National Academies Press: OpenBook

Future Directions for the Demography of Aging: Proceedings of a Workshop (2018)

Chapter: 2 Racial/Ethnic and Nativity Disparities in the Health of Older U.S. Men and Women - Robert A. Hummer and Iliya Gutin

« Previous: 1 Trends in Mortality, Disease, and Physiological Status in the Older Population - Eileen Crimmins
Suggested Citation:"2 Racial/Ethnic and Nativity Disparities in the Health of Older U.S. Men and Women - Robert A. Hummer and Iliya Gutin." National Academies of Sciences, Engineering, and Medicine. 2018. Future Directions for the Demography of Aging: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25064.
×

2

Racial/Ethnic and Nativity Disparities in the Health of Older U.S. Men and Women
1

Robert A. Hummer2
and
Iliya Gutin

INTRODUCTION

Over the last couple of decades, demographers have documented an array of racial/ethnic health disparities. While the National Research Council’s 1994 Demography of Aging volume did not include any chapters specifically devoted to racial/ethnic disparities, it later published two entire volumes focused on the topic (National Research Council, 1997, 2004). However, the racial/ethnic demography of the country has changed dramatically in the intervening years. Beyond changing population composition, it is also important to continually reassess racial/ethnic health disparities, given the fundamental importance of good health and long life to each group’s overall well-being, especially in the context of a society that has long been stratified along racial/ethnic lines.

___________________

1 This research was supported in part by grant R24 AG045061, The Network on Life Course Health Dynamics and Disparities in 21st Century America, funded by the National Institute on Aging. We also received support from the Population Research Training grant (T32 HD007168) and the Population Research Infrastructure Program (P2C HD050924) awarded to the Carolina Population Center at the University of North Carolina at Chapel Hill by the Eunice Kennedy Shriver National Institute of Child Health and Human Development. We are grateful to the National Center for Health Statistics and Minnesota Population Center for making the public-use data available for this paper. We also thank Daniel Powers for his expert statistical assistance.

2 Department of Sociology and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27516. The authors share equal responsibility for this paper. Please contact Robert A. Hummer at rhummer@email.unc.edu for any questions or comments.

Suggested Citation:"2 Racial/Ethnic and Nativity Disparities in the Health of Older U.S. Men and Women - Robert A. Hummer and Iliya Gutin." National Academies of Sciences, Engineering, and Medicine. 2018. Future Directions for the Demography of Aging: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25064.
×

Demographers have also learned that it is insufficient to narrowly assess racial/ethnic health disparities; simultaneous consideration of nativity (i.e., whether individuals are U.S. or foreign born) and gender is paramount. Nativity is of critical concern because more than one in eight Americans is foreign born; further, the foreign-born proportions in each racial/ethnic group differ and are changing (Colby and Ortman, 2015). Moreover, a large body of research has demonstrated that foreign-born individuals in most racial/ethnic groups tend to have more favorable health patterns than their U.S.-born counterparts (Hummer et al., 2015). Furthermore, while it is very well documented that U.S. women live longer but less healthy lives than men (Case and Paxson, 2005), it is less well recognized that racial/ethnic disparities in health are generally wider among women than men (Brown et al., 2016; Richardson and Brown, 2016). Clearly, it is important to differentiate racial/ethnic health disparities by both nativity and gender to best understand which groups exhibit the largest and smallest disparities and why.

The goal of this chapter is to provide a contemporary portrait of U.S. racial/ethnic disparities in older adult (ages 65+) health, while simultaneously considering nativity- and gender-specific subpopulations. To provide insight into future racial/ethnic health disparities among the older population, we also estimate and briefly discuss middle-aged (ages 45–64) racial/ethnic health disparities. We consider a wide range of health measures, including those tapping dimensions of general health, morbidity, functioning and disability, health care, and mortality. Our chapter first provides brief overviews of some key theoretical and methodological considerations in the study of older adult health disparities. Doing so provides a context within which to interpret the disparities that we document. We close with a summary of the analysis and a forward-thinking agenda on which to push future research in this critical area of study.

THEORETICAL AND METHODOLOGICAL CONSIDERATIONS

A Context for Understanding Racial/Ethnic Health Disparities

It is very well recognized that Black Americans have been seriously discriminated against both institutionally and individually throughout the course of U.S. history, stemming from the earliest days of the Slave Trade, through the era of Jim Crow, to the mid- and late-20th-century decades of almost complete residential segregation from Whites, and into the present post–civil rights period (Gates et al., 2012). While the forms of discriminatory treatment have changed over the years, racism on the part of the White majority population continues to be the critical ideology underlying such discrimination, which contributes to both lower socioeconomic status

Suggested Citation:"2 Racial/Ethnic and Nativity Disparities in the Health of Older U.S. Men and Women - Robert A. Hummer and Iliya Gutin." National Academies of Sciences, Engineering, and Medicine. 2018. Future Directions for the Demography of Aging: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25064.
×

(SES) and poorer health profiles among Blacks relative to Whites (Williams et al., 2010). Each year, Blacks suffer between 60,000 and 100,000 excess deaths compared to Whites, a figure calculated by applying the annual death rate of Whites to the Black population (Satcher et al., 2005). The worse health and higher mortality of Blacks is due both to their lower level of SES resources (Hayward et al., 2000) and to the accumulated physiological stress of dealing with discrimination across the life course (Phelan and Link, 2015).

Fortunately, the gap in life expectancy between Blacks and Whites, which was about 14 years in 1900, is now smaller than ever before, at 3.5 years (Arias et al., 2017). This long-term narrowing reflects improved African American well-being due to both public health improvements (e.g., sanitation and vaccinations) and specific civil rights and health care legislation (Masters et al., 2014). However, the narrowing gap in life expectancy is also due to recent increases in mortality rates among Whites. Indeed, research has highlighted the dramatic surge in mortality affecting White adults, with the opioid epidemic being the driving force behind such adverse trends. Moreover, there has been a disproportionate impact on White adults with a high school education or less (Case and Deaton, 2015). In fact, the magnitude of increased mortality attributable to accidental poisonings almost entirely accounts for the recent decline in life expectancy among Whites and for the country as a whole (Kochanek et al., 2016). Clearly, then, Black–White health and mortality disparities have exhibited dynamic changes in recent years.

The Native American population has also experienced a tragic history of racism, resulting in their near genocide and continued social and economic marginalization. At present, the Native American population exhibits patterns of low SES and poor health that are similar to African Americans (Jones, 2006). Many Native American communities are geographically and socially isolated, resulting in limited opportunities for individual socioeconomic mobility (Smith-Kaprosy et al., 2012). Perhaps unsurprisingly, a recent analysis shows that counties with Native American reservations exhibit among the worst health profiles in the United States, with life expectancy figures often 10 years below the national average (Dwyer-Lindgren et al., 2017).

In recent decades, some Native American communities have experienced an influx of resources owing to the growth of the gambling industry. However, this influx has not uniformly resulted in positive health changes. On the one hand, some tribal economies have improved, leading to the greater availability of community health resources and social services, as well as increased individual financial stability. Conversely, this additional income may have a negative population health impact by enabling substance abuse, increasing the availability of unhealthy food, and, more

Suggested Citation:"2 Racial/Ethnic and Nativity Disparities in the Health of Older U.S. Men and Women - Robert A. Hummer and Iliya Gutin." National Academies of Sciences, Engineering, and Medicine. 2018. Future Directions for the Demography of Aging: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25064.
×

broadly, disrupting traditional social value systems (Kodish et al., 2016). Studies have reached mixed conclusions regarding the effects of this influx (Bruckner et al., 2011; Costello et al., 2010; Jones-Smith et al., 2014; Wolfe et al., 2012). The continued assessment of Native American health is both necessary and important in the context of Native Americans’ persistent social disadvantages and the changes in economic structure that some communities are experiencing.

While both the Asian American and Hispanic populations trace their American roots centuries into the past, the vast majority of individuals in both groups are either post-1960s immigrants or the descendants of those migrants. Together, Latinos and Asians have been instrumental in reshaping American diversity over the course of the late 20th and early 21st centuries (Lee and Bean, 2007), most notably among children and young adults but increasingly among older adults as well. Much work on the Latino and Asian populations has pointed to the importance of healthy immigrant selectivity in shaping the relatively favorable population health patterns of these rapidly growing groups (Akresh and Frank, 2008). However, at least some work finds that U.S.-born Hispanics and Asian Americans exhibit less favorable health and mortality patterns than their immigrant counterparts. Such a pattern of worsening health for the U.S.-born relative to the immigrant generation may vary across racial/ethnic groups, based on each group’s experience with socioeconomic incorporation (Hummer et al., 2015).

Asian Americans exhibit substantial diversity, not only by immigrant status but also by national origin. Most national-level population health work, including the present effort, cannot address such heterogeneity, given relatively small sample sizes of specific groups within national datasets. Nonetheless, the Chinese, Japanese, and Korean national origin subgroups have been shown to exhibit more favorable health profiles when compared to the South and Southeast Asian origin subgroups (Frisbie et al., 2001). Overall, though, the strong health and educational selectivity of most Asian immigrant groups in the United States have led to a relatively positive context for favorable population health among Asian Americans as a whole.

The Hispanic population, which now comprises 18 percent of the U.S. population and a rapidly growing share of older adults (Flores, 2017), is also very diverse and includes individuals who trace their roots in the United States for centuries, along with recent immigrants who arrived from nations throughout Central and South America and the Caribbean. Much demographic work documents diversity in health patterns across Hispanic subgroups, with Puerto Ricans generally exhibiting the worst population health profile, Cubans the most positive, and the Mexican origin population in the middle (Cho et al., 2004). The Mexican origin population consti-

Suggested Citation:"2 Racial/Ethnic and Nativity Disparities in the Health of Older U.S. Men and Women - Robert A. Hummer and Iliya Gutin." National Academies of Sciences, Engineering, and Medicine. 2018. Future Directions for the Demography of Aging: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25064.
×

tutes the largest subgroup, accounting for 63 percent of all Hispanics; about one-third of the Mexican origin population in the United States is foreign born (Flores, 2017). Given the large size of the Mexican origin population, our documentation examines them separately, along with a heterogeneous group of other Hispanics.

Although positive health and educational selectivity has long characterized Hispanic immigration and has helped to account for the favorable health patterns among the immigrant generation (Akresh and Frank, 2008), such patterns of positive selectivity may be waning, particularly for immigrants from Mexico (Feliciano, 2005). Notably, Mexico now has the highest obesity rate in the world and, as a result, Mexican immigrants to the United States also exhibit higher obesity rates than ever before (Hummer and Hayward, 2015). In the United States, Mexican immigrants also encounter an array of challenging social conditions, including high levels of stress, fear, and discrimination (particularly among undocumented immigrants); low wages and hazardous working conditions in manual-labor industries; and lack of access to health care (Hummer and Hayward, 2015). Given that the second and higher generations of Hispanics encounter multiple forms of discrimination and poor access to high-quality schooling and jobs (National Research Council, 2006), it is critical that researchers continue to carefully document population health patterns, trends, and heterogeneity among both the immigrant and U.S.-born segments of this rapidly growing group.

Health as a Multidimensional Concept

Given the multidimensionality of health, capturing only one or a few of its dimensions may lead to biased conclusions regarding racial/ethnic health disparities. As just one noteworthy example, older-age Hispanics exhibit substantially lower mortality rates than Whites but far higher rates of disability (Hayward et al., 2014). Consequently, an important goal of our chapter is to provide a comprehensive documentation of racial/ethnic differences in older adult health. Thus, we take a broad view in terms of conceptualizing and measuring health. Per the World Health Organization, physical, mental, and social well-being are equally relevant in developing a multifaceted understanding of health (World Health Organization, 2006). Therefore, we include indicators of “global” physical and mental health status, medical conditions/diseases and pain, functioning and activity limitations, access to and utilization of health care, and mortality. We also document differences in SES across groups, to better contextualize racial/ethnic health disparities.

Suggested Citation:"2 Racial/Ethnic and Nativity Disparities in the Health of Older U.S. Men and Women - Robert A. Hummer and Iliya Gutin." National Academies of Sciences, Engineering, and Medicine. 2018. Future Directions for the Demography of Aging: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25064.
×

Methodological Considerations in the Documentation of Racial/Ethnic Health Disparities

Documentation of racial/ethnic health disparities is not a straightforward endeavor. First, there is the question of who identifies in which racial/ethnic groups in health surveys. Self-reported surveys provide respondents with the opportunity to choose groups they most closely identify with, which is an important strength of the empirical patterns we describe below. This also means that empirically derived health disparities are subject to shifting understandings and reporting patterns of race/ethnicity across time and space (Sandefur et al., 2004). Moreover, as discussed above, many specific subgroups (e.g., Native American tribes, national origin subgroups of racial/ethnic groups) are numerically too small to be identified in the datasets that we use. Given such limitations, it is important to note that the health disparity patterns described below are based on individuals who are identifying with internally heterogeneous groups at one specific point in historical time and in one national context.

