The Myriad Racial, Ethnic Disparities in Health are Dramatic

It does not seem like an exaggeration to say that the difference in older White and Black Americans’ health is shocking.

A 51-year-old Black woman has the frailer health of a 69-year-old White woman. A 51-year-old Black man is in the same condition as a 64-year-old White man. Hispanic men and women, at 51, have also aged more than Whites. But older Black Americans still have the worst health.

These are just a few of the myriad ways researchers recently documented what they call “enormous health inequality” in this country. The health conditions that affect people as they age are also a driving force in who goes on federal disability, how long they are able to work, and how long they remain fairly healthy. In fact, health inequality at age 55 often explains half of the Black-White gaps in where they wind up later in life.

Both Black and Hispanic men and women in their 50s are more likely to have numerous health problems, with diabetes and obesity at the top of that list. But every group stands out for different reasons. White women in their late 50s, for example, more often have smoked than women of color at some point in their lives.

For this study, the researchers constructed six frailty indexes, for Black, Hispanic, and White men and for Black, Hispanic and White women. The indexes, which were the basis for two sets of comparisons – for men and for women – tracked 35 medical conditions and functional deficiencies over two decades. They range from the common, such as arthritis, to cancer, which is rare. Diagnoses like diabetes, high blood pressure, lung disease and stroke are also inventoried. Endurance and executive function are gauged by activities like being able to climb several flights of stairs and manage one’s medications and money.

The overall patterns to emerge from the study are the disparities by race and ethnicity. Nearly 12 percent of older White men have none of the 35 health deficits in the frailty index. That’s the case for just 6 percent of older Black men and almost 10 percent of older Hispanic men. The magnitudes are similar for women.

The health disparities are also clear within many of the 35 health and functional deficiencies. In one extreme example, White women have only one condition that is worse than Black women: lung cancer diagnoses, which are no doubt related to the higher smoking rates.

Blacks’ and Hispanics’ relatively frail health also makes a difference in their late-life decisions. Black men and women are the most likely to go on federal disability benefits, the researchers found. On the retirement front, poor health is a major reason that older Hispanic men in particular start their Social Security benefits earlier, but that is fairly unusual for women.

Older Americans in poor health, predictably, are more likely to end up in a nursing home. But unhealthy White women are much more likely to go into a nursing home than unhealthy Hispanic women. The authors don’t explain this difference but other research has shown that aging Hispanics and Blacks more often avoid nursing homes because they live with an adult child or other caregiver.

The researchers uncovered some disadvantages for the older Whites. But the evidence overwhelmingly points to “enormous health inequality” by race and ethnicity.

To read this study by Nicolò Russo, Rory McGee, Mariacristina DeNardi, Margherita Borella and Ross Abram, see “Health Inequality by Race and Ethnicity.”

The research reported herein was derived in whole or in part from research activities performed pursuant to a grant from the U.S. Social Security Administration (SSA) funded as part of the Retirement and Disability Research Consortium.  The opinions and conclusions expressed are solely those of the authors and do not represent the opinions or policy of SSA, any agency of the federal government, or Boston College.  Neither the United States Government nor any agency thereof, nor any of their employees, make any warranty, express or implied, or assumes any legal liability or responsibility for the accuracy, completeness, or usefulness of the contents of this report.  Reference herein to any specific commercial product, process or service by trade name, trademark, manufacturer, or otherwise does not necessarily constitute or imply endorsement, recommendation or favoring by the United States Government or any agency thereof.