generation (Akresh and Frank, 2008) , such patterns of positive selectivity may be waning, particularly for immigrants from Mexico (Feliciano, 2005)
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. Moreover, as discussed above, many specific subgroups (e.g., Native American tribes, national origin subgroups of racial/ethnic groups)
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adults, we pool survey data from 16 waves of NHIS between 2000 and 2015 and 8 waves of continuous 2-year NHANES between 1999 and 2014. For measures obtained from NHIS, we provide estimates for non-Hispanic Whites, non-Hispanic Blacks, Mexican Americans, other Hispanics, Asians or Pacific Islanders, and Native Americans.
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From page 38... ...
and foreign born, exhibit the most favorable socioeconomic profiles, while Native Americans, U.S.-born Blacks, foreign-born Mexican Americans, and other Hispanics exhibit the least favorable distributions. Turning first to education, foreign-born Mexican American men and women exhibit the lowest levels of high school completion (~17%)
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From page 39... ...
Non-Hispanic Whites fare much better on these measures compared to most of their minority counterparts. Under one-quarter of U.S.-born White adults report fair/poor health, compared to 30–45 percent of Blacks, Mexican Americans, other Hispanics, foreign-born Asians, and Native Americans.
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N-H Black Mexican American F-B US-B F-B US-B FEMALE Overall 0.01 0.08 0.02 0.02 Education |
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Bold indicates significantly different from U.S.-born non-Hispanic Whites at p<0.05. Underline indicates significantly different from U.S.-born members of same racial/ethnic group at p<0.05.
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From page 42... ...
N-H Black Mexican American F-B US-B F-B US-B FEMALE GLOBAL HEALTH Fair/poor health 0.35 0.39 0.44 0.36 Health status worse compared to 0.17 0.13 0.18 0.14 last year N days physical health not good 3.44 5.65 7.78 5.29 last month N days mental health not good 2.65 3.32 5.49 4.52 last month Two+ severe mental health symptomsa 0.20 0.20 0.25 0.23 Obese (self-report) b 0.29 0.39 0.34 0.30 Obese (measured)
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0.39 0.32 0.32 0.18 0.37 0.25 0.22 0.17 0.15 0.19 0.10 0.19 0.16 0.13 7.63 4.06 -- -- -- 5.00 5.07 4.88 2.79 -- -- -- 2.24 3.39 0.27 0.21 0.18 0.10 0.27 0.21 0.18 0.25 0.28 0.08 0.13 0.33 0.21 0.23 0.33 0.24 -- -- -- 0.26 0.32 0.76 0.67 -- -- -- 0.69 0.73 ref. 0.35 0.31 0.29 0.22 0.37 0.25 0.23 0.16 0.14 0.18 0.08 0.18 0.15 0.12 5.12 1.74 -- -- -- 3.64 4.18 2.09 2.78 -- -- -- 0.71 1.62 0.18 0.18 0.11 0.10 0.21 0.17 0.13 0.22 0.23 0.05 0.12 0.31 0.20 0.23 0.25 -- -- -- -- 0.33 0.29 0.47 0.27 -- -- -- 0.57 0.59 Bold indicates significantly different from U.S.-born non-Hispanic Whites at p<0.05.
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From page 44... ...
. Looking more closely, U.S.-born Black, Mexican American, and Native American men also have higher self-reported obesity than their non-Hispanic White counterparts; yet non-Hispanic White men have a 10–30 percent higher prevalence of risky waist circumference.
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Black, Mexican American, and Native American women have the highest prevalence of reported diabetes (30–35%) , followed closely by other Hispanic women (~24%)
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N-H Black Mexican American F-B US-B F-B US-B FEMALE MORBIDITY Told you had: Coronary heart disease 0.09 0.14 0.15 0.17 Congestive heart failure 0.02 0.07 0.05 0.09 Heart condition 0.09 0.14 0.11 0.12 Heart attack 0.07 0.12 0.09 0.13 Stroke 0.08 0.12 0.08 0.11 Arthritis 0.27 0.45 0.34 0.42 Hypertension 0.70 0.71 0.48 0.60 Diabetes + taking medication 0.33 0.28 0.28 0.36 Undiagnosed or Diagnosed/Controlleda Hypertensionb 0.75 0.82 0.63 0.69 Diabetesc 0.54 0.53 0.55 0.61 Experienced: Pain/aching joints, past mo. 0.46 0.45 0.39 0.41 Lower back pain, past 3 mo.