Second, there is selectivity with regard to the individuals who are included or excluded in the datasets used to document disparities. Perhaps most important, individuals necessarily have survived long enough to be in the dataset(s) being used; moreover, mortality differentials prior to the age groups under study strongly influence subsequent age-specific health disparities (Hayward et al., 2000). This well-known demographic issue of selective survival results in relatively healthy subgroups of individuals in population-based datasets, which mutes racial/ethnic disparities in older ages, given the selective processes involved (Palloni and Ewbank, 2004). Other issues of selection in nationally representative datasets involve the inclusion/exclusion of institutionalized, homeless or transient, and undocumented residents. The datasets we use below are household-based surveys; consequently, they likely exclude institutionalized, homeless, and transient individuals. Thus, estimates of racial/ethnic disparities are systematically tilted toward a modestly healthier older adult population than is actually the case in the complete population. While undocumented residents living in U.S. households are eligible for such surveys, such individuals may be highly skeptical about actually participating in them.

DATA AND METHODS

Data come from the National Health Interview Survey (NHIS) and the National Health and Nutrition Examination Survey (NHANES). NHIS is the largest nationally representative survey of health, with tens of thousands of annual participants providing information on a range of topics (National Center for Health Statistics, 2016). NHANES is also nationally represen-

Suggested Citation:"2 Racial/Ethnic and Nativity Disparities in the Health of Older U.S. Men and Women - Robert A. Hummer and Iliya Gutin." National Academies of Sciences, Engineering, and Medicine. 2018. Future Directions for the Demography of Aging: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25064.
×

tative and is another valuable source of health data through its unique combination of interviews and physical examinations (National Center for Health Statistics, 2005). We use the smaller NHANES for anthropometric and biomarker data, while relying on the statistical power of NHIS for questionnaire-based measures of health and the assessment of mortality disparities. NHIS is especially useful for mortality documentation because of its large size and self-reported racial/ethnic data, which alleviates the well-known problems with racial/ethnic reporting in vital statistics data (Bilheimer and Klein, 2010).

Drawing on both surveys, we provide population-level estimates of over 50 different health measures, categorized into five broad domains. First, the Global Health domain includes subjective reports of individuals’ overall physical and mental health status. We also include body mass index and waist circumference as proxies for weight-related health in this domain. In doing so, we distinguish survey-based definitions of obesity at the population level—which represent a summary measure of weight-related health status and risk (Gutin, 2017)—from clinical obesity at the individual level as a diagnosed condition (i.e., a “morbidity”). Measures of Morbidity are primarily based on individuals’ reports of being diagnosed with various conditions or diseases, as well as their reports of pain. Importantly, we also include NHANES-based biomarker assessments of hypertension and diabetes in this domain. In the case of Functioning and Disability, we use respondent information on confusion and/or memory problems, functional limitations and their interference with work, and multiple measures of activity limitations. We also focus on survey reports related to Health Care, including possession of health insurance, assessments of access, and an overview of individuals’ receipt of care in the past year. Finally, Mortality is documented as a rate per 100,000 person-years of exposure for each group, focusing both on all-cause mortality and underlying causes of death.

Limiting our analyses of both the NHIS and NHANES data to older (65+) and middle-aged (ages 45–64) adults, we pool survey data from 16 waves of NHIS between 2000 and 2015 and 8 waves of continuous 2-year NHANES between 1999 and 2014. For measures obtained from NHIS, we provide estimates for non-Hispanic Whites, non-Hispanic Blacks, Mexican Americans, other Hispanics, Asians or Pacific Islanders, and Native Americans. Due to the smaller sample sizes, we exclude Asians or Pacific Islanders and Native Americans from NHANES-based estimates. Given our stratification of racial/ethnic groups by both nativity and gender, there are nevertheless population subgroups for whom reliable estimates of certain health indicators are not possible because of small cell sizes. We thus exclude any estimates based on a group-specific prevalence of less than 10 cases. To account for differences in the age distribution of adults across groups, we standardized all proportions and means to the age distribu-

Suggested Citation:"2 Racial/Ethnic and Nativity Disparities in the Health of Older U.S. Men and Women - Robert A. Hummer and Iliya Gutin." National Academies of Sciences, Engineering, and Medicine. 2018. Future Directions for the Demography of Aging: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25064.
×

tion of adults in the 2000 decennial U.S. Census (as per National Center for Health Statistics [NCHS] recommendations). We applied appropriate survey weights to facilitate unbiased estimates and appropriate statistical significance levels when comparing across groups. Finally, we specified U.S.born non-Hispanic Whites as the referent group in testing for racial/ethnic/nativity differences across measures of health included in our analyses; we note significant nativity differences within racial/ethnic groups as well.

RESULTS

The Socioeconomic Context for Racial/Ethnic Health Disparities

Table 2-1 uses NHIS data to examine the distribution of SES across racial/ethnic groups, focusing on individuals’ educational attainment and a ratio of income to needs (adjusted for inflation and changing poverty guidelines across years). Non-Hispanic Whites and Asian Americans, both U.S. and foreign born, exhibit the most favorable socioeconomic profiles, while Native Americans, U.S.-born Blacks, foreign-born Mexican Americans, and other Hispanics exhibit the least favorable distributions. Turning first to education, foreign-born Mexican American men and women exhibit the lowest levels of high school completion (~17%), and less than 1 in 10 have any postsecondary education. Rates of high school completion and postsecondary schooling are higher among their U.S.-born counterparts, at ~50 percent and ~20 percent, respectively, though still far lower than all other racial/ethnic groups. For instance, non-Hispanic Black, other Hispanic, and Native American women and men have more than double the percentage of postsecondary educational attainment (~25–45%). Asian Americans and non-Hispanic Whites have by far the highest proportion of highly educated older adults; approximately 40 percent of women and 55 percent of men are in the “some college” or “college+” categories.

Table 2-1 also shows stark disparities in ratio of income to needs. Non-Hispanic White and Asian older men and women are also the most affluent: ~30 percent of White women, ~35 percent of Asian women, ~37 percent of White men, and ~40 percent of Asian men report an income at least four times greater than the poverty line. By contrast, U.S.-born Black, foreign-born Mexican American and other Hispanic, and Native American older adults have far less favorable distributions of income to needs relative to their non-Hispanic White and Asian counterparts. Strikingly, almost 70 percent of foreign-born Mexican Americans and ~60 percent of Native Americans and foreign-born other Hispanics have an income less than twice the poverty line. However, among other Hispanics, the U.S. born fare slightly better, with around ~50 percent in the same income-to-needs bracket. Conversely, foreign-born Blacks—especially women—exhibit a

Suggested Citation:"2 Racial/Ethnic and Nativity Disparities in the Health of Older U.S. Men and Women - Robert A. Hummer and Iliya Gutin." National Academies of Sciences, Engineering, and Medicine. 2018. Future Directions for the Demography of Aging: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25064.
×

more favorable income distribution than their U.S.-born counterparts (52% versus 38% with an income-to-needs ratio of 2.00+).

Global Assessments of Health

Table 2-2 considers our global assessments of health. Non-Hispanic Whites fare much better on these measures compared to most of their minority counterparts. Under one-quarter of U.S.-born White adults report fair/poor health, compared to 30–45 percent of Blacks, Mexican Americans, other Hispanics, foreign-born Asians, and Native Americans. For both genders, foreign-born Mexican Americans report the highest levels of fair/poor health (~43%), while U.S.-born Asians compare favorably to Whites and other racial/ethnic groups. Nativity is a particularly important distinction for reports of poor health or declines in health over the last year. With the exception of Blacks, foreign-born men and women consistently report higher levels of poor health than their U.S.-born counterparts. Further, foreign-born Mexican Americans, other Hispanics, Asians, and non-Hispanic Whites all report higher levels of worsening health over the past year (15–20%) as compared to ~13 percent among U.S.-born Whites and ~8 percent of U.S.-born Asian Americans.

Although reports of poor self-rated health are comparable for women and men, women consistently report a higher average number of days of poor physical and mental health than their male counterparts. However, there are clear racial/ethnic differences within genders, as foreign-born Mexican American and other Hispanic women report nearly 8 days of poor physical health and 4–5 days of poor mental health in the last month, compared to only 4–5 days of poor physical health and 2–3 days of poor mental health for Blacks and non-Hispanic Whites. Among men, Mexican Americans again have the highest average number of days of poor physical health in the last month (~6), while foreign-born Blacks and Whites have a significantly lower number of poor mental health days (<1) than their U.S.-born White counterparts (1.62). Racial/ethnic disparities in mental health are also wide. While approximately one-quarter of U.S.-born Black, Mexican American, Other Hispanic, Native American, and foreign-born non-Hispanic White women (and 18% of men) report two or more severe mental health symptoms, only 18 percent of U.S.-born non-Hispanic White and 10 percent of U.S.-born Asian women (and 13% and 10%, respectively, of men) report the same problems.

With respect to overall weight-related health status, Black and Mexican American women have much higher prevalence of obesity and at-risk waist circumference than non-Hispanic Whites, other Hispanics, and Asians. Approximately 40 percent of U.S.-born Black women are obese based on self-reported height and weight (and more than 50% based on measured

Suggested Citation:"2 Racial/Ethnic and Nativity Disparities in the Health of Older U.S. Men and Women - Robert A. Hummer and Iliya Gutin." National Academies of Sciences, Engineering, and Medicine. 2018. Future Directions for the Demography of Aging: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25064.
×

TABLE 2-1 Racial/Ethnic Composition and Socioeconomic Status among U.S. Adults, by Gender, Ages 65+ (NHIS 2000–2015)

N-H Black Mexican American
F-B US-B F-B US-B
FEMALE
Overall 0.01 0.08 0.02 0.02
Education
<HS 0.42 0.40 0.82 0.54
HS 0.29 0.29 0.10 0.28
Some College 0.15 0.19 0.05 0.13
College+ 0.13 0.12 0.02 0.05
Income-to-Needs Ratio
0–1.00 0.22 0.29 0.34 0.21
1.01–1.99 0.25 0.33 0.35 0.33
2.00–3.99 0.32 0.25 0.23 0.30
4.00+ 0.20 0.13 0.08 0.16
MALE
Overall 0.01 0.07 0.02 0.02
Education
<HS 0.33 0.44 0.83 0.47
HS 0.29 0.28 0.08 0.27
Some College 0.15 0.17 0.05 0.17
College+ 0.23 0.12 0.03 0.09
Income-to-Needs Ratio
0–1.00 0.22 0.18 0.33 0.14
1.01–1.99 0.25 0.32 0.36 0.33
2.00–3.99 0.30 0.31 0.23 0.33
4.00+ 0.23 0.19 0.08 0.20

NOTES: NHIS N(Overall) = 181,924; NHIS N(Female) = 102,971; NHIS N(Male) = 78,953. HS = high school completion, NH = non-Hispanic, PI = Pacific Islander, F-B = foreign born, US-B = U.S. born.

Percent/mean estimates based on nonmissing responses for given survey item or measure. Income-to-needs ratio of 1.00 represents income at the poverty line.

Suggested Citation:"2 Racial/Ethnic and Nativity Disparities in the Health of Older U.S. Men and Women - Robert A. Hummer and Iliya Gutin." National Academies of Sciences, Engineering, and Medicine. 2018. Future Directions for the Demography of Aging: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25064.
×
Other Hispanic N-H Asian/PI Native Amer. N-H White
F-B US-B F-B US-B US-B F-B US-B
0.03 0.01 0.03 0.01 0.00 0.05 0.75
ref.
0.53 0.36 0.37 0.13 0.43 0.26 0.19
0.23 0.33 0.24 0.39 0.26 0.31 0.39
0.12 0.20 0.11 0.26 0.23 0.23 0.24
0.12 0.11 0.28 0.22 0.08 0.20 0.17
0.30 0.16 0.21 0.05 0.30 0.14 0.09
0.31 0.34 0.23 0.19 0.31 0.25 0.26
0.24 0.30 0.26 0.35 0.26 0.32 0.36
0.14 0.20 0.30 0.40 0.13 0.29 0.29
0.03 0.01 0.03 0.01 0.00 0.04 0.78
ref.
0.48 0.29 0.21 0.12 0.39 0.23 0.19
0.23 0.27 0.20 0.30 0.28 0.23 0.30
0.12 0.23 0.13 0.26 0.21 0.18 0.22
0.16 0.21 0.45 0.32 0.12 0.36 0.28
0.25 0.10 0.18 0.03 0.17 0.11 0.05
0.33 0.26 0.23 0.14 0.37 0.22 0.19
0.26 0.35 0.26 0.34 0.27 0.31 0.38
0.15 0.30 0.33 0.48 0.20 0.36 0.38

All estimates age-standardized to 2000 U.S. Census and weighted based on NCHS-provided survey weights, to be representative of the U.S. population.

