title: Racial disparities in self-rated health: trends, explanatory factors, and the changing role of socio-demographics.
abstract: This paper uses data from the U.S. National Health Interview Surveys (N = 1,513,097) to describe and explain temporal patterns in black-white health disparities with models that simultaneously consider the unique effects of age, period, and cohort. First, we employ cross-classified random effects age-period-cohort (APC) models to document black-white disparities in self-rated health across temporal dimensions. Second, we use decomposition techniques to shed light on the extent to which socio-economic shifts in cohort composition explain the age and period adjusted racial health disparities across successive birth cohorts. Third, we examine the extent to which exogenous conditions at the time of birth help explain the racial disparities across successive cohorts. Results show that black-white disparities are wider among the pre-1935 cohorts for women, falling thereafter; disparities for men exhibit a similar pattern but exhibit narrowing among cohorts born earlier in the century. Differences in socioeconomic composition consistently contribute to racial health disparities across cohorts; notably, marital status differences by race emerge as an increasingly important explanatory factor in more recent cohorts for women whereas employment differences by race emerge as increasingly salient in more recent cohorts for men. Finally, our cohort characteristics models suggest that cohort economic conditions at the time of birth (percent large family, farm or Southern birth) help explain racial disparities in health for both men and women.
authors.affiliation: San Diego State University, San Diego, CA 92123, USA. Electronic address: abeck@projects.sdsu.edu.
authors.forename: Audrey N
authors.initials: AN
authors.lastname: Beck
authors.affiliation: University of Southern California, USA.
authors.forename: Brian K
authors.initials: BK
authors.lastname: Finch
authors.affiliation: San Diego State University, San Diego, CA 92123, USA.
authors.forename: Shih-Fan
authors.initials: SF
authors.lastname: Lin
authors.affiliation: University of Texas at Austin, USA.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Hummer
authors.affiliation: University of Colorado at Boulder, USA.
authors.forename: Ryan K
authors.initials: RK
authors.lastname: Masters
mesh_terms: D000328:Adult; D001741:Black or African American / Q000523:psychology* / Q000706:statistics & numerical data; D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D059026:Diagnostic Self Evaluation; D005260:Female; D054624:Health Status Disparities; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012959:Socioeconomic Factors; D013997:Time Factors; D014481:United States; D044465:White People / Q000523:psychology* / Q000706:statistics & numerical data
keywords: Age–period–cohort; Conditions at birth; Health inequalities; Racial disparities; Self-rated health