The chapter is organized into six sections. First, we outline overall mortality and cause-specific mortality disparities by race/ethnicity among the elderly population (ages 65+) in the United States. Second, we describe racial/ethnic disparities across general indicators of health for the U.S. elderly population. Third, we briefly compare current racial/ethnic health and mortality disparities among the elderly with those observed for younger age groups. Fourth, we examine whether health and mortality disparities among the elderly correspond with racial/ethnic differences in some key sociodemographic characteristics. Fifth, we present some simple models of health and mortality disparities among the elderly to assess the impact of those sociodemographic factors on the observed differentials. Our concluding section summarizes the findings from the chapter, notes some important data limitations in understanding the national picture of racial/ethnic health disparities among the elderly, and briefly notes future research needs.
We begin by examining racial/ethnic disparities in older adult mortality. The National Center for Health Statistics (NCHS) constructs official mortality rates based on U.S. Vital Statistics (numerator) and Census (denominator) data. The advantages of these data sources are that they are large and cover the entire population, including individuals in nursing homes, long-term care institutions, and prisons. Although important and informative, there are some well-known limitations with the quality and reliability of the official death rates by race/ethnicity, especially among the elderly (Coale and Kisker, 1986; Elo and Preston, 1997; Kestenbaum, 1992; Lauderdale and Kestenbaum, 2002; Preston, Elo, Rosenwaike, and Hill, 1996; Rosenberg et al., 1999; Rosenwaike and Hill, 1996). One problem is reporting disparities between the two data sources. Disparities may occur because racial/ethnic identification on the Census is completed most often by a household member, while identification at the time of death is assigned most often by a funeral director (Rosenberg et al., 1999). Another problem is that a number of recent studies have shown significant levels of age misreporting among the elderly, which can seriously bias old-age mortality estimates (e.g., Preston et al., 1996). Third, Census undercount, particularly of racial and ethnic minority populations, can artificially bias mortality estimates for these groups upward, although adjustments can be made for the estimated undercount (Rosenberg et al., 1999). Despite these limitations, these official data remain a key source for describing racial/ethnic mortality disparities by age, sex, and geographic area.