Bold indicates significantly different from U.S.-born non-Hispanic Whites at p<0.05.

Underline indicates significantly different from U.S.-born members of same racial/ethnic group at p<0.05.

Suggested Citation:"2 Racial/Ethnic and Nativity Disparities in the Health of Older U.S. Men and Women - Robert A. Hummer and Iliya Gutin." National Academies of Sciences, Engineering, and Medicine. 2018. Future Directions for the Demography of Aging: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25064.
×

TABLE 2-2 Global Health Indicators among U.S. Adults, Ages 65+ (NHIS 2000–2015, NHANES 1999–2015)

N-H Black Mexican American
F-B US-B F-B US-B
FEMALE
GLOBAL HEALTH
Fair/poor health 0.35 0.39 0.44 0.36
Health status worse compared to last year 0.17 0.13 0.18 0.14
N days physical health not good last month 3.44 5.65 7.78 5.29
N days mental health not good last month 2.65 3.32 5.49 4.52
Two+ severe mental health symptomsa 0.20 0.20 0.25 0.23
Obese (self-report)b 0.29 0.39 0.34 0.30
Obese (measured)b 0.52 0.50 0.43 0.32
Risky waist circum.c 0.87 0.80 0.78 0.76
MALE
GLOBAL HEALTH
Fair/poor health 0.32 0.38 0.42 0.33
Health status worse compared to last year 0.12 0.11 0.13 0.14
N days physical health not good last month 3.28 4.91 5.89 5.95
N days mental health not good last month 0.34 2.12 1.20 2.25
Two+ severe mental health symptomsa 0.15 0.16 0.18 0.18
Obese (self-report)b 0.17 0.25 0.25 0.27
Obese (measured)b 0.17 0.32 0.26 0.30
Risky waist circum.c 0.39 0.47 0.42 0.50

NOTES: NHIS N(Overall) = 181,924; NHANES N(Overall) = 11,173; NHIS N(Female) = 102,971; NHANES N(Female) = 5,734; NHIS N(Male) = 78,953; NHANES N(Male) = 5,439. HS = high school completion, N-H = non-Hispanic, PI = Pacific Islander, F-B = foreign born, US-B = U.S. born.

Percent/mean estimates based on nonmissing responses for given survey item or measure. All estimates weighted based on NCHS-derived weights, and age-standardized to 2000 U.S. Census.

Cells with <10 incidences excluded.

Suggested Citation:"2 Racial/Ethnic and Nativity Disparities in the Health of Older U.S. Men and Women - Robert A. Hummer and Iliya Gutin." National Academies of Sciences, Engineering, and Medicine. 2018. Future Directions for the Demography of Aging: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25064.
×
Other Hispanic N-H Asian/PI Native Amer. N-H White
F-B US-B F-B US-B US-B F-B US-B
ref.
0.39 0.32 0.32 0.18 0.37 0.25 0.22
0.17 0.15 0.19 0.10 0.19 0.16 0.13
7.63 4.06 — — — 5.00 5.07
4.88 2.79 — — — 2.24 3.39
0.27 0.21 0.18 0.10 0.27 0.21 0.18
0.25 0.28 0.08 0.13 0.33 0.21 0.23
0.33 0.24 — — — 0.26 0.32
0.76 0.67 — — — 0.69 0.73
ref.
0.35 0.31 0.29 0.22 0.37 0.25 0.23
0.16 0.14 0.18 0.08 0.18 0.15 0.12
5.12 1.74 — — — 3.64 4.18
2.09 2.78 — — — 0.71 1.62
0.18 0.18 0.11 0.10 0.21 0.17 0.13
0.22 0.23 0.05 0.12 0.31 0.20 0.23
0.25 — — — — 0.33 0.29
0.47 0.27 — — — 0.57 0.59

Bold indicates significantly different from U.S.-born non-Hispanic Whites at p<0.05.

Underline indicates significantly different from U.S.-born members of same racial/ethnic group at p<0.05.

a Severe mental health symptoms measured in NHIS include reports of feeling everything an effort; feelings interfering with life; hopelessness; nervousness; restlessness; sadness; and worthlessness sometimes or often in the past month.

b Obese defined as having body mass index ≥ 30.0.

c Risky waist circumference defined as ≥88 cm for women and ≥102 cm for men.

Suggested Citation:"2 Racial/Ethnic and Nativity Disparities in the Health of Older U.S. Men and Women - Robert A. Hummer and Iliya Gutin." National Academies of Sciences, Engineering, and Medicine. 2018. Future Directions for the Demography of Aging: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25064.
×

height and weight), while over 80 percent have a waist circumference considered “at risk” for poor health. These prevalence levels are the highest among the groups we examine, especially compared to Asian women (of whom ~11% are obese based on self-reports) and non-Hispanic White women (of whom 25–30% are obese based on both self-reports and measurements). As a group, older men have more favorable weight-related health than their female counterparts. Though non-Hispanic White men and women have similar obesity prevalence, approximately 25–30 percent of U.S.-born Black and Mexican American men are considered obese, based on self-reports and physical measurements, compared to 40–50 percent of their female counterparts. Men of any race/ethnicity also have a lower prevalence of risky waist circumference than women (~46% vs. 76%). Looking more closely, U.S.-born Black, Mexican American, and Native American men also have higher self-reported obesity than their non-Hispanic White counterparts; yet non-Hispanic White men have a 10–30 percent higher prevalence of risky waist circumference. Asian-American men have the lowest self-reported obesity (<15%), while foreign-born Blacks have the lowest measured obesity (17%).

Morbidity

Table 2-3 considers measures of morbidity among those aged 65 and older. Although non-Hispanic White adults show more favorable global health profiles than their minority counterparts, diagnoses of chronic conditions and diseases exhibit a much less consistent pattern of racial/ethnic disparities for both genders. For instance, hypertension is potentially under-diagnosed in this age group, as the combined undiagnosed or diagnosed/controlled rates observed in NHANES data are higher than the self-reports in NHIS (e.g., ~75% in NHANES compared to ~59% in NHIS for U.S.born non-Hispanic White women; ~67% compared to ~57% for U.S.-born non-Hispanic White men). Nevertheless, across both measures of hypertension, Black, Mexican American, Native American, and foreign-born other Hispanic and Asian women have higher rates than non-Hispanic White women. Though Black, foreign-born Asian, and Native American men also have higher rates compared to non-Hispanic White men, foreign-born Mexican American and other Hispanic men instead have lower self-reported hypertension (~50% compared to 57% among non-Hispanic Whites), and comparable rates of undiagnosed/diagnosed or controlled hypertension (~66% compared to 67% among non-Hispanic Whites).

Looking at other measures of cardiovascular health, U.S.-born Black women report among the highest prevalence of coronary heart disease, congestive heart failure, and stroke, with approximately 12 percent reporting a diagnosis of one or more of these conditions. However, for heart

Suggested Citation:"2 Racial/Ethnic and Nativity Disparities in the Health of Older U.S. Men and Women - Robert A. Hummer and Iliya Gutin." National Academies of Sciences, Engineering, and Medicine. 2018. Future Directions for the Demography of Aging: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25064.
×

attacks and any other heart condition, U.S.-born Whites report marginally higher rates than all other racial/ethnic/nativity groups (e.g., 17% report some other heart condition, compared to ~13% across other groups). This pattern holds for men as well, with significantly lower rates of reported coronary heart disease, congestive heart failure, other heart conditions, and heart attacks for Black, Mexican American, other Hispanic, Asian, and foreign-born non-Hispanic Whites relative to U.S.-born non-Hispanic Whites. Across both genders, foreign-born Blacks stand out as having a particularly low prevalence of heart problems, especially compared to their U.S.-born counterparts.

Also apparent is the lower prevalence of diabetes among non-Hispanic Whites compared to most other race/ethnic groups, regardless of nativity or gender. Black, Mexican American, and Native American women have the highest prevalence of reported diabetes (30–35%), followed closely by other Hispanic women (~24%) and foreign-born Asians (21%). Mexican American women also have the highest rates of diabetes based on diagnosis or measurement in NHANES (~55%), followed by U.S.-born Black women (52%). Older males exhibit a nearly identical racial/ethnic distribution of diabetes, though rates for all groups other than non-Hispanic Whites (with the exception of U.S.-born Asians) are closer in value, ranging from 25 percent for foreign-born Asians to 35 percent for U.S.-born Mexican Americans. However, when considering high blood glucose, these data show that U.S.-born Mexican American and foreign-born other Hispanic men have the highest rates of undiagnosed or diagnosed/controlled diabetes (61%), while prior racial/ethnic disparities on the basis of self-reported diabetes are less evident. Among the other common morbidities observed in this 65 and older age group, arthritis is significantly higher among U.S.born Black compared to U.S.-born non-Hispanic White women, while foreign-born Black and non-Hispanic White women report lower rates. Diagnoses of cancer are significantly higher among U.S.-born non-Hispanic White women (23%) and men (29%) compared to all other groups, with foreign-born Mexican American and Asian adults having the lowest rates (8% for women, 10% for men). Generally speaking, cancer rates are lower for women (14%) as compared to men (~17%), and foreign born (~13%) as compared to U.S. born (~18%). However, we caution that cancer is a condition especially prone to under-diagnosis on the basis of racial/ethnic, nativity, and socioeconomic inequities in access to care (Ward et al., 2004).

Finally, across all four measures of pain (joints, lower back, neck, and severe migraines) and all racial/ethnic groups, women consistently report greater pain than their male counterparts. Among women, Native Americans stand out as having the highest reports of pain for three of the four measures, while U.S.-born Asians have the lowest reports in three of the four measures, as well. Older men show slightly different patterns of

Suggested Citation:"2 Racial/Ethnic and Nativity Disparities in the Health of Older U.S. Men and Women - Robert A. Hummer and Iliya Gutin." National Academies of Sciences, Engineering, and Medicine. 2018. Future Directions for the Demography of Aging: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25064.
×

TABLE 2-3 Measurements of Morbidity among U.S. Adults, Ages 65+ (NHIS 2000-2015; NHANES 1999–2014)

N-H Black Mexican American
F-B US-B F-B US-B
FEMALE
MORBIDITY
Told you had:
Coronary heart disease 0.09 0.14 0.15 0.17
Congestive heart failure 0.02 0.07 0.05 0.09
Heart condition 0.09 0.14 0.11 0.12
Heart attack 0.07 0.12 0.09 0.13
Stroke 0.08 0.12 0.08 0.11
Arthritis 0.27 0.45 0.34 0.42
Hypertension 0.70 0.71 0.48 0.60
Diabetes + taking medication 0.33 0.28 0.28 0.36
Undiagnosed or Diagnosed/Controlleda
Hypertensionb 0.75 0.82 0.63 0.69
Diabetesc 0.54 0.53 0.55 0.61
Experienced:
Pain/aching joints, past mo. 0.46 0.45 0.39 0.41
Lower back pain, past 3 mo. 0.31 0.25 0.27 0.27
Neck pain, past 3 mo. 0.10 0.12 0.16 0.15
Severe migraine, past 3 mo. 0.08 0.06 0.06 0.05
MALE
MORBIDITY
Told you had:
Coronary heart disease 0.09 0.14 0.15 0.17
Congestive heart failure 0.02 0.07 0.05 0.09
Heart condition 0.09 0.14 0.11 0.12
Heart attack 0.07 0.12 0.09 0.13
Stroke 0.08 0.12 0.08 0.11
Arthritis 0.27 0.45 0.34 0.42
Hypertension 0.70 0.71 0.48 0.60
Diabetes + taking medication 0.33 0.28 0.28 0.36
Undiagnosed or Diagnosed/Controlleda
Hypertensionb 0.75 0.82 0.63 0.69
Diabetesc 0.54 0.53 0.55 0.61
Experienced:
Pain/aching joints, past mo. 0.46 0.45 0.39 0.41
Lower back pain, past 3 mo. 0.31 0.25 0.27 0.27
Neck pain, past 3 mo. 0.10 0.12 0.16 0.15
Severe migraine, past 3 mo. 0.08 0.06 0.06 0.05

NOTES: NHIS N(Overall) = 181,924; NHANES N(Overall) = 11,173; NHIS N(Female) = 102,971; NHANES N(Female) = 5,734; NHIS N(Male) = 78,953; NHANES N(Male) = 5,439. HS = high school completion, N-H = non-Hispanic, PI = Pacific Islander, F-B = foreign born, US-B = U.S. born.

