Racial and Ethnic Differences in the Health of Older Americans

Linda G. Martin and Beth J. Soldo, Editors

Committee on Population

Commission on Behavioral and Social Sciences and Education

National Research Council

NATIONAL ACADEMY PRESS
Washington, D.C.
1997



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--> Racial and Ethnic Differences in the Health of Older Americans Linda G. Martin and Beth J. Soldo, Editors Committee on Population Commission on Behavioral and Social Sciences and Education National Research Council NATIONAL ACADEMY PRESS Washington, D.C. 1997

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--> NATIONAL ACADEMY PRESS 2101 Constitution Avenue, NW Washington, D.C. 20418 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. This workshop was supported by funds from the National Institute on Aging through grant No. SES 9116694 by the National Science Foundation to the National Academy of Sciences for activities of the Committee on Population, and by Contract No. N01-0D-4-2139 between the National Academy of Sciences and the National Institute on Aging. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project. Library of Congress Cataloging-in-Publication Data Racial and ethnic differences in the health of older Americans / Linda G. Martin and Beth J. Soldo, editors; Committee on Population, Commission on Behavioral and Social Sciences and Education, National Research Council. p. cm. Revised versions of some of the papers originally presented at a workshop held Dec. 1994 in Washington. Includes bibliographical references. ISBN 0-309-05489-3 (pbk.) 1. Minority aged—Health and hygiene—United States. 2. Minority aged—Diseases—United States. I. Martin, Linda G. II. Soldo, Beth J. III. National Research Council (U.S.). Committee on Population. RA408.M54R33 1997 613'.0438'08900973—dc21 97-33731 This book is available for sale from the National Academy Press, 2101 Constitution Avenue, N.W., Box 285, Washington, D.C. 20418. Call 800-624-6242 or 202-334-3313 (in the Washington Metropolitan Area). This report is also available on line at http://www.nap.edu Printed in the United States of America Copyright 1997 by the National Academy of Sciences. All rights reserved.

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--> COMMITTEE ON POPULATION RONALD D. LEE (Chair), Demography and Economics, University of California, Berkeley CAROLINE H. BLEDSOE, Department of Anthropology, Northwestern University JOSÉ LUIS BOBADILLA,* Inter-American Development Bank, Washington, D.C. JOHN BONGAARTS, The Population Council, New York JOHN B. CASTERLINE, The Population Council, New York LINDA G. MARTIN, RAND, Santa Monica, California JANE MENKEN, University of Pennsylvania ROBERT A. MOFFITT, Department of Economics, Johns Hopkins University MARK R. MONTGOMERY, The Population Council, New York W. HENRY MOSLEY, Department of Population Dynamics, Johns Hopkins University School of Hygiene and Public Health ALBERTO PALLONI, Department of Sociology, University of Wisconsin, Madison JAMES P. SMITH, RAND, Santa Monica, California BETH J. SOLDO, Department of Demography, Georgetown University MARTA TIENDA,** Population Research Center, University of Chicago AMY O. TSUI,** Carolina Population Center, University of North Carolina, Chapel Hill JOHN HAAGA, Director BARNEY COHEN, Program Officer TRISH DeFRISCO, Senior Project Assistant KAREN FOOTE, Program Officer (through May 1996) JOEL ROSENQUIST, Senior Project Assistant *   deceased October 1996 **   through October 1996

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--> CONTRIBUTORS RONALD J. ANGEL, Department of Sociology, University of Texas at Austin LISA F. BERKMAN, Departments of Health and Social Behavior and Epidemiology, Harvard School of Public Health, Harvard University JIMING CHEN, Columbia University Center for Geriatrics and Gerontology in the Faculty of Medicine and New York State Psychiatric Institute PETER CROSS, Columbia University Center for Geriatrics and Gerontology in the Faculty of Medicine and New York State Psychiatric Institute IRMA T. ELO, Population Studies Center, University of Pennsylvania JOSÉ J. ESCARCE, RAND, Santa Monica, CA DAVID V. ESPINO, Department of Family Practice, University of Texas Health Science Center at San Antonio BARRY GURLAND, Columbia University Stroud Center in the Faculty of Medicine and New York State Psychiatric Institute ELOISE KILLEFFER, Columbia University Center for Geriatrics and Gerontology in the Faculty of Medicine and New York State Psychiatric Institute RAYNARD S. KINGTON, RAND, Santa Monica, CA RAFAEL LANTIGUA, Columbia University College of Physicians & Surgeons KENNETH G. MANTON, Center for Demographic Studies, Duke University KYRIAKOS S. MARKIDES, Center on Aging and Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston LINDA G. MARTIN, RAND, Santa Monica, CA RICHARD MAYEUX, Departments of Neurology and Psychiatry and Gertrude H. Sergievsky Center, Columbia University College of Physicians & Surgeons JEWEL M. MULLEN, Department of Epidemiology and Public Health, School of Medicine, Yale University JAMES V. NEEL, Department of Human Genetics (Medical School), University of Michigan SAMUEL H. PRESTON, Population Studies Center, University of Pennsylvania FRANK W. PUFFER, Department of Economics, Clark University DWAYNE REED, Buck Center for Research in Aging, Novato, CA LAURA RUDKIN, Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston JAMES P. SMITH, RAND, Santa Monica, CA BETH J. SOLDO, Department of Demography, Georgetown University ERIC STALLARD, Center for Demographic Studies, Duke University