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0.15 0.21 0.15 0.20 0.21 0.21 0.22 0.08 0.05 -- -- -- 0.04 0.11 0.11 0.19 0.14 0.18 0.17 0.19 0.21 0.13 0.16 0.10 0.11 0.15 0.13 0.17 0.09 0.10 0.10 0.09 0.13 0.09 0.09 0.34 0.21 -- -- -- 0.30 0.46 0.53 0.60 0.61 0.60 0.65 0.51 0.57 0.28 0.33 0.27 0.21 0.34 0.20 0.20 0.69 0.60 -- -- -- 0.72 0.67 0.61 0.52 -- -- -- 0.48 0.51 0.34 0.52 0.28 0.35 0.54 0.37 0.46 0.30 0.29 0.19 0.22 0.33 0.27 0.29 0.19 0.19 0.09 0.06 0.16 0.12 0.13 0.06 0.06 0.04 0.01 0.05 0.05 0.04 ref. 0.15 0.21 0.15 0.20 0.21 0.21 0.22 0.08 0.05 -- -- -- 0.04 0.11 0.11 0.19 0.14 0.18 0.17 0.19 0.21 0.13 0.16 0.10 0.11 0.15 0.13 0.17 0.09 0.10 0.10 0.09 0.13 0.09 0.09 0.34 0.21 -- -- -- 0.30 0.46 0.53 0.60 0.61 0.60 0.65 0.51 0.57 0.28 0.33 0.27 0.21 0.34 0.20 0.20 0.69 0.60 -- -- -- 0.72 0.67 0.61 0.52 -- -- -- 0.48 0.51 0.34 0.52 0.28 0.35 0.54 0.37 0.46 0.30 0.29 0.19 0.22 0.33 0.27 0.29 0.19 0.19 0.09 0.06 0.16 0.12 0.13 0.06 0.06 0.04 0.01 0.05 0.05 0.04 Underline indicates significantly different from U.S.-born members of same racial/ethnic group at p<0.05.
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From page 48... ...
Based on NHIS estimates, U.S.-born Blacks, Mexican Americans, and Native Americans have the highest rates of any activity limitation (~42%) , while foreignborn non-Hispanic Whites and Asians of any nativity report significantly lower rates (~28%)
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, Black, Mexican American, other Hispanic, Native American, and foreign-born Asian and non-Hispanic White men and women are significantly more likely to report not having health insurance compared to their U.S.-born non-Hispanic White counterparts. Nativity is particularly important, as foreign-born adults report the highest rates, especially Mexican American women (12%)
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N-H Black Mexican American F-B US-B F-B US-B FEMALE FUNCTIONING Any functional limitation 0.64 0.72 0.70 0.70 Limitations keep you from working 0.15 0.24 0.39 0.21 Limited in amount of work you can do 0.24 0.42 0.47 0.36 Experience confusion/memory problems 0.14 0.20 0.34 0.18 DISABILITY Bed disabled 8+ days last year 0.10 0.12 0.13 0.10 Has any activity limitation (NHIS) 0.34 0.47 0.41 0.40 Has any activity limitation (NHANES)
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RACIAL/ETHNIC AND NATIVITY DISPARITIES 51 Native Other Hispanic N-H Asian/PI Amer. N-H White F-B US-B F-B US-B US-B F-B US-B ref.
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N-H Black Mexican American F-B US-B F-B US-B FEMALE HEALTH CARE Uninsured 0.09 0.01 0.12 0.01 During last year: Medical care delayed due to cost 0.06 0.06 0.07 0.06 Couldn't afford medical care 0.05 0.05 0.06 0.04 Had 10+ care visits 0.18 0.23 0.23 0.20 In hospital overnight 0.18 0.19 0.16 0.16 MALE HEALTH CARE Uninsured 0.05 0.01 0.10 0.01 During last year: Medical care delayed due to cost 0.07 0.04 0.06 0.04 Couldn't afford medical care 0.06 0.04 0.04 0.03 Had 10+ care visits 0.17 0.21 0.19 0.19 In hospital overnight 0.17 0.19 0.15 0.17 NOTES: NHIS N(Overall) = 181,924; NHANES N(Overall)
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Bold indicates significantly different from U.S.-born non-Hispanic Whites at p<0.05. Underline indicates significantly different from U.S.-born members of same racial/ethnic group at p<0.05.
