title: Ethnicity, Socioeconomic Status, and Health Disparities in a Mixed Rural-Urban US Community-Olmsted County, Minnesota.
abstract: To characterize health disparities in common chronic diseases among adults by socioeconomic status (SES) and ethnicity in a mixed rural-urban community of the United States.
  
  
  
  We conducted a cross-sectional study to assess the association of the prevalence of the 5 most burdensome chronic diseases in adults with SES and ethnicity and their interaction. The Rochester Epidemiology Project medical records linkage system was used to identify the prevalence of coronary heart disease, asthma, diabetes, hypertension, and mood disorder using International Classification of Diseases, Ninth Revision codes recorded from January 1, 2005, through December 31, 2009, among all adult residents of Olmsted County, Minnesota, on April 1, 2009. For SES measurements, an individual HOUsing-based index of SocioEconomic Status (HOUSES) derived from real property data was used. Logistic regression models were used to examine the association of the prevalence of chronic diseases with ethnicity and HOUSES score and their interaction.
  
  
  
  We identified 88,010 eligible adults with HOUSES scores available, of whom 48,086 (54.6%) were female and 80,699 (91.7%) were non-Hispanic white; the median (interquartile range) age was 45 years (30-58 years). Overall and in the subgroup of non-Hispanic whites, SES measured by HOUSES was inversely associated with the prevalence of all 5 chronic diseases independent of age, sex, and ethnicity (P<.001). While an association of ethnicity with disease prevalence was observed for all the chronic diseases, SES modified the effect of ethnicity for clinically less overt conditions (interaction P<.05 for each condition [diabetes, hypertension, and mood disorder]) but not for coronary heart disease, a clinically more overt condition.
  
  
  
  In a mixed rural-urban setting with a predominantly non-Hispanic white population, health disparities in chronic diseases still exist across SES. The extent to which SES modifies the effect of ethnicity on the risk of chronic diseases may depend on the nature of the disease.
authors.affiliation: Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Chung-Il
authors.initials: CI
authors.lastname: Wi
authors.affiliation: Division of Epidemiology, Mayo Clinic, Rochester, MN.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: St Sauver
authors.affiliation: Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN.
authors.forename: Debra J
authors.initials: DJ
authors.lastname: Jacobson
authors.affiliation: Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN.
authors.forename: Richard S
authors.initials: RS
authors.lastname: Pendegraft
authors.affiliation: Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN.
authors.forename: Brian D
authors.initials: BD
authors.lastname: Lahr
authors.affiliation: Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN; Center for Individualized Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Euijung
authors.initials: E
authors.lastname: Ryu
authors.affiliation: Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Beebe
authors.affiliation: Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN.
authors.forename: Jeff A
authors.initials: JA
authors.lastname: Sloan
authors.affiliation: Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Rand-Weaver
authors.affiliation: Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Krusemark
authors.affiliation: Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN.
authors.forename: YuBin
authors.initials: Y
authors.lastname: Choi
authors.affiliation: Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN. Electronic address: Juhn.young@mayo.edu.
authors.forename: Young J
authors.initials: YJ
authors.lastname: Juhn
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D001213:Asian / Q000706:statistics & numerical data; D002908:Chronic Disease / Q000191:economics / Q000453:epidemiology* / Q000208:ethnology; D003430:Cross-Sectional Studies; D005260:Female; D062305:Geographic Mapping; D054624:Health Status Disparities; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D038801:International Classification of Diseases; D016015:Logistic Models; D008297:Male; D008498:Medical Record Linkage; D008499:Medical Records; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D015995:Prevalence; D012111:Residence Characteristics / Q000145:classification; D012923:Social Class; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult