Skin thin
Evidence of accelerated aging among African Americans and its implications for mortality
Morgan Levine & Eileen Crimmins
Social Science & Medicine, October 2014, Pages 27–32
Abstract:
Blacks experience morbidity and mortality earlier in the life course compared to whites. Such premature declines in health may be indicative of an acceleration of the aging process. The current study uses data on 7,644 black and white participants, ages 30 and above, from the third National Health and Nutrition Examination Survey, to compare the biological ages of blacks and whites as indicated from a combination of ten biomarkers and to determine if such differences in biological age relative to chronological age account for racial disparities in mortality. At a specified chronological age, blacks are approximately 3 years older biologically than whites. Differences in biological age between blacks and whites appear to increase up until ages 60-65 and then decline, presumably due to mortality selection. Finally, differences in biological age were found to completely account for higher levels of all-cause, cardiovascular and cancer mortality among blacks. Overall, these results suggest that being black is associated with significantly higher biological age at a given chronological age and that this is a pathway to early death both overall and from the major age-related diseases.
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Are the costs of neuroticism inevitable? Evidence of attenuated effects in U.S. Latinas
Belinda Campos et al.
Cultural Diversity and Ethnic Minority Psychology, July 2014, Pages 430-440
Abstract:
Neuroticism is the heritable and stable personality trait defined by the tendency to experience negative emotion, be easily stressed, and slow to soothe. Neuroticism poses a risk for poor social and health outcomes that has been identified as a major public health concern. To date, factors that attenuate neuroticism’s costs have not been identified. The goal of this work was to test the hypothesis that the costs of neuroticism would be attenuated in sociocultural contexts that emphasize readily accessible social support, emotional positivity, and physical proximity in interdependent relationships. U.S. Latino culture fits these characteristics. Two studies, an online survey study (Study 1) and a laboratory study (Study 2), tested whether three key costs of high neuroticism — less support (Study 1), more distress (Study 2), and blunted cortisol reactivity (Study 2) — would be attenuated in U.S. Latinas relative to non-Latinas of European and East Asian cultural background. Consistent with previous research, neuroticism was associated with less perceived support, more distress, and blunted cortisol reactivity in non-Latina women of European and East Asian cultural background. For Latina women, however, these effects were attenuated. Latina women who were high in neuroticism continued to feel supported, were not as distressed, and their cortisol reactivity was less blunted. The role of sociocultural context for generating a better understanding of personality processes and the social malleability of neuroticism’s costs are discussed.
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The Impact of the Great Migration on Mortality of African Americans: Evidence from the Deep South
Dan Black et al.
American Economic Review, forthcoming
Abstract:
The Great Migration — the massive migration of African Americans out of the rural South to largely urban locations in the North, Midwest, and West — was a landmark event in U.S. history. Our paper shows that this migration increased mortality of African Americans born in the early twentieth century South. This inference comes from an analysis that uses proximity of birthplace to railroad lines as an instrument for migration.
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An empirical analysis of White privilege, social position and health
Naa Oyo Kwate & Melody Goodman
Social Science & Medicine, September 2014, Pages 150–160
Abstract:
Accumulated evidence has demonstrated that social position matters for health. Those with greater socioeconomic resources and greater perceived standing in the social hierarchy have better health than those with fewer resources and perceived standing. Race is another salient axis by which health is stratified in the U.S., but few studies have examined the benefit of White privilege. In this paper, we investigated how perceptions of inequality, subjective and objective social status affected the health and well-being of N=630 White residents in three Boston neighborhoods lying on a social gradient differentiated by race, ethnicity, income and prestige. Outcomes were self-rated health, dental health, and happiness. Results suggested that: neighborhood residence was not associated with health after controlling for individual level factors (e.g., positive ratings of the neighborhood, education level); objective measures of socioeconomic status were associated with better self-reported and dental health, but subjective assessments of social position were more strongly associated; and White residents living in the two wealthiest neighborhoods, and who perceived Black families as welcome in their neighborhoods enjoyed better health than those who believed them to be less welcome. However, those who lived in the least wealthy and most diverse neighborhood fared worse when reporting Black families to be welcome. These results suggest that White privilege and relative social position interact to shape health outcomes.
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The Persistence and Heterogeneity of Health among Older Americans
Florian Heiss, Steven Venti & David Wise
NBER Working Paper, July 2014
Abstract:
We consider how age-health profiles differ by demographic characteristics such as education, race, and ethnicity. A key feature of the analysis is the joint estimation of health and mortality to correct for the effect of mortality selection on observed age-health profiles. The model also allows for heterogeneity in individual health at a point in time and the persistence of the unobserved component of health over time. The observed component of health is based on a multidimensional index based on 27 indicators of health. Most of the key results are shown by simulations that illustrate the range of issues that can be addressed using the model. Differences in health by education and racial-ethnic group at age 50 persist throughout the remainder of life. Based on observed profiles, the health of whites is about 8 percentile points greater than the health of blacks at age 50 but by age 90 the gap is only 5 percentile points. However, when corrected for mortality selection, the health of blacks is actually declining more rapidly with age than the health of whites; the true gap widens with age. We also find that much of the difference in age-health profiles by racial-ethnic group is accounted for by differences in the levels of education between race-ethnic groups -- from two-thirds to 85 percent for men and about half for women. We also simulate differences in survival probabilities by level of education and health and use these probabilities to calculate the expected present discounted value (EPDV) of an immediate annuity with first payout at age 66 for persons by gender, level of education, and health decile. The range of EPDVs is over two-fold for both men and women suggesting enormous potential for adverse selection.
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Racial and Ethnic Stratification in the Relationship Between Homeownership and Self-Rated Health
Ryan Finnigan
Social Science & Medicine, August 2014, Pages 72–81
Abstract:
Social scientists have long demonstrated that socioeconomic resources benefit health. More recently, scholars have begun to examine the potential stratification in the health returns different groups receive for a given resource. Motivated by fundamental cause theory, this paper examines homeownership as a salient health resource with potentially stratified benefits. Homeowners have significantly greater housing quality, wealth, neighborhood quality and integration, and physical and mental health than renters. However, there are compelling theoretical reasons to expect the health advantage of homeownership to be unequally distributed across racial and ethnic groups. Regression analyses of 71,874 household heads in the United States from the 2012 March Current Population Survey initially suggest all homeowners experience a significant health advantage. Further examination finds robust evidence for a homeowner health advantage among Whites, on par with the difference between the married and divorced. The advantage among minority households is considerably smaller, and not significant among Latinos or Asians. Conditioning on a broad array of observable characteristics, White homeowners emerge as exceptionally healthy compared to White renters and all minority groups. This leads to the unexpected finding that racial/ethnic differences in health are concentrated among homeowners. The findings demonstrate the interactive nature of racial/ethnic stratification in health through both access to and returns from socioeconomic resources.
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The Relationships among Vigilant Coping Style, Race, and Depression
Thomas LaVeist et al.
Journal of Social Issues, June 2014, Pages 241–255
Abstract:
Although Black–White differences in depression are well documented, vigilant coping style as an explanation for the observed inequalities in depression is less understood. Using data from 718 adults in the Exploring Health Disparities in Integrated Communities (EHDIC) Study, we estimated logistic regression models to examine the cross-sectional relationship between race, vigilant coping style, and depression. After controlling for demographic variables, White adults were more likely to report depression than Black adults. Moreover, when accounting for coping style, the Black–White difference in depression widened. This association persisted even with the addition of the covariates. While high rates of depression among Whites compared with Blacks are well documented, the degree of the differences appears to be greater than previously reported once vigilance is accounted for. This finding suggests that if it were not for the high prevalence of vigilant coping in Blacks, the well-documented Black advantage regarding depression compared to Whites would likely be even greater.
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Chandra Jackson et al.
Social Science & Medicine, forthcoming
Abstract:
Sleep duration, associated with increased morbidity/mortality, has been shown to vary by race and occupation. Few studies have examined the additional influence of immigrant status. Using a nationally-representative sample of 175,244 US adults from the National Health Interview Survey from 2004-2011, we estimated prevalence ratios (PRs) for short sleep duration (<7 hours/per day) among US- and non-US born Blacks and Latinos by occupation compared to their White counterparts using adjusted Poisson regression models with robust variance. Non-US born participants’ mean age was 46 years, 55% were men, 58% were Latino, and 65% lived in the US ≥15 years. Short sleep prevalence was highest among US- and non-US born Blacks in all occupations, and the prevalence generally increased with increasing professional/management roles in Blacks and Latinos while it decreased among Whites. Adjusted short sleep was more prevalent in US-born Blacks compared to Whites in professional/management (PR=1.52 [95% confidence interval (CI): 1.42-1.63]), support services (PR=1.31 [95% CI: 1.26-1.37]), and laborers (PR=1.11 [95% CI: 1.06-1.16]). The Black-White comparison was even higher for non-US born Black laborers (PR=1.50 [95% CI: 1.24-1.80]). Similar for non-US born Latinos, Latinos born in the US had a higher short sleep prevalence in professional/management (PR=1.14 [95% CI: 1.04-1.24]) and support services (PR=1.06 [95% CI: 1.01-1.11]), but a lower prevalence among laborers (PR=0.77 [95% CI: 0.74-0.81]) compared to Whites. Short sleep varied within and between immigrant status for some ethnicities in particular occupations, further illuminating the need for tailored interventions to address sleep disparities among US workers.
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Race, unemployment rate, and chronic mental illness: A 15-year trend analysis
Celia Lo & Tyrone Cheng
Social Psychiatry and Psychiatric Epidemiology, July 2014, Pages 1119-1128
Purpose: Before abating, the recession of the first decade of this century doubled the US unemployment rate. High unemployment is conceptualized as a stressor having serious effects on individuals’ mental health. Data from surveys administered repeatedly over 15 years (1997–2011) described changes over time in the prevalence of chronic mental illness among US adults. The data allowed us to pinpoint changes characterizing the White majority — but not Black, Hispanic, or Asian minorities — and to ask whether such changes were attributable to economic conditions (measured via national unemployment rates).
Methods: We combined 1.5 decades’ worth of National Health Interview Survey data in one secondary analysis. We took social structural and demographic factors into account and let adjusted probability of chronic mental illness indicate prevalence of chronic mental illness
Results: We observed, as a general trend, that chronic mental illness probability increased as the unemployment rate rose. A greater increase in probability was observed for Blacks than Whites, notably during 2007–2011, the heart of the recession
Conclusions: Our results confirmed that structural risk posed by the recent recession and by vulnerability to the recession’s effects was differentially linked to Blacks. This led to the group’s high probability of chronic mental illness, observed even when individual-level social structural and demographic factors were controlled. Future research should specify the particular kinds of vulnerability that created the additional disadvantage experienced by Black respondents.
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Ann Adams et al.
Social Science & Medicine, September 2014, Pages 161–168
Abstract:
This paper explores differences in how primary care doctors process the clinical presentation of depression by African American and African-Caribbean patients compared with white patients in the US and the UK. The aim is to gain a better understanding of possible pathways by which racial disparities arise in depression care. One hundred and eight doctors described their thought processes after viewing video recorded simulated patients presenting with identical symptoms strongly suggestive of depression. These descriptions were analysed using the CliniClass system, which captures information about micro-components of clinical decision making and permits a systematic, structured and detailed analysis of how doctors arrive at diagnostic, intervention and management decisions. Video recordings of actors portraying black (both African American and African-Caribbean) and white (both White American and White British) male and female patients (aged 55 years and 75 years) were presented to doctors randomly selected from the Massachusetts Medical Society list and from Surrey/South West London and West Midlands National Health Service lists, stratified by country (US v.UK), gender, and years of clinical experience (less v. very experienced). Findings demonstrated little evidence of bias affecting doctors' decision making processes, with the exception of less attention being paid to the potential outcomes associated with different treatment options for African American compared with White American patients in the US. Instead, findings suggest greater clinical uncertainty in diagnosing depression amongst black compared with white patients, particularly in the UK. This was evident in more potential diagnoses. There was also a tendency for doctors in both countries to focus more on black patients' physical rather than psychological symptoms and to identify endocrine problems, most often diabetes, as a presenting complaint for them. This suggests that doctors in both countries have a less well developed mental model of depression for black compared with white patients.
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Attitudes of Black, White, and Hispanic Community Residents Toward Seeking Medical Help
Ellen Dornelas, Edward Fischer & Terry DiLorenzo
Race and Social Problems, June 2014, Pages 135-142
Abstract:
With regard to racial/ethnic health disparities, a variable that has not been well explored is the person’s willingness to seek medical aid when symptoms appear. Until recently, there has been no comprehensive scale to measure these predispositions and their significance for public health. This study’s purpose was to determine whether specific attitudinal differences might constitute barriers to medical help-seeking for racial/ethnic subgroups. In a sample of 380 community residents responding to a mailed survey in the Hartford, CT metropolitan area, racial/ethnic differences were examined for four attitudinal aspects of medical help-seeking: action/intention, cynicism/fatalism, confidence in medical professionals, and fear/avoidance. Multivariate analyses controlling for other demographic, health crisis, and health insurance variables indicated that black, white, and Hispanic subgroups differed strongly on the battery of medical help-seeking attitudes. Although all groups were generally favorable to help-seeking, black and Hispanic respondents expressed more favorable, pro-help-seeking attitudes than did white respondents. Their attitudes were highly significant for action/intention and confidence in medical professionals. This study showed no evidence that racial/ethnic health disparities might result from negative predispositions as barriers to medical help-seeking.
