Are racial disparities in health conditional on socioeconomic status?
Racial health inequality is related to socioeconomic status (SES), but debate ensues on the nature of the relationship. Using the US National Health and Nutrition Examination Survey I and the subsequent follow-up interviews, this research examines health disparities between white and black adults and whether the SES/health gradient differs across the two groups in the USA. Two competing mechanisms for the conditional or interactive relationship between race and SES on health are examined during a 20-year period for black and white Americans. Results show that black adults began the study with more serious illnesses and poorer self-rated health than white adults and that the disparity continued over the 20 years. Significant interactions were found between race and education as well as race and employment status on health outcomes. The interaction effect of race and education showed that the racial disparity in self-rated health was largest at the higher levels of SES, providing some evidence for the "diminishing returns" hypothesis; as education levels increased, black adults did not have the same improvement in self-rated health as white adults. Overall, the findings provide evidence for the continuing significance of both race and SES in determining health status over time.
VA Center for the Study of Healthcare Provider Behavior, VA Health Services Research and Development Center of Excellence, Sepulveda Ambulatory and Nursing Home Center, Sepulveda, CA 91343, USA. farmermm@ucla.edu
Melissa M
MM
Farmer
Kenneth F
KF
Ferraro
D000328:Adult; D000368:Aged; D044383:Black People / Q000706:statistics & numerical data*; D002908:Chronic Disease / Q000453:epidemiology; D003430:Cross-Sectional Studies; D006233:Persons with Disabilities / Q000706:statistics & numerical data; D004522:Educational Status; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006305:Health Status Indicators; D006801:Humans; D008019:Life Style; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011203:Poverty / Q000706:statistics & numerical data; D012803:Sick Role; D012959:Socioeconomic Factors; D014481:United States; D044465:White People / Q000706:statistics & numerical data*; D001741:Black or African American