Percent/mean estimates based on nonmissing responses for given survey item or measure.

All estimates weighted based on NCHS-derived weights, and age-standardized to 2000 U.S. Census.

Cells with <10 incidences excluded.

Bold indicates significantly different from U.S.-born non-Hispanic Whites at p<0.05.

Suggested Citation:"2 Racial/Ethnic and Nativity Disparities in the Health of Older U.S. Men and Women - Robert A. Hummer and Iliya Gutin." National Academies of Sciences, Engineering, and Medicine. 2018. Future Directions for the Demography of Aging: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25064.
×
Other Hispanic N-H Asian/PI Native Amer. N-H White
F-B US-B F-B US-B US-B F-B US-B
ref.
0.15 0.21 0.15 0.20 0.21 0.21 0.22
0.08 0.05 — — — 0.04 0.11
0.11 0.19 0.14 0.18 0.17 0.19 0.21
0.13 0.16 0.10 0.11 0.15 0.13 0.17
0.09 0.10 0.10 0.09 0.13 0.09 0.09
0.34 0.21 — — — 0.30 0.46
0.53 0.60 0.61 0.60 0.65 0.51 0.57
0.28 0.33 0.27 0.21 0.34 0.20 0.20
0.69 0.60 — — — 0.72 0.67
0.61 0.52 — — — 0.48 0.51
0.34 0.52 0.28 0.35 0.54 0.37 0.46
0.30 0.29 0.19 0.22 0.33 0.27 0.29
0.19 0.19 0.09 0.06 0.16 0.12 0.13
0.06 0.06 0.04 0.01 0.05 0.05 0.04
ref.
0.15 0.21 0.15 0.20 0.21 0.21 0.22
0.08 0.05 — — — 0.04 0.11
0.11 0.19 0.14 0.18 0.17 0.19 0.21
0.13 0.16 0.10 0.11 0.15 0.13 0.17
0.09 0.10 0.10 0.09 0.13 0.09 0.09
0.34 0.21 — — — 0.30 0.46
0.53 0.60 0.61 0.60 0.65 0.51 0.57
0.28 0.33 0.27 0.21 0.34 0.20 0.20
0.69 0.60 — — — 0.72 0.67
0.61 0.52 — — — 0.48 0.51
0.34 0.52 0.28 0.35 0.54 0.37 0.46
0.30 0.29 0.19 0.22 0.33 0.27 0.29
0.19 0.19 0.09 0.06 0.16 0.12 0.13
0.06 0.06 0.04 0.01 0.05 0.05 0.04

Underline indicates significantly different from U.S.-born members of same racial/ethnic group at p<0.05.

a Controlled is defined as those individuals taking a medication, which accounts for a small percentage of adults who do not report hypertension and/or diabetes despite taking medication. Uncontrolled includes adults having either diagnosed or undiagnosed (on the basis of NHANES measures) hypertension and/or diabetes.

b Hypertension is defined as >140 mmHg for systolic BP OR >90 mmHg for diastolic.

c High blood glucose is defined as >100 mg/dL for blood glucose.

Suggested Citation:"2 Racial/Ethnic and Nativity Disparities in the Health of Older U.S. Men and Women - Robert A. Hummer and Iliya Gutin." National Academies of Sciences, Engineering, and Medicine. 2018. Future Directions for the Demography of Aging: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25064.
×

racial/ethnic variation in pain-related morbidity. Although Asian Americans report the lowest pain, no single racial/ethnic group emerges as consistently reporting the highest level.

Functioning and Disability

Table 2-4 turns to functioning and disability. Across all 15 measures, one can see the extent to which older Black, Mexican American, other Hispanic, and Native American adults experience significantly higher rates of functional, physical, and cognitive limitations as compared to non-Hispanic Whites, while Asian adults consistently exhibit the lowest rates. These racial/ethnic patterns are similar for both women and men, though women have a higher prevalence of functional limitations and disability, on average. Intriguingly, this racial/ethnic pattern of functional limitations would not be apparent solely based on adults reporting “any functional limitation.” Across all groups, an average of 67 percent of women report any functional limitation, with U.S.-born Blacks and Native Americans having the highest rates (~75%) and Asians and foreign-born non-Hispanic Whites reporting the lowest (~60%). By comparison, ~57 percent of older men report having any functional limitation, with Native Americans having a far higher prevalence than any other group (72%) and Asians and foreign-born other Hispanics and non-Hispanic Whites experiencing significantly lower rates (~50%) than their U.S.-born non-Hispanic White counterparts (60%). However, when focusing on the more detailed assessments of functioning and disability, one observes clearer racial/ethnic gradients for both genders. For instance, U.S.-born Blacks, foreign-born Mexican Americans, and Other Hispanics are significantly more likely than U.S.-born non-Hispanic Whites to report limitations keeping them from working and/or impeding the amount of work they could do or report that they experienced confusion/memory problems. This was especially true of foreign-born Mexican Americans who, unlike their U.S.-born counterparts, reported ~10–20 percent higher rates across all three types of functional limitations.

Though functional limitations primarily relate to mental and cognitive health, we also observe many of the aforementioned patterns across multiple measures of disability. Approximately 13 percent of Native American, U.S.-born Black, and foreign-born Mexican American, other Hispanic, Asian, and non-Hispanic White women report 8 or more days of disability requiring bed rest in the past year; this is significantly higher than the 10 percent among U.S.-born non-Hispanic Whites. Based on NHIS estimates, U.S.-born Blacks, Mexican Americans, and Native Americans have the highest rates of any activity limitation (~42%), while foreign-born non-Hispanic Whites and Asians of any nativity report significantly lower rates (~28%), compared to ~34 percent of U.S.-born non-Hispanic

Suggested Citation:"2 Racial/Ethnic and Nativity Disparities in the Health of Older U.S. Men and Women - Robert A. Hummer and Iliya Gutin." National Academies of Sciences, Engineering, and Medicine. 2018. Future Directions for the Demography of Aging: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25064.
×

Whites. NHANES-based estimates of activity limitations are higher than those obtained from NHIS, yet we observe a similar pattern of disparities. Once again, a more fine-grained analysis of activity limitations helps to reveal the full extent of racial/ethnic differences in disability among older adults. Among individuals reporting 10 or more activity limitations, we continue to observe higher rates for U.S.-born Black, Mexican American, and other Hispanic women (~29%) compared to non-Hispanic White women (~17%), and higher rates for U.S.-born Black (15%) and foreign-born Mexican American (21%) men compared to U.S.-born non-Hispanic White men (12%).

Further subclassifying activity limitations based on physical or psychosocial health, older U.S.-born non-Hispanic White adults experience lower rates of disability than all other racial/ethnic groups (with the exception of U.S.-born Asians). Only ~6 percent of U.S.-born non-Hispanic White and Asian women and men report any activity of daily living limitations, compared to ~12 percent of women and ~8 percent of men across all other racial/ethnic groups. Similarly, ~12 percent of U.S.-born non-Hispanic White and Asian women and ~8 percent of men report any instrumental activity of daily living limitations, compared to ~19 percent of women and ~12 percent of men for all other racial/ethnic groups. These same patterns are replicated across measures of disability relating to limitations in leisure and social activities and general physical activities. Though women report higher average rates than men, for both genders U.S.-born Blacks and Mexican Americans (of any nativity) stand out as having the highest rates on these measures. That said, one can clearly see the critical role of nativity as a source of disparity in functional limitations and disability-related health among Mexican American and Asian women, as foreign-born adults have significantly worse health than their U.S.-born counterparts on nearly every measure.

Health Care

Given the importance of health care access and utilization as critical determinants of health among older adults, it is not surprising to find that many of the previously noted racial/ethnic patterns are reflected in health care measures as well (Table 2-5). Though the proportion of older adults reporting having no health insurance is low (owing to Medicare), Black, Mexican American, other Hispanic, Native American, and foreign-born Asian and non-Hispanic White men and women are significantly more likely to report not having health insurance compared to their U.S.-born non-Hispanic White counterparts. Nativity is particularly important, as foreign-born adults report the highest rates, especially Mexican American women (12%) and men (10%).

Suggested Citation:"2 Racial/Ethnic and Nativity Disparities in the Health of Older U.S. Men and Women - Robert A. Hummer and Iliya Gutin." National Academies of Sciences, Engineering, and Medicine. 2018. Future Directions for the Demography of Aging: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25064.
×

TABLE 2-4 Measures of Functioning and Disability among U.S. Adults, Ages 65+ (NHIS 2000–2015; NHANES 1999–2014)

N-H Black Mexican American
F-B US-B F-B US-B
FEMALE
FUNCTIONING
Any functional limitation 0.64 0.72 0.70 0.70
Limitations keep you from working 0.15 0.24 0.39 0.21
Limited in amount of work you can do 0.24 0.42 0.47 0.36
Experience confusion/memory problems 0.14 0.20 0.34 0.18
DISABILITY
Bed disabled 8+ days last year 0.10 0.12 0.13 0.10
Has any activity limitation (NHIS) 0.34 0.47 0.41 0.40
Has any activity limitation (NHANES) 0.72 0.78 0.87 0.76
N of activity limitations 4.86 5.68 6.70 5.30
Has 10+ activity limitations 0.21 0.26 0.35 0.24
Help w/ ADLs (NHIS)a 0.11 0.13 0.15 0.12
Any ADL limit (NHANES) 0.25 0.36 0.47 0.33
Help w/ IADLs (NHIS)b 0.17 0.22 0.21 0.19
Any IADL limit (NHANES) 0.37 0.46 0.56 0.41
Any limitation in leisure and social activitiesc 0.27 0.39 0.49 0.40
Any limitation in general physical activitiesd 0.61 0.75 0.82 0.69
MALE
FUNCTIONING
Any functional limitation 0.54 0.60 0.59 0.56
Limitations keep you from working 0.18 0.22 0.35 0.26
Limited in amount of work you can do 0.41 0.41 0.44 0.42
Experience confusion/memory problems 0.12 0.13 0.23 0.18
DISABILITY
Bed disabled 8+ days last year 0.09 0.10 0.09 0.10
Has any activity limitation (NHIS) 0.31 0.40 0.35 0.35
Has any activity limitation (NHANES) 0.61 0.64 0.72 0.72
N of activity limitations 2.96 3.94 4.77 4.27
Has 10+ activity limitations 0.11 0.15 0.21 0.15
Help w/ ADLs (NHIS)a 0.08 0.08 0.08 0.08
Any ADL limit (NHANES) 0.16 0.24 0.31 0.27
Help w/ IADLs (NHIS)b 0.09 0.14 0.13 0.11
Any IADL limit (NHANES) 0.33 0.37 0.40 0.42
Any limitation in leisure and social activitiesc 0.18 0.26 0.39 0.27
Any limitation in general physical activitiesd 0.57 0.58 0.59 0.64

NOTES: NHIS N(Overall) = 181,924; NHANES N(Overall) = 11,173; NHIS N(Female) = 102,971; NHANES N(Female) = 5,734; NHIS N(Male) = 78,953; NHANES N(Male) = 5,439. HS = high school completion, N-H = non-Hispanic, PI = Pacific Islander, F-B = foreign born, US-B = U.S. born.

Percent/mean estimates based on nonmissing responses for given survey item or measure.

All estimates weighted based on NCHS-derived weights, and age-standardized to 2000 U.S. Census.

Cells with <10 incidences excluded.

Bold indicates significantly different from U.S.-born non-Hispanic Whites at p<0.05.

Underline indicates significantly different from U.S.-born members of same racial/ethnic group at p<0.05.

