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Education, income, and net worth explain more U.S. racial/ethnic health disparities than health behaviors and insurance

Public health initiatives to reduce racial/ethnic disparities in health promote changes in individual health behaviors such as smoking and overeating and increasing rates of insurance coverage among blacks and Hispanics. But this approach will result in only modest decreases in health disparities. Education, income, and net worth explain more of these disparities than either health behaviors or insurance coverage, according to a new study. It is important to address the effects of lower socioeconomic status on racial/ethnic health disparities, note Joseph J. Sudano, Ph.D., of Case Western Reserve University, and David W. Baker, M.D., of Northwestern University.

Drs. Sudano and Baker found that crude mortality rates over a 6-year period for late middle-aged whites, blacks, English-speaking (ES) Hispanics and Spanish-speaking (SS) Hispanics were 5.8 percent, 10.6 percent, 5.8 percent, and 4.4 percent, respectively. Rates of major decline in self-reported overall health (SROH) were 14.6 percent, 23.2 percent, 22.1 percent, and 39.4 percent, respectively. Higher mortality rates for black versus white people were mostly explained by worse baseline health. Results were similar for Hispanics, but less pronounced.

However, accounting for education, income, and net worth reduced disparities in declining SROH for blacks and ES Hispanics (but not SS Hispanics) to nonsignificance. In contrast, health insurance and health behaviors (for example, smoking, alcohol use, and body mass index) explained little of the racial/ethnic differences in health outcomes. The findings suggest that risk factors for death and health decline differ, as do the differences in the prevalence of these risk factors across racial/ethnic groups. As a result, the explanations for disparities may vary depending upon the health outcomes examined and upon the racial/ethnic groups compared, note the researchers. Their findings were based on analysis of data from Wave 1 (1992) and Wave 4 (1998) of the Health and Retirement Survey, a nationally representative survey of U.S. adults aged 51 to 61 years old in 1992. Their study was supported by the Agency for Healthcare Research and Quality (HS10283 and HS11462).

More details are in "Explaining U.S. racial/ethnic disparities in health decline and mortality in late middle age: The roles of socioeconomic status, health behaviors, and health insurance, by Drs. Sudano, and Baker, in the February 2006 Social Science & Medicine 62, pp. 909-922.

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