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Understanding Racial and Ethnic Differences in Health in Late Life: A Research Agenda
Filipinos, and Japanese report similar or better health status than whites (Kuo and Porter, 1998), while Native Hawaiians and Samoans appear to have worse health (Hoyert and Kung, 1997). Older U.S. residents of Chinese, Filipino, Indian, Korean, and Vietnamese heritage have lower mortality than whites. Mortality rates among these groups do not follow socioeconomic rankings. For instance, Vietnamese, who have lower average incomes than Indians, have lower mortality than Indians in every age group of 65 years and older (Lauderdale and Kestenbaum, 2002).
Besides differences in broad disease categories, racial and ethnic differences exist in specific diseases. With cancer, for instance, the data show these differences (Burdette, 1998; Manton and Stallard, 1997):
more cases of melanoma among whites than other groups;
high rates of ovarian cancer among whites of European ancestry;
lower incidence of breast cancer among blacks and Hispanics than other groups;
twice as many cases of cervical cancer among blacks than among all other groups, though not among those aged 65 years and older, and higher incidence among Hispanics than non-Hispanics (Armstrong et al., 2002);
a high incidence of pancreatic cancer among blacks and those of Polynesian ancestry;
lower rates of cancers of the gallbladder and cystic ducts among blacks than other groups; and
a higher risk of multiple myeloma among blacks than whites.
Differences also exist within the major racial and ethnic groups. Among Asians, for instance, breast cancer incidence is twice as high among Japanese as among Vietnamese women; in contrast, cervical cancer incidence is seven times as high among Vietnamese as among Japanese women (Miller et al., 1996; Williams, 2001b).
Knowledge about all these differences is limited by numerous problems of measurement. For instance, the ethnicity of decedents may not be reliably determined, because it must be reported by someone else. For other health indicators, ethnic identification could be more accurate, though people may be inconsistent in reporting their own race or ethnic status, particularly when they are of mixed descent. Health status may also be reported inconsistently. For instance, disability is often defined relative to normal activities, which may vary from group to group. Groups accustomed to more physically challenging work may report greater disability than other groups. Reports of medical conditions may be affected by the amount of contact with providers of medical care. Racial and ethnic groups with more access to the medical system may report more health problems simply because of greater contact. And there are special problems in comparing