Suggested Citation:"2 Racial/Ethnic and Nativity Disparities in the Health of Older U.S. Men and Women - Robert A. Hummer and Iliya Gutin." National Academies of Sciences, Engineering, and Medicine. 2018. Future Directions for the Demography of Aging: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25064.
×
Other Hispanic N-H Asian/PI Native Amer. N-H White
F-B US-B F-B US-B US-B F-B US-B
ref.
0.66 0.68 0.63 0.54 0.79 0.62 0.69
0.26 0.35 — — — 0.16 0.17
0.42 0.51 — — — 0.36 0.39
0.22 0.30 — — — 0.15 0.14
0.14 0.11 0.12 0.05 0.16 0.12 0.10
0.35 0.41 0.33 0.24 0.53 0.32 0.35
0.69 0.81 — — — 0.65 0.75
5.18 6.62 — — — 4.13 4.40
0.25 0.34 — — — 0.18 0.16
0.12 0.10 0.12 0.05 0.13 0.08 0.06
0.34 0.41 — — — 0.26 0.25
0.17 0.18 0.17 0.10 0.25 0.15 0.14
0.42 0.50 — — — 0.37 0.37
0.34 0.45 — — — 0.25 0.27
0.34 0.73 — — — 0.59 0.72
ref.
0.51 0.65 0.48 0.49 0.72 0.52 0.60
0.24 0.31 — — — 0.15 0.16
0.40 0.50 — — — 0.31 0.37
0.19 — — — — 0.19 0.12
0.09 0.10 0.09 0.06 0.13 0.11 0.09
0.28 0.37 0.28 0.25 0.49 0.29 0.33
0.62 0.69 — — — 0.57 0.63
3.86 3.96 — — — 3.74 3.33
0.17 — — — — 0.16 0.12
0.09 0.08 0.08 0.06 0.10 0.08 0.05
0.29 — — — — 0.29 0.22
0.11 0.11 0.12 0.07 0.16 0.11 0.08
0.33 0.43 — — — 0.33 0.30
0.22 0.28 — — — 0.26 0.21
0.58 0.67 — — — 0.48 0.57

a ADLs: dressing oneself, eating and drinking, walking between rooms, getting in and out of bed.

b IADLs: managing money/finances; performing household chores; preparing meals.

c Leisure and social activities: going out for events/activities; attending social gatherings; performing leisure activities at home.

d General physical activities: pushing and pulling large objects; grasping/holding small objects; standing or sitting for long periods; reaching up over head; stooping, crouching, and kneeling; lifting or carrying; standing from an armless chair.

Suggested Citation:"2 Racial/Ethnic and Nativity Disparities in the Health of Older U.S. Men and Women - Robert A. Hummer and Iliya Gutin." National Academies of Sciences, Engineering, and Medicine. 2018. Future Directions for the Demography of Aging: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25064.
×

TABLE 2-5 Measures of Health Care Use and Access among U.S. Adults, Ages 65+ (NHIS 2000–2015)

N-H Black Mexican American
F-B US-B F-B US-B
FEMALE
HEALTH CARE
Uninsured 0.09 0.01 0.12 0.01
During last year:
Medical care delayed due to cost 0.06 0.06 0.07 0.06
Couldn’t afford medical care 0.05 0.05 0.06 0.04
Had 10+ care visits 0.18 0.23 0.23 0.20
In hospital overnight 0.18 0.19 0.16 0.16
MALE
HEALTH CARE
Uninsured 0.05 0.01 0.10 0.01
During last year:
Medical care delayed due to cost 0.07 0.04 0.06 0.04
Couldn’t afford medical care 0.06 0.04 0.04 0.03
Had 10+ care visits 0.17 0.21 0.19 0.19
In hospital overnight 0.17 0.19 0.15 0.17

NOTES: NHIS N(Overall) = 181,924; NHANES N(Overall) = 11,173; NHIS N(Female) = 102,971; NHANES N(Female) = 5,734; NHIS N(Male) = 78,953; NHANES N(Male) = 5,439. HS = high school completion, N-H = non-Hispanic, PI = Pacific Islander, F-B = foreign born, US-B = U.S. born.

Percent/mean estimates based on nonmissing responses for given survey item or measure. All estimates weighted based on NCHS-derived weights, and age-standardized to 2000 U.S. Census.

Suggested Citation:"2 Racial/Ethnic and Nativity Disparities in the Health of Older U.S. Men and Women - Robert A. Hummer and Iliya Gutin." National Academies of Sciences, Engineering, and Medicine. 2018. Future Directions for the Demography of Aging: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25064.
×
Other Hispanic N-H Asian/PI Native Amer. N-H White
F-B US-B F-B US-B US-B F-B US-B
ref.
0.05 0.01 0.04 0.00 0.03 0.02 0.00
0.05 0.06 0.03 0.02 0.07 0.04 0.04
0.03 0.04 0.02 0.01 0.05 0.03 0.02
0.23 0.19 0.19 0.15 0.29 0.19 0.20
0.16 0.16 0.11 0.11 0.23 0.15 0.17
ref.
0.03 0.01 0.04 0.00 0.04 0.02 0.00
0.04 0.04 0.03 0.02 0.07 0.04 0.03
0.03 0.03 0.02 0.01 0.06 0.03 0.02
0.20 0.20 0.16 0.15 0.23 0.20 0.20
0.16 0.19 0.12 0.11 0.19 0.16 0.18

Cells with <10 incidences excluded.

Bold indicates significantly different from U.S.-born non-Hispanic Whites at p<0.05.

Underline indicates significantly different from U.S.-born members of same racial/ethnic group at p<0.05.

Suggested Citation:"2 Racial/Ethnic and Nativity Disparities in the Health of Older U.S. Men and Women - Robert A. Hummer and Iliya Gutin." National Academies of Sciences, Engineering, and Medicine. 2018. Future Directions for the Demography of Aging: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25064.
×

These patterns are similar with respect to health care during the last year. U.S.-born Black, foreign-born Mexican American and other Hispanic, and Native American women are more likely to report delaying medical care due to cost or not being able to afford medical care than are their U.S.born non-Hispanic White and Asian counterparts. These racial/ethnic and nativity patterns are true of older men as well, with the addition of foreign-born Black, U.S.-born Mexican American, and foreign-born non-Hispanic White men also reporting more difficulties in receiving care than U.S.-born non-Hispanic White and Asian men. At the same time, non-Hispanic White and Asian women are less likely to have 10 or more health care visits in the last year (~17%), compared to U.S.-born Blacks, Native Americans, and foreign-born Mexican Americans and Other Hispanics (~24%). Similarly, U.S.-born Black and Native American women have the highest rate of overnight hospital stays (not related to surgery) at ~20 percent, while Asian women have the lowest at 11 percent. Asian American men also have the lowest rates of frequent care visits and overnight hospital stays compared to other groups.

Mortality

Table 2-6 highlights racial/ethnic and nativity differences in mortality among older adults. U.S.-born Blacks and Native Americans have higher all-cause mortality rates than do U.S.-born non-Hispanic Whites and other minority groups, while foreign-born non-Hispanic Whites and Asians have the lowest rates. These all-cause racial/ethnic patterns are replicated in the case of diseases of the heart, cancer, and mortality from all other causes. Cancer and all-other-cause mortality rates are particularly high among Native American men. Nativity is crucial in shaping mortality among older adults; foreign-born groups have lower all-cause and cause-specific mortality rates than do U.S.-born groups, across both genders (with the exception of Asian women).

Though many of the detailed causes of death have cell counts for specific groups that are too small to report reliably estimated rates, we note racial/ethnic variation across a number of cause-specific categories. Chronic lower respiratory disease is the only cause for which U.S.-born non-Hispanic White adults have higher mortality relative to U.S.-born Blacks, Mexican Americans, and foreign-born Hispanics and non-Hispanic Whites. Conversely, diabetes mortality is highest for those groups, and lowest among U.S.-born non-Hispanic White women (while second lowest among U.S.-born non-Hispanic White men). Cerebrovascular disease mortality is especially high among U.S.-born Black women and men, as is kidney-related disease, when compared to the other groups.

Suggested Citation:"2 Racial/Ethnic and Nativity Disparities in the Health of Older U.S. Men and Women - Robert A. Hummer and Iliya Gutin." National Academies of Sciences, Engineering, and Medicine. 2018. Future Directions for the Demography of Aging: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25064.
×

Racial/Ethnic Health Disparities among Middle-Aged Adults

Our main results above focused on racial/ethnic disparities among older U.S. adults. In this section, we briefly discuss disparities among middle-aged adults. Given the rapidly changing demographic composition of the United States, a multidimensional perspective on the health of younger adults provides valuable insight on the future of health disparities among rising cohorts of aging Americans. In a series of supplementary analyses, we examined racial/ethnic disparities in the same measures of health among adults aged 45–64 (tables available from the authors by request).

Though there is considerable and predictable age-based variation in the prevalence of certain health measures and conditions, our results nevertheless demonstrate that the above-described racial/ethnic health disparities in older adult health are largely evident among middle-aged adults as well. For example, though middle-aged adults report 20–30 percent less poor/fair health than older adults, Blacks, Mexican Americans, other Hispanics, and Native Americans report significantly higher levels than their non-Hispanic White counterparts. They are also more likely to indicate a recent decline in health and more days of poor health. Meanwhile, Asian adults and foreign-born non-Hispanic Whites continue to have the lowest rates of poor/fair or worsening health. In contrast to self-rated health, this younger age group has a 5–20 percent higher prevalence of obesity and risky waist circumference across all groups compared with older adults, with women continuing to have worse weight-related health than men. Black, Mexican American, and Native American women have the highest rates of self-reported and measured obesity (~40–60%) and risky waist circumference (~70–90%), while Asians have the lowest obesity rate among all groups at ~10–20 percent. In general, foreign-born men have the lowest rates of self-reported or measured obesity.

With respect to morbidity, though prevalence for most conditions and diseases is far lower than older adults, there is a remarkable degree of consistency in group differences when compared to their older counterparts. Self-reported hypertension follows similar racial/ethnic patterns for this age group as among older adults, with Black, Mexican American, and Native American women reporting the highest rates (37–55%). For both genders, foreign-born Asians and non-Hispanic Whites continue to have the lowest reports of hypertension. U.S.-born Black and Native American women have the highest reported diagnoses of heart-related conditions, while foreign-born Asian adults exhibit the best overall indicators of positive heart health. Foreign-born Black, Mexican American, other Hispanic, and non-Hispanic White men also compare favorably on these measures against U.S.-born non-Hispanic White men. Diabetes continues to be higher for non-White and Hispanic compared to non-Hispanic White adults, with

Suggested Citation:"2 Racial/Ethnic and Nativity Disparities in the Health of Older U.S. Men and Women - Robert A. Hummer and Iliya Gutin." National Academies of Sciences, Engineering, and Medicine. 2018. Future Directions for the Demography of Aging: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25064.
×

TABLE 2-6 Mortality among U.S. Adults, Ages 65+ (NHIS 2000–2015)

N-H Black Mexican American
F-B US-B F-B US-B
FEMALE
MORTALITY (rate per 100,000 person-years)
All-cause 2410 4341 2898 3262
Disease of heart 399 964 514 573
Malignant neoplasms 643 910 476 530
Chronic lower respiratory diseases — 139 126 115
Cerebrovascular diseases — 323 177 242
Alzheimer’s disease — 146 — 233
Diabetes mellitus — 232 208 244
Influenza/pneumonia — 122 — —
Kidney-related diseases — 143 105 105
Accidents — 40 — 86
All other causes 627 1298 1009 1046
MALE
MORTALITY (rate per 100,000 person-years)
All-cause 3883 5924 3592 4484
Disease of heart 947 1289 784 866
Malignant neoplasms 1030 1635 856 1047
Chronic lower respiratory diseases — 275 116 254
Cerebrovascular diseases — 296 298 216
Alzheimer’s disease — 120 — 132
Diabetes mellitus — 198 256 —
Influenza/pneumonia — 129 — 124
Kidney-related diseases — 213 107 166
Accidents — 105 105 —
All other causes 855 1636 845 1280

NOTES: NHIS N(Overall) = 181,924; NHANES N(Overall) = 11,173; NHIS N(Female) = 102,971; NHANES N(Female) = 5,734; NHIS N(Male) = 78,953; NHANES N(Male) = 5,439. HS = high school completion, N-H = non-Hispanic, PI = Pacific Islander, F-B = foreign born, US-B = U.S. born.

Public use NHIS data up to 2009 are linked to National Death Index records through December 31, 2011.

Percent/mean estimates based on nonmissing responses for given survey item or measure.

Suggested Citation:"2 Racial/Ethnic and Nativity Disparities in the Health of Older U.S. Men and Women - Robert A. Hummer and Iliya Gutin." National Academies of Sciences, Engineering, and Medicine. 2018. Future Directions for the Demography of Aging: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25064.
×
Other Hispanic N-H Asian/PI Native Amer. N-H White
F-B US-B F-B US-B US-B F-B US-B
ref.
2407 2936 2334 1871 4533 2586 3568
536 676 352 460 627 503 639
580 624 603 274 — 601 787
85 — — 77 — 160 279
164 — 303 — — 206 246
80 — — — — — 148
127 — 139 — — — 92
— — — — — — 90
77 — — — — — 76
— — — — — 80 78
672 1047 575 603 1520 785 1121
ref.
4259 4662 3097 3295 6470 3674 5308
1167 847 549 576 — 828 1147
958 1315 883 790 1748 1068 1321
153 — 151 — — 79 418
266 — 389 — — 208 277
— — — — — 149 133
208 — — — — 68 151
110 — — — — — 116
82 — — — — — 121
77 — — — — — 121
1085 1210 759 868 1709 1056 1488

All estimates weighted based on NCHS-derived weights, and age-standardized to 2000 U.S. Census.

Cells with <10 incidences excluded.

Bold indicates significantly different from U.S.-born non-Hispanic Whites at p<0.05.

Underline indicates significantly different from U.S.-born members of same racial/ethnic group at p<0.05.

Suggested Citation:"2 Racial/Ethnic and Nativity Disparities in the Health of Older U.S. Men and Women - Robert A. Hummer and Iliya Gutin." National Academies of Sciences, Engineering, and Medicine. 2018. Future Directions for the Demography of Aging: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25064.
×

Native American adults having the highest self-reported rates and Mexican Americans having among the highest measured or diagnosed rates. The most significant age differences are related to pain. Among middle-aged adults, reported pain is lower on average, and the gender gap among older adults is largely absent. For both genders, Native Americans report the most pain across all indicators, while Asians and foreign-born Blacks and non-Hispanic Whites report the least. Overall, middle-aged U.S.-born non-Hispanic White adults report higher levels of pain compared to all other groups except Native Americans, consistent with recent studies (Case and Deaton, 2015).

Compared to measures of global health and morbidity, functional limitations and disability are much less frequent among middle-aged adults. Nonetheless, again, many of the same racial/ethnic patterns noted for older adults are observed. U.S.-born Blacks have worse functioning- and disability-related health than their Asian and non-Hispanic White counterparts. As with older adults, Mexican Americans, other Hispanics, and U.S.born Blacks have a greater prevalence of severe mental health symptoms compared to U.S.-born non-Hispanic Whites. However, nativity is particularly important in shaping racial/ethnic group differences: foreign-born Blacks, Mexican Americans, other Hispanics, and non-Hispanic Whites consistently exhibit more favorable functional health and disability rates than their U.S.-born racial/ethnic counterparts and, in some cases, than U.S.-born non-Hispanic Whites.

U.S.-born non-Hispanic White and Asian men and women also continue to report greater health care access and utilization than their racial/ethnic counterparts. Although more adults in this age range report not having health insurance (~20% across all groups), foreign-born Mexican Americans still have the highest rates (~44%) and U.S.-born Asians have the lowest (~6%), compared to ~10 percent for U.S.-born Whites. These middle-aged adults also report more issues with the cost or affordability of medical care in the last year, especially among U.S.-born Black, Mexican American, other Hispanic, and Native American women. Overall, foreign-born adults have the lowest levels of interaction with the health care system in this age range.

Finally, patterns of racial/ethnic disparities in mortality at these ages are entirely consistent with those among older adults. All-cause mortality is highest for U.S.-born Blacks and Native Americans among both genders. U.S.-born Asians have among the lowest mortality rates; foreign-born other Hispanic and non-Hispanic White adults have similarly low levels of mortality. Nativity remains a key stratifying variable, as mortality among foreign-born groups is lower than among their U.S.-born counterparts in every group. U.S.-born Black women have high rates of mortality due to diseases of the heart, cancer, and the all-other-causes category, while U.S.-

Suggested Citation:"2 Racial/Ethnic and Nativity Disparities in the Health of Older U.S. Men and Women - Robert A. Hummer and Iliya Gutin." National Academies of Sciences, Engineering, and Medicine. 2018. Future Directions for the Demography of Aging: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25064.
×

born Black men also have high rates of mortality from these causes, close to the rates observed among Native American men.

SUMMARY AND DISCUSSION

Summary of Disparities

Our results reveal five overarching patterns that best describe current racial/ethnic health disparities among older Americans. First, Asian American men and women, especially the U.S. born, consistently have the most favorable health profiles. Both U.S.- and foreign-born non-Hispanic White adults are comparable to Asians on some but not all measures of health; most important, U.S.-born Whites exhibit higher rates of obesity and smoking, a greater prevalence of heart-related conditions, and higher mortality rates than Asians. Second, there is a substantial gap in overall population health between, on the one hand, Asian Americans and non-Hispanic Whites, who exhibit the healthiest overall profiles in the country, and Blacks, Mexican Americans, and other Hispanics, who exhibit the least healthy overall profiles. Though the latter three groups are similar on a number of measures (e.g., self-rated health, heart-related morbidities, functioning and disability, health care access/use), U.S.-born Black adults typically report the poorest overall, physical, and mental health and well-being. By contrast, there are measures on which foreign-born Blacks compare favorably to their non-Hispanic White and Asian-American peers (e.g., low rates of obesity and smoking). Third, Native American older adults exhibit the worst overall health profile. For the majority of available measures, their rates of poor health are far higher than the elevated rates among U.S.-born Black adults. Fourth, we find that the above-described racial/ethnic disparities are typically more pronounced among women than men. For instance, a number of indicators of poor health—obesity, risky waist circumference, hypertension, pain, and most measures of impaired functioning and disability—exhibit similar patterns of racial/ethnic disparities by gender, but the disparities tend to be greater among women. Finally, nativity is an important moderator of racial/ethnic disparities in health, with the direction of its influence varying across groups. Foreign-born non-Hispanic White adults are typically healthier than their U.S.-born counterparts, although the former report higher rates of poor/fair health. Similarly, foreign-born Blacks often have better health than their U.S.-born Black counterparts, and in many cases better health than U.S.-born non-Hispanic Whites. Conversely, foreign-born Asian Americans tend to fare worse than their U.S.-born counterparts, though most of the disparities are small. Similarly, foreign-born Mexican Americans have worse functioning, disability-related health, and subjective health than U.S.-born Mexican

Suggested Citation:"2 Racial/Ethnic and Nativity Disparities in the Health of Older U.S. Men and Women - Robert A. Hummer and Iliya Gutin." National Academies of Sciences, Engineering, and Medicine. 2018. Future Directions for the Demography of Aging: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25064.
×

Americans, while only the latter is true among other Hispanics. Yet foreign-born members of both groups have lower mortality compared to U.S.-born adults. Notably, there is no uniform pattern of healthy immigrants relative to the U.S. born across racial/ethnic groups.

Clearly, these racial/ethnic disparities are vital to understanding overall population health in the United States. Yet, consistent with our objective of providing a comprehensive and multidimensional portrait of older adult health, we find that a narrow focus on specific health disparities is equally warranted, as reflected in the unique patterns observed for particular measures of health. For example, the subjective health of groups other than non-Hispanic Whites, with the exception of Asian Americans, is far worse in terms of physical, mental, and overall well-being than their U.S.-born non-Hispanic White counterparts (and for foreign-born adults relative to their U.S.-born co-racial/ethnic group members). Women generally fare worse than men, and foreign-born Mexican American women consistently have the worst subjective health across all groups. Weight-related health risk is also particularly high among Black women, especially compared to men. Only Native American men consistently exhibit poor health across all global health indicators.

Morbidity patterns are also nuanced. U.S.-born Black, Mexican American, and other Hispanics typically have higher levels of diabetes and hypertension, yet lower or similar rates of diagnosed cardiovascular conditions when compared to non-Hispanic Whites; this is perhaps attributable to racial/ethnic disparities in health care access. Nativity is particularly salient in comparing reports of diagnosed conditions, as foreign-born adults exhibit lower disease prevalence than their U.S.-born counterparts (especially among Black adults); again, access to health care may be playing a role. Native Americans again emerge as a group with consistently elevated disease prevalence. Pain, while on the rise among non-Hispanic White adults (Case and Deaton, 2015), is highest among foreign-born Mexican Americans and other Hispanics and among Native Americans, especially women.

Relatedly, functioning and disability represent other dimensions of health in which groups other than non-Hispanic Whites (with the exception of Asians) fare worse, as is especially evident for U.S.-born Blacks and foreign-born Mexican Americans. Older adults other than Asians and non-Hispanic Whites have much higher rates of physical and mental disability and impaired functioning, even at younger ages where these conditions are far less prevalent. Nativity is once again critical as, with the exception of Mexican Americans, U.S.-born adults often fare worse than their foreign-born counterparts. Yet again, Native American men and women exhibit the least favorable patterns of functional health, consistently reporting the highest rates among all groups of impaired functioning, poor mental health, and everyday disabilities or limitations.

Suggested Citation:"2 Racial/Ethnic and Nativity Disparities in the Health of Older U.S. Men and Women - Robert A. Hummer and Iliya Gutin." National Academies of Sciences, Engineering, and Medicine. 2018. Future Directions for the Demography of Aging: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25064.
×

Finally, mortality is especially high among U.S.-born Blacks for all-cause, disease of the heart, cancer, and residual causes of mortality—especially among men—whereas Asian Americans have the lowest rates. As with most of the health measures discussed above, we again emphasize the very high rates of mortality among Native Americans, comparable with U.S.-born Blacks. On the other hand, rates of mortality are particularly low among foreign-born Mexican Americans and Other Hispanics, as well as other foreign-born groups relative to the U.S. born, consistent with the well-documented immigrant mortality advantage (Hummer et al., 2015).

Future Directions

The U.S. older population is rapidly growing and diversifying (Ortman et al., 2014). At the same time, both the older adult and middle-aged populations exhibit very wide racial/ethnic and nativity disparities in educational attainment and family income. But with the important exceptions of Asian Americans (both foreign born and U.S. born), foreign-born Blacks, and foreign-born non-Hispanic Whites, most racial/ethnic and nativity groups exhibit worse health across a number of important domains relative to U.S.-born non-Hispanic Whites, who also (along with Asian Americans) exhibit the most favorable socioeconomic profile for health. Thus, as we look ahead to a larger and more diverse U.S. older adult population as the 21st century unfolds, there is substantial concern for the health of older Americans—especially Mexican Americans, other Hispanics, U.S.-born Blacks, and Native Americans—given the extent of the socioeconomic and health disparities we outlined above, both among older Americans and among middle-aged adults.

One key role of the demographic research community will be to continue to carefully document racial/ethnic and nativity disparities in health as the size and diversity of the older adult population changes. This documentation will not be straightforward, given changing immigration and emigration streams and shifts in racial/ethnic identities across time. Fortunately, the NHIS and NHANES data we used here, while imperfect, provide the research community with invaluable sources of information on the health of the U.S. population. Importantly, the continued production of these datasets relies on adequate federal government budget allocations to the National Center for Health Statistics. Thus, we urge researchers not only to use these datasets for continued documentation of disparities but to help provide justification to policy makers for the continued production of such data, without which researchers will not have the information necessary to produce detailed accounts of U.S. health disparities.

Given both racial/ethnic disparities in SES and wide racial/ethnic health disparities in middle age, we unfortunately expect that racial/ethnic health

Suggested Citation:"2 Racial/Ethnic and Nativity Disparities in the Health of Older U.S. Men and Women - Robert A. Hummer and Iliya Gutin." National Academies of Sciences, Engineering, and Medicine. 2018. Future Directions for the Demography of Aging: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25064.
×

disparities in older adulthood will continue to be wide well into the future. As supported by decades of research, the higher levels of education and income observed among non-Hispanic White, Asian American, and foreign-born non-Hispanic White and Black middle- and older-aged adults coincided with their better health outcomes across a variety of outcomes. While SES disparities do not perfectly map onto health disparities (e.g., Mexican immigrants have the lowest educational attainment, yet do not consistently exhibit the worst health), they are strongly aligned with observed racial/ethnic variations in health. Even with rising overall educational attainment in the United States across all racial/ethnic and nativity groups (Everett et al., 2011), large educational and income disparities across groups persist. Future research efforts will need to focus on the extent to which socioeconomic differences across groups are responsible for observed health disparities. In turn, our nation’s policy efforts will continue to need to emphasize the reduction of disparities in educational attainment, income, and other dimensions of SES if one wishes to reduce and/or eliminate racial/ethnic disparities in health.

Our documentation focused on health disparities, with socioeconomic disparities provided for context. This does not mean that other factors are not important for the understanding of racial/ethnic disparities in health. Consider, for example, cigarette smoking, which not only is responsible for over 500,000 adult deaths per year in the United States (Carter et al., 2015) but also undoubtedly contributes to some of the racial/ethnic disparities documented here. Historically higher patterns of smoking among U.S.born Blacks, Native Americans, and non-Hispanic Whites relative to other groups are in part responsible for some of the higher rates of mortality for those groups exhibited above. In this case, policies and programs to eliminate cigarette smoking in the United States would have major influences not only on improving older adult population health but also on reducing some of the racial/ethnic and nativity disparities documented above.

Our chapter focused on national-level estimates, and consequently our future research suggestions and policy recommendations also focus on the national level. At the same time, racial/ethnic disparities in older adult health are not uniform across geographic areas. Recent research, for example, highlights important variations in social and policy environments across states—variations that may be particularly important in structuring access to resources that engender good health, especially for women (Montez et al., 2016, 2017), and may have important impacts on racial/ethnic disparities in health. Other research documents substantial geographic variation in the clustering of key health behaviors and conditions—such as smoking, alcohol and substance use, and obesity—that further contributes to the geographic patterning of morbidity and mortality (Fenelon, 2013; Patel et al., 2014; Tencza et al., 2014) and may impact racial/ethnic disparities. Looking ahead,

Suggested Citation:"2 Racial/Ethnic and Nativity Disparities in the Health of Older U.S. Men and Women - Robert A. Hummer and Iliya Gutin." National Academies of Sciences, Engineering, and Medicine. 2018. Future Directions for the Demography of Aging: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25064.
×

a greater focus on both the individual level and on the contexts within which individuals are embedded will be important for the more complete understanding of racial/ethnic health disparities.

Perhaps most importantly, our analysis of the health of older adults reveals the need to look further “upstream” in the population age distribution to uncover the etiology of racial/ethnic disparities in health. In the present study, we also examined the group ages 45–64 to estimate disparities among contemporary middle-aged adults. The middle-aged group will soon become the next generation of older adults; consequently they provide an indication of America’s future health patterns and needs. As evidenced by our results (available from the authors by request), the majority of disparities documented among older adults are mirrored among this younger generation, suggesting that the origins of many group health inequities can be traced back earlier in the life course. A more complete understanding of health disparities would benefit from the careful documentation of racial/ethnic differences in health among even younger-aged groups, including childhood.

In closing, we turn back to one of the key theoretical considerations with which we opened. Given the tragic history of racism that has been so influential in the social and economic life of African Americans and Native Americans, it is unfortunately no surprise that these two groups stood out for generally exhibiting the worst older-adult population health across nearly all measures, in comparison with the other groups we considered. The socioeconomic and health disparities we documented among middle-aged individuals, for which African Americans and Native Americans also exhibited substantial disadvantages on most measures relative to the other groups, further suggest that racial/ethnic health disparities will not disappear anytime soon. Such evidence strongly suggests that the national policy agenda must focus aggressive attention on promoting socioeconomic equity between African Americans, Native Americans, and non-Hispanic Whites—without which large disparities in population health will likely linger well into the future.

REFERENCES

Akresh, I.R., and Frank, R. (2008). Health selection among new immigrants. American Journal of Public Health, 98(11), 2058–2064.

Arias, E., Heron, M., and Xu, J. (2017). United States Life Tables, 2013 (National Vital Statistics Reports, vol. 66 no. 3). Hyattsville, MD: National Center for Health Statistics.

Bilheimer, L.T., and Klein, R.J. (2010). Data and measurement issues in the analysis of health disparities. Health Services Research, 45(5), 1489–1507.

Suggested Citation:"2 Racial/Ethnic and Nativity Disparities in the Health of Older U.S. Men and Women - Robert A. Hummer and Iliya Gutin." National Academies of Sciences, Engineering, and Medicine. 2018. Future Directions for the Demography of Aging: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25064.
×

Brown, T.H., Richardson, L.J., Hargrove, T.W., and Thomas, C.S. (2016). Using multiple-hierarchy stratification approaches to understand health inequalities: The intersecting consequences of race, gender, SES and age. Journal of Health and Social Behavior, 57(2), 200–222.

Bruckner, T.A., Brown, R.A., and Margerison-Zilko, C. (2011). Positive income shocks and accidental deaths among Cherokee Indians: A natural experiment. International Journal of Epidemiology, 40(4), 1083–1090.

Carter, B.D., Abnet, C.C., Feskanich, D., Freedman, N.D., Hartge, P., Lewis, C.E., Ockene, J.K., Prentice, R.L., Speizer, F.E., Thun, M.J., and Jacobs, E.J. (2015). Smoking and mortality—beyond established causes. New England Journal of Medicine, 372(7), 631–640.

Case, A., and Deaton, A. (2015). Rising morbidity and mortality in midlife among White non-Hispanic Americans in the 21st century. Proceedings of the National Academy of Sciences of the United States of America, 112(49), 5078–5083.

Case, A., and Paxson, C.H. (2005). Sex differences in morbidity and mortality. Demography, 42(2), 189–214.

Cho, Y., Frisbie, W.P., Hummer, R.A., and Rogers, R.G. (2004). Nativity, duration of residence, and the health of Hispanic adults in the United States. International Migration Review, 38(1), 184–211.

Colby, S.L., and Ortman, J.M. (2015). Projections of the Size and Composition of the U.S. Population: 2014 to 2060 (Current Population Reports P25-1143). Washington, DC: U.S. Census Bureau. Available: https://census.gov/content/dam/Census/library/publications/2015/demo/p25-1143.pdf [February 2018].

Costello, E.J., Erkanli, A., Copeland, W., and Angold, A. (2010). Association of family income supplements in adolescence with development of psychiatric and substance use disorders in adulthood among an American Indian population. Journal of the American Medical Association, 303(19), 1954–1960.

Dwyer-Lindgren, L., Bertozzi-Villa, A., Stubbs, R.W., Morozoff, C., Mackenbach, J.P., van Lenthe, F.J., Mokdad, A.H., and Murray, C.J. (2017). Inequalities in life expectancy among U.S. counties, 1980 to 2014: Temporal trends and key drivers. JAMA Internal Medicine, 177(7), 1003–1011.

Everett, B.G., Rogers, R.G., Krueger, P.M., and Hummer, R.A. (2011). Trends in educational attainment by race/ethnicity, nativity, and sex in the United States, 1989-2005. Ethnic and Racial Studies, 34(9), 1543–1566.

Feliciano, C. (2005). Educational selectivity in U.S. immigration: How do immigrants compare to those left behind? Demography, 42(1), 131–152.

Fenelon, A. (2013). Geographic divergence in mortality in the United States. Population and Development Review, 39(4), 611–634.

Flores, A. (2017). How the U.S. Hispanic population is changing. Fact Tank: News in the Numbers. Pew Research Center. Available: http://www.pewresearch.org/facttank/2017/09/18/how-the-u-s-hispanic-population-is-changing/ [March 2018].

Frisbie, W.P., Cho, Y., and Hummer, R.A. (2001). Immigration and the health of Asian and Pacific Islander adults in the U.S. American Journal of Epidemiology, 153(4), 372–380.

Gates, H.L., Steele, C., Bobo, L.D., Dawson, M., Jaynes, G., Crooms-Robinson, L., and Darling-Hammond, L. (Eds.). (2012). The Oxford Handbook of African American Citizenship, 1865–Present. New York: Oxford University Press.

Gutin, I. (2017). In BMI we trust: Reframing the body mass index as a measure of health. Social Theory & Health, 1–16. doi: https://doi.org/10.1057/s41285-017-0055-0.

Hayward, M.D., Miles, T.P., Crimmins, E.M., and Yang, Y. (2000). The significance of socioeconomic status in explaining the racial gap in chronic health conditions. American Sociological Review, 65(6), 910–930.

Suggested Citation:"2 Racial/Ethnic and Nativity Disparities in the Health of Older U.S. Men and Women - Robert A. Hummer and Iliya Gutin." National Academies of Sciences, Engineering, and Medicine. 2018. Future Directions for the Demography of Aging: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25064.
×

Hayward, M.D., Hummer, R.A., Chiu, C.T., González-González, C., and Wong, R. (2014). Does the Hispanic paradox in U.S. adult mortality extend to disability? Population Research and Policy Review, 33(1), 81–96.

Hummer, R.A., and Hayward, M.D. (2015). Hispanic older adult health and longevity in the United States: Current patterns and concerns for the future. Daedalus, 144(2), 20–30.

Hummer, R.A., Melvin, J.E., and He, M. (2015). Immigration, health, and mortality. In J.D. Wright (editor-in-chief), International Encyclopedia of Social and Behavioral Sciences (2nd ed., vol. 11, pp. 654–661). Oxford: Elsevier Press.

Jones, D.S. (2006). The persistence of American Indian health disparities. American Journal of Public Health, 96(12), 2122–2134.

Jones-Smith, J.C., Dow, W.H., and Chichlowska, K. (2014). Association between casino opening or expansion and risk of childhood overweight and obesity. Journal of the American Medical Association, 311(9), 929–936.

Kochanek, K.D., Arias, E., and Bastian, B.A. (2016). The Effect of Changes in Selected Age-Specific Causes of Death on Non-Hispanic White Life Expectancy Between 2000 and 2014. NCHS Data Brief 250, pp. 1–7. Hyattsville, MD: National Center for Health Statistics. Available: https://www.cdc.gov/nchs/data/databriefs/db250.pdf [February 2018].

Kodish, S.R., Gittelsohn, J., Oddo, V.M., and Jones-Smith, J.C. (2016). Impacts of casinos on key pathways to health: Qualitative findings from American Indian gaming communities in California. BMC Public Health, 16(1), 621–633.

Lee, J., and Bean, F.D. (2007). Reinventing the color line: Immigration and America’s new racial/ethnic divide. Social Forces, 86(2), 561–586.

Masters, R.K., Hummer, R.A., Powers, D.A., Beck, A., Lin, S., and Finch, B.K. (2014). Long-term trends in adult mortality for U.S. Blacks and Whites: An examination of period- and cohort-based changes. Demography, 51(6), 2047–2073.

Montez, J.K., Zajacova, A., and Hayward, M.D. (2016). Explaining inequalities in women’s mortality between U.S. states. SSM Population Health, 2, 561–571.

Montez, J.K., Hayward, M.D., and Wolf, D.A. (2017). Do U.S. states’ socioeconomic and policy contexts shape adult disability? Social Science & Medicine, 178, 115–126.

National Center for Health Statistics. (2005). National Health and Nutrition Examination Survey: Overview. Available: https://www.cdc.gov/nchs/data/nhanes/nhanes_13_14/nhanes_overview_brochure.pdf [March 2018].

National Center for Health Statistics. (2016). About the National Health Interview Survey. Available: https://www.cdc.gov/nchs/nhis/about_nhis.htm [March 2018].

National Research Council. (1994). Demography of Aging. L.G. Martin and S.H. Preston, Eds. Committee on Population, Commission on Behavioral and Social Sciences and Education. Washington, DC: National Academy Press.

National Research Council. (1997). Racial and Ethnic Differences in the Health of Older Americans. L.G. Martin and B.J. Soldo, Eds. Committee on Population, Commission on Behavioral and Social Sciences and Education. Washington, DC: National Academy Press.

National Research Council. (2004). Critical Perspectives on Racial and Ethnic Differences in Health in Late Life. N.B. Anderson, R.A. Bulatao, and B. Cohen, Eds. Panel on Race, Ethnicity, and Health in Later Life. Committee on Population, Division of Behavioral and Social Sciences and Education. Washington, DC: The National Academies Press.

National Research Council. (2006). Multiple Origins, Uncertain Destinies: Hispanics and the American Future. Panel on Hispanics in the United States. M. Tienda and F. Mitchell (Eds.), Committee on Population. Division of Behavioral and Social Sciences and Education. Washington, DC: The National Academies Press.

Suggested Citation:"2 Racial/Ethnic and Nativity Disparities in the Health of Older U.S. Men and Women - Robert A. Hummer and Iliya Gutin." National Academies of Sciences, Engineering, and Medicine. 2018. Future Directions for the Demography of Aging: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25064.
×

Ortman, J.M., Velkoff, V.A., and Hogan, H. (2014). An Aging Nation: The Older Population in the United States. Current Population Reports P25-1140. Washington, DC: U.S. Census Bureau.

Palloni, A., and Ewbank, D.C. (2004). Selection processes in the study of racial and ethnic differentials in adult health and mortality. In N.B. Anderson, R.A. Bulatao, and B. Cohen, (Eds.), Critical Perspectives on Racial and Ethnic Differences in Health in Late Life (pp. 171–226). Committee on Population, Division of Behavioral and Social Sciences and Education. Washington, DC: The National Academies Press.

Patel, S.A., Narayan, K.V., Ali, M.K., and Mehta, N.K. (2014). Interstate variation in modifiable risk factors and cardiovascular mortality in the United States. PLoS One, 9(7), e101531.

Phelan, J.C., and Link, B.G. (2015). Is racism a fundamental cause of inequalities in health? Annual Review of Sociology, 41(1), 311–330.

Richardson, L.J., and Brown, T.H. (2016). (En)gendering racial disparities in health trajectories: A life course and intersectional analysis. Social Science & Medicine: Population Health, 2(1), 425–435.

Sandefur, G., Campbell, M.E., and Eggerling-Boeck, J. (2004). Racial and ethnic identification, official classifications, and health disparities. In N.B. Anderson, R.A. Bulatao, and B. Cohen (Eds.), Critical Perspectives on Racial and Ethnic Differences in Health in Late Life (pp. 25–52). Committee on Population, Division of Behavioral and Social Sciences and Education. Washington, DC: The National Academies Press.