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Ceren Akdeniz et al.
JAMA Psychiatry, June 2014, Pages 672-680
Importance: Relative risk for the brain disorder schizophrenia is more than doubled in ethnic minorities, an effect that is evident across countries and linked to socially relevant cues such as skin color, making ethnic minority status a well-established social environmental risk factor. Pathoepidemiological models propose a role for chronic social stress and perceived discrimination for mental health risk in ethnic minorities, but the neurobiology is unexplored.
Design, Setting, and Participants: Cross-sectional design in a university setting using 3 validated paradigms to challenge neural social stress processing and, to probe for specificity, emotional and cognitive brain functions. Healthy participants included those with German lineage (n = 40) and those of ethnic minority (n = 40) from different ethnic backgrounds matched for sociodemographic, psychological, and task performance characteristics. Control comparisons examined stress processing with matched ethnic background of investigators (23 Turkish vs 23 German participants) and basic emotional and cognitive tasks (24 Turkish vs 24 German participants).
Results: There were significant increases in heart rate (P < .001), subjective emotional response (self-related emotions, P < .001; subjective anxiety, P = .006), and salivary cortisol level (P = .004) during functional magnetic resonance imaging stress induction. Ethnic minority individuals had significantly higher perceived chronic stress levels (P = .02) as well as increased activation (family-wise error–corrected [FWE] P = .005, region of interest corrected) and increased functional connectivity (PFWE = .01, region of interest corrected) of perigenual anterior cingulate cortex (ACC). The effects were specific to stress and not explained by a social distance effect. Ethnic minority individuals had significant correlations between perceived group discrimination and activation in perigenual ACC (PFWE = .001, region of interest corrected) and ventral striatum (PFWE = .02, whole brain corrected) and mediation of the relationship between perceived discrimination and perigenual ACC–dorsal ACC connectivity by chronic stress (P < .05).
Conclusions and Relevance: Epidemiologists proposed a causal role of social-evaluative stress, but the neural processes that could mediate this susceptibility effect were unknown. Our data demonstrate the potential of investigating associations from epidemiology with neuroimaging, suggest brain effects of social marginalization, and highlight a neural system in which environmental and genetic risk factors for mental illness may converge.
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James Scanlan
Society, August 2014, Pages 328-346
"In summary, while there has been increasing recognition of the ways that relative differences in outcome rates tend to be systematically affected by the prevalence (frequency) of an outcome, that recognition has yet to affect the way observers analyze group differences in outcome rates in any context. Though today vastly greater resources are devoted to the study of disparities in health and healthcare outcomes...almost nothing said about such things as whether those disparities have increased or decreased over time or are otherwise larger in one setting than another, or even whether a disparity should be deemed large or small, has had a sound statistical basis. Meanwhile, federal regulators encourage mortgage lenders and public schools to reduce the frequency of adverse borrowing and student discipline outcomes in order to reduce the commonly observed several-fold racial and ethnic differences in rates of experiencing those outcomes. Neither the regulators, the congressional committees monitoring regulator policies, nor the institutions reducing the frequency of those outcomes in response to federal encouragements understand that reducing any outcome tends to increase, not reduce, relative differences in experiencing it."
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Heart Trouble and Racial Group Identity: Exploring Ethnic Heterogeneity Among Black Americans
Helena Dagadu & André Christie-Mizell
Race and Social Problems, June 2014, Pages 143-160
Abstract:
Heart disease is the leading cause of death among men and women in the United States, and compared to other racial and ethnic groups, Blacks between the ages of 45 and 65 have the highest likelihood of dying from heart disease. Nevertheless, relatively little is known about intragroup variation among the US Black population. In this study, utilizing a nationally representative sample of Black Americans, we examine the relationship between heart trouble and racial group identity for two groups of Blacks: African Americans and Caribbean Blacks. We include two measures of racial group identity: closeness to other Blacks and Black group evaluation. Our results reveal three important patterns. First, closeness to other Blacks is suppressed by Black group evaluation. Second, at low levels of closeness to other Blacks, there is little difference between African Americans and Caribbean Blacks in the probability of heart trouble. However, as closeness to other Blacks increases, the probability of heart trouble increases for African Americans, but decreases for Caribbean Blacks. Finally, with respect to positive Black group evaluation, both African Americans and Caribbean Blacks benefit and experience a lower probability of heart trouble.