Health inequality between White and African Americans: A 20-year longitudinal analysis.

摘要

This research is an examination of racial differences in health over a 20-year period. Using the National Health and Nutrition Examination Survey I and the subsequent follow-up interviews, four health outcomes were examined including morbidity (chronic and serious illness), disability, subjective health and mortality. Given the vast amount of literature supporting the existence of racial disparities in the health, this research aimed to uncover what behavioral and social epidemiological processes were involved in the continuing disparity in health between White and African Americans. Unlike much of the previous research, this investigation incorporated an interactional framework outlined by Pettigrew for assessing the magnitude of the racial differences in health across levels of socioeconomic status. Following the work of Pettigrew (1981) and Wilson (1980, 1987), it was hypothesized that the African Americans of the lowest socioeconomic status, the "truly disadvantaged", would experience the poorest health. Both main and interactive effects were tested to examine how socioeconomic status and race influence health. The role of health behaviors such as obesity, smoking and alcohol consumption was also examined.;At baseline, African Americans were more likely to report serious illness than White Americans. Over time, the change in morbidity was not significantly influenced by race. In terms of disability, African Americans were more likely to report disability at wave 4 but the effect was only modestly significant. At baseline, African Americans reported poorer subjective health than White Americans and the rate of decline was faster for blacks over the study period. In terms of mortality, race was a significant predictor of survival and the effect was concentrated within the first 10 years of the study period. Socioeconomic status did not explain all the racial differences in health status. Contradictory to Wilson's theory of the truly disadvantaged, interaction effects showed that in the majority of health outcomes, the racial disparity in health was largest at the higher levels of socioeconomic status. African Americans and White Americans at the lowest level of socioeconomic status often reported similar health. These findings support the continued importance of both race and class in determining health status.