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--> YAAKOV STERN, Gertrude H. Sergievsky Center, Columbia University College of Physicians & Surgeons DAVID WILDER, Columbia University Center for Geriatrics and Gerontology in the Faculty of Medicine and New York State Psychiatric Institute KATSUKIKO YANO, Honolulu Heart Program, Honolulu, HI

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--> The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Bruce M. Alberts is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. William A. Wulf is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy's purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Bruce M. Alberts and Dr. William A. Wulf are chairman and vice chairman, respectively, of the National Research Council.

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--> Contents     PREFACE   ix 1   INTRODUCTION Linda G. Martin and Beth J. Soldo   1 2   RACIAL AND ETHNIC DIFFERENCES IN MORTALITY AT OLDER AGES Irma T. Elo and Samuel H. Preston   10 3   HEALTH AND DISABILITY DIFFERENCES AMONG RACIAL AND ETHNIC GROUPS Kenneth G. Manton and Eric Stallard   43 4   RACE, SOCIOECONOMIC STATUS, AND HEALTH IN LATE LIFE James P. Smith and Raynard S. Kington   105 5   HOW HEALTH BEHAVIORS AND THE SOCIAL ENVIRONMENT CONTRIBUTE TO HEALTH DIFFERENCES BETWEEN BLACK AND WHITE OLDER AMERICANS Lisa F. Berkman and Jewel M. Mullen   163 6   BLACK-WHITE DIFFERENCES IN THE USE OF MEDICAL CARE BY THE ELDERLY: A CONTEMPORARY ANALYSIS José J. Escarce and Frank W. Puffer   183

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--> 7   ARE GENETIC FACTORS INVOLVED IN RACIAL AND ETHNIC DIFFERENCES IN LATE-LIFE HEALTH? James V. Neel   210 8   DIFFERENCES IN RATES OF DEMENTIA BETWEEN ETHNO-RACIAL GROUPS Barry Gurland, David Wilder, Rafael Lantigua, Richard Mayeux, Yaakov Stern, Jiming Chen, Peter Cross, and Eloise Killeffer   233 9   CARDIOVASCULAR DISEASE AMONG ELDERLY ASIAN AMERICANS Dwayne Reed and Katsukiko Yano   270 10   HEALTH STATUS OF HISPANIC ELDERLY Kyriakos S. Markides, Laura Rudkin, Ronald J. Angel, and David V. Espino   285

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--> Preface The Committee on Population was established in 1983 to bring the knowledge and methods of the population sciences to bear on major issues of science and public policy. The committee's work has increasingly dealt with the demography and health of aging populations. Together with the Committee on National Statistics and the Division of Health Promotion and Disease Prevention of the Institute of Medicine, the committee sponsored a Workshop on Forecasting Survival, Health, and Disability in 1992. In December 1992, the committee organized a Workshop on Demography of Aging, which led to the publication of a volume of edited papers (Preston and Martin, 1995) that covered a range of topics, from household and family demography, to work and retirement, intergenerational transfers, and health. Two chapters in that volume, in particular, Medical Demography (Kenneth G. Manton and Eric Stallard) and Socioeconomic Differences in Adult Mortality and Health Status (Samuel H. Preston and Paul Taubman), pointed to the need for more in-depth analysis of racial and ethnic differences in health at older ages. This concern prompted the Committee, with funding from the National Institute on Aging (NIA), to organize a workshop, held in Washington in December 1994, at which scholars from diverse health disciplines could present and discuss analyses and reviews. This volume includes revised versions of some of the papers originally presented at the workshop. They have benefited both from the discussion at the original workshop, for which we thank all the participants, and from later review, for which we thank the generous scholars who must remain anonymous. The committee was very fortunate to have two members, Linda Martin and Beth Soldo, who devoted time and energy to planning the workshop, guiding authors in their revisions, and editing this volume.

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--> We want to thank our colleagues who helped develop the 1994 workshop: Ronald Abeles (NIA), Jacob Feldman (National Center for Health Statistics), Samuel Preston (the immediate past chair of the committee), Burton Singer (Princeton University), Richard Suzman (NIA), and David Willis (NIA). Thanks also are due Robert Moffitt and James Smith, members of the committee who assisted with the review of the papers. We also appreciate the contributions of Michael McGinniss and Michael Stoto. Beyond his role on the organizing group, Richard Suzman was a catalyst, both intellectually and financially, and we are grateful to him and the National Institute on Aging for their support. Finally, the staff of the Committee on Population were essential to this endeavor. Karen Foote was diligent and thorough in handling the organization of the workshop and the review process. Joel Rosenquist ably handled all the administrative tasks for the workshop and manuscript production. John Haaga, the committee director, provided supervision throughout and critical insight in the final stages of the project. Barbara White gave a helpful and thorough copyediting of the report. Most of all, of course, we appreciate the contributions of the authors. Ronald Lee Chair, Committee on Population

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