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, compared to U.S.-born Blacks, Native Americans, and foreign-born Mexican Americans and Other Hispanics (~24%)
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For example, though middle-aged adults report 20–30 percent less poor/fair health than older adults, Blacks, Mexican Americans, other Hispanics, and Native Americans report significantly higher levels than their non-Hispanic White counterparts. They are also more likely to indicate a recent decline in health and more days of poor health.
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N-H Black Mexican American F-B US-B F-B US-B FEMALE MORTALITY (rate per 100,000 person-years) All-cause 2410 4341 2898 3262 Disease of heart 399 964 514 573 Malignant neoplasms 643 910 476 530 Chronic lower respiratory diseases -- 139 126 115 Cerebrovascular diseases -- 323 177 242 Alzheimer's disease -- 146 -- 233 Diabetes mellitus -- 232 208 244 Influenza/pneumonia -- 122 -- -- Kidney-related diseases -- 143 105 105 Accidents -- 40 -- 86 All other causes 627 1298 1009 1046 MALE MORTALITY (rate per 100,000 person-years)
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Bold indicates significantly different from U.S.-born non-Hispanic Whites at p<0.05. Underline indicates significantly different from U.S.-born members of same racial/ethnic group at p<0.05.
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From page 58... ...
As with older adults, Mexican Americans, other Hispanics, and U.S.born Blacks have a greater prevalence of severe mental health symptoms compared to U.S.-born non-Hispanic Whites. However, nativity is particularly important in shaping racial/ethnic group differences: foreign-born Blacks, Mexican Americans, other Hispanics, and non-Hispanic Whites consistently exhibit more favorable functional health and disability rates than their U.S.-born racial/ethnic counterparts and, in some cases, than U.S.-born non-Hispanic Whites.
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Both U.S.- and foreign-born non-Hispanic White adults are comparable to Asians on some but not all measures of health; most important, U.S.-born Whites exhibit higher rates of obesity and smoking, a greater prevalence of heart-related conditions, and higher mortality rates than Asians. Second, there is a substantial gap in overall population health between, on the one hand, Asian Americans and nonHispanic Whites, who exhibit the healthiest overall profiles in the country, and Blacks, Mexican Americans, and other Hispanics, who exhibit the least healthy overall profiles.
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Nativity is once again critical as, with the exception of Mexican Americans, U.S.-born adults often fare worse than their foreignborn counterparts. Yet again, Native American men and women exhibit the least favorable patterns of functional health, consistently reporting the highest rates among all groups of impaired functioning, poor mental health, and everyday disabilities or limitations.
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Thus, as we look ahead to a larger and more diverse U.S. older adult population as the 21st century unfolds, there is substantial concern for the health of older Americans -- especially Mexican Americans, other Hispanics, U.S.-born Blacks, and Native Americans -- given the extent of the socioeconomic and health disparities we outlined above, both among older Americans and among middle-aged adults.
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Historically higher patterns of smoking among U.S.born Blacks, Native Americans, and non-Hispanic Whites relative to other groups are in part responsible for some of the higher rates of mortality for those groups exhibited above. In this case, policies and programs to eliminate cigarette smoking in the United States would have major influences not only on improving older adult population health but also on reducing some of the racial/ethnic and nativity disparities documented above.
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Given the tragic history of racism that has been so influential in the social and economic life of African Americans and Native Americans, it is unfortunately no surprise that these two groups stood out for generally exhibiting the worst older-adult population health across nearly all measures, in comparison with the other groups we considered. The socioeconomic and health disparities we documented among middleaged individuals, for which African Americans and Native Americans also exhibited substantial disadvantages on most measures relative to the other groups, further suggest that racial/ethnic health disparities will not disappear anytime soon.
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. Trends in educational attainment by race/ethnicity, nativity, and sex in the United States, 1989-2005.
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states. SSM Population Health, 2, 561–571.
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Social Science & Medicine: Population Health, 2(1)
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