Satcher, D., Fryer, G.E., Jr., McCann, J., Troutman, A., Woolf, S.H., and Rust, G. (2005). What if we were equal? A comparison of the Black-White mortality gap in 1960 and 2000. Health Affairs, 24(2), 459–464.

Smith-Kaprosy, N., Martin, P.P., and Whitman, K. (2012). An overview of American Indians and Alaska Natives in the context of Social Security and Supplemental Security Income. Social Security Bulletin, 72(4), 1.

Tencza, C., Stokes, A., and Preston, S. (2014). Factors responsible for mortality variation in the United States: A latent variable analysis. Demographic Research, 21(2), 27–70.

Ward, E., Jemal, A., Cokkinides, V., Singh, G.K., Cardinez, C., Ghafoor, A., and Thun, M. (2004). Cancer disparities by race/ethnicity and socioeconomic status. CA: A Cancer Journal for Clinicians, 54(2), 78–93.

Williams, D.R., Mohammed, S.A., Leavell, J., and Collins, C. (2010). Race, socioeconomic status, and health: Complexities, ongoing challenges, and research opportunities. Annals of the New York Academy of Sciences, 1186(1), 69–101.

Wolfe, B., Jakubowski, J., Haveman, R., and Courey, M. (2012). The income and health effects of tribal casino gaming on American Indians. Demography, 49(2), 499–524.

World Health Organization. (2006). Constitution of the World Health Organization (Basic Documents, 45th ed., Supplement). Available: http://www.who.int/governance/eb/who_constitution_en.pdf [March 2018].

Suggested Citation:"2 Racial/Ethnic and Nativity Disparities in the Health of Older U.S. Men and Women - Robert A. Hummer and Iliya Gutin." National Academies of Sciences, Engineering, and Medicine. 2018. Future Directions for the Demography of Aging: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25064.
×
Page 31
Suggested Citation:"2 Racial/Ethnic and Nativity Disparities in the Health of Older U.S. Men and Women - Robert A. Hummer and Iliya Gutin." National Academies of Sciences, Engineering, and Medicine. 2018. Future Directions for the Demography of Aging: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25064.
×
Page 32
Suggested Citation:"2 Racial/Ethnic and Nativity Disparities in the Health of Older U.S. Men and Women - Robert A. Hummer and Iliya Gutin." National Academies of Sciences, Engineering, and Medicine. 2018. Future Directions for the Demography of Aging: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25064.
×
Page 33
Suggested Citation:"2 Racial/Ethnic and Nativity Disparities in the Health of Older U.S. Men and Women - Robert A. Hummer and Iliya Gutin." National Academies of Sciences, Engineering, and Medicine. 2018. Future Directions for the Demography of Aging: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25064.
×
Page 34
Suggested Citation:"2 Racial/Ethnic and Nativity Disparities in the Health of Older U.S. Men and Women - Robert A. Hummer and Iliya Gutin." National Academies of Sciences, Engineering, and Medicine. 2018. Future Directions for the Demography of Aging: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25064.
×
Page 35
Suggested Citation:"2 Racial/Ethnic and Nativity Disparities in the Health of Older U.S. Men and Women - Robert A. Hummer and Iliya Gutin." National Academies of Sciences, Engineering, and Medicine. 2018. Future Directions for the Demography of Aging: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25064.
×
Page 36
Suggested Citation:"2 Racial/Ethnic and Nativity Disparities in the Health of Older U.S. Men and Women - Robert A. Hummer and Iliya Gutin." National Academies of Sciences, Engineering, and Medicine. 2018. Future Directions for the Demography of Aging: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25064.
×
Page 37
Suggested Citation:"2 Racial/Ethnic and Nativity Disparities in the Health of Older U.S. Men and Women - Robert A. Hummer and Iliya Gutin." National Academies of Sciences, Engineering, and Medicine. 2018. Future Directions for the Demography of Aging: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25064.
×
Page 38
Suggested Citation:"2 Racial/Ethnic and Nativity Disparities in the Health of Older U.S. Men and Women - Robert A. Hummer and Iliya Gutin." National Academies of Sciences, Engineering, and Medicine. 2018. Future Directions for the Demography of Aging: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25064.
×
Page 39
Suggested Citation:"2 Racial/Ethnic and Nativity Disparities in the Health of Older U.S. Men and Women - Robert A. Hummer and Iliya Gutin." National Academies of Sciences, Engineering, and Medicine. 2018. Future Directions for the Demography of Aging: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25064.
×
Page 40
Suggested Citation:"2 Racial/Ethnic and Nativity Disparities in the Health of Older U.S. Men and Women - Robert A. Hummer and Iliya Gutin." National Academies of Sciences, Engineering, and Medicine. 2018. Future Directions for the Demography of Aging: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25064.
×
Page 41
Suggested Citation:"2 Racial/Ethnic and Nativity Disparities in the Health of Older U.S. Men and Women - Robert A. Hummer and Iliya Gutin." National Academies of Sciences, Engineering, and Medicine. 2018. Future Directions for the Demography of Aging: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25064.
×
Page 42
Suggested Citation:"2 Racial/Ethnic and Nativity Disparities in the Health of Older U.S. Men and Women - Robert A. Hummer and Iliya Gutin." National Academies of Sciences, Engineering, and Medicine. 2018. Future Directions for the Demography of Aging: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25064.
×
Page 43
Suggested Citation:"2 Racial/Ethnic and Nativity Disparities in the Health of Older U.S. Men and Women - Robert A. Hummer and Iliya Gutin." National Academies of Sciences, Engineering, and Medicine. 2018. Future Directions for the Demography of Aging: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25064.
×
Page 44
Suggested Citation:"2 Racial/Ethnic and Nativity Disparities in the Health of Older U.S. Men and Women - Robert A. Hummer and Iliya Gutin." National Academies of Sciences, Engineering, and Medicine. 2018. Future Directions for the Demography of Aging: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25064.
×
Page 45
Suggested Citation:"2 Racial/Ethnic and Nativity Disparities in the Health of Older U.S. Men and Women - Robert A. Hummer and Iliya Gutin." National Academies of Sciences, Engineering, and Medicine. 2018. Future Directions for the Demography of Aging: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25064.
×
Page 46
Suggested Citation:"2 Racial/Ethnic and Nativity Disparities in the Health of Older U.S. Men and Women - Robert A. Hummer and Iliya Gutin." National Academies of Sciences, Engineering, and Medicine. 2018. Future Directions for the Demography of Aging: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25064.
×
Page 47
Suggested Citation:"2 Racial/Ethnic and Nativity Disparities in the Health of Older U.S. Men and Women - Robert A. Hummer and Iliya Gutin." National Academies of Sciences, Engineering, and Medicine. 2018. Future Directions for the Demography of Aging: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25064.
×
Page 48
Suggested Citation:"2 Racial/Ethnic and Nativity Disparities in the Health of Older U.S. Men and Women - Robert A. Hummer and Iliya Gutin." National Academies of Sciences, Engineering, and Medicine. 2018. Future Directions for the Demography of Aging: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25064.
×
Page 49
Suggested Citation:"2 Racial/Ethnic and Nativity Disparities in the Health of Older U.S. Men and Women - Robert A. Hummer and Iliya Gutin." National Academies of Sciences, Engineering, and Medicine. 2018. Future Directions for the Demography of Aging: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25064.
×
Page 50
Suggested Citation:"2 Racial/Ethnic and Nativity Disparities in the Health of Older U.S. Men and Women - Robert A. Hummer and Iliya Gutin." National Academies of Sciences, Engineering, and Medicine. 2018. Future Directions for the Demography of Aging: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25064.
×
Page 51
Suggested Citation:"2 Racial/Ethnic and Nativity Disparities in the Health of Older U.S. Men and Women - Robert A. Hummer and Iliya Gutin." National Academies of Sciences, Engineering, and Medicine. 2018. Future Directions for the Demography of Aging: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25064.
×
Page 52
Suggested Citation:"2 Racial/Ethnic and Nativity Disparities in the Health of Older U.S. Men and Women - Robert A. Hummer and Iliya Gutin." National Academies of Sciences, Engineering, and Medicine. 2018. Future Directions for the Demography of Aging: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25064.
×
Page 53
Suggested Citation:"2 Racial/Ethnic and Nativity Disparities in the Health of Older U.S. Men and Women - Robert A. Hummer and Iliya Gutin." National Academies of Sciences, Engineering, and Medicine. 2018. Future Directions for the Demography of Aging: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25064.
×
Page 54
Suggested Citation:"2 Racial/Ethnic and Nativity Disparities in the Health of Older U.S. Men and Women - Robert A. Hummer and Iliya Gutin." National Academies of Sciences, Engineering, and Medicine. 2018. Future Directions for the Demography of Aging: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25064.
×
Page 55
Suggested Citation:"2 Racial/Ethnic and Nativity Disparities in the Health of Older U.S. Men and Women - Robert A. Hummer and Iliya Gutin." National Academies of Sciences, Engineering, and Medicine. 2018. Future Directions for the Demography of Aging: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25064.
×
Page 56
Suggested Citation:"2 Racial/Ethnic and Nativity Disparities in the Health of Older U.S. Men and Women - Robert A. Hummer and Iliya Gutin." National Academies of Sciences, Engineering, and Medicine. 2018. Future Directions for the Demography of Aging: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25064.
×
Page 57
Suggested Citation:"2 Racial/Ethnic and Nativity Disparities in the Health of Older U.S. Men and Women - Robert A. Hummer and Iliya Gutin." National Academies of Sciences, Engineering, and Medicine. 2018. Future Directions for the Demography of Aging: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25064.
×
Page 58
Suggested Citation:"2 Racial/Ethnic and Nativity Disparities in the Health of Older U.S. Men and Women - Robert A. Hummer and Iliya Gutin." National Academies of Sciences, Engineering, and Medicine. 2018. Future Directions for the Demography of Aging: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25064.
×
Page 59
Suggested Citation:"2 Racial/Ethnic and Nativity Disparities in the Health of Older U.S. Men and Women - Robert A. Hummer and Iliya Gutin." National Academies of Sciences, Engineering, and Medicine. 2018. Future Directions for the Demography of Aging: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25064.
×
Page 60
Suggested Citation:"2 Racial/Ethnic and Nativity Disparities in the Health of Older U.S. Men and Women - Robert A. Hummer and Iliya Gutin." National Academies of Sciences, Engineering, and Medicine. 2018. Future Directions for the Demography of Aging: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25064.
×
Page 61
Suggested Citation:"2 Racial/Ethnic and Nativity Disparities in the Health of Older U.S. Men and Women - Robert A. Hummer and Iliya Gutin." National Academies of Sciences, Engineering, and Medicine. 2018. Future Directions for the Demography of Aging: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25064.
×
Page 62
Suggested Citation:"2 Racial/Ethnic and Nativity Disparities in the Health of Older U.S. Men and Women - Robert A. Hummer and Iliya Gutin." National Academies of Sciences, Engineering, and Medicine. 2018. Future Directions for the Demography of Aging: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25064.
×
Page 63
Suggested Citation:"2 Racial/Ethnic and Nativity Disparities in the Health of Older U.S. Men and Women - Robert A. Hummer and Iliya Gutin." National Academies of Sciences, Engineering, and Medicine. 2018. Future Directions for the Demography of Aging: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25064.
×
Page 64
Suggested Citation:"2 Racial/Ethnic and Nativity Disparities in the Health of Older U.S. Men and Women - Robert A. Hummer and Iliya Gutin." National Academies of Sciences, Engineering, and Medicine. 2018. Future Directions for the Demography of Aging: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25064.
×
Page 65
Suggested Citation:"2 Racial/Ethnic and Nativity Disparities in the Health of Older U.S. Men and Women - Robert A. Hummer and Iliya Gutin." National Academies of Sciences, Engineering, and Medicine. 2018. Future Directions for the Demography of Aging: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/25064.
×
Page 66
Next: 3 Socioeconomic Status, Health, and Mortality in Aging Populations - Angela M. O'Rand and Scott M. Lynch »
Future Directions for the Demography of Aging: Proceedings of a Workshop Get This Book
×
Buy Paperback | $75.00 Buy Ebook | $59.99
MyNAP members save 10% online.
Login or Register to save!
Download Free PDF

Almost 25 years have passed since the Demography of Aging (1994) was published by the National Research Council. Future Directions for the Demography of Aging is, in many ways, the successor to that original volume. The Division of Behavioral and Social Research at the National Institute on Aging (NIA) asked the National Academies of Sciences, Engineering, and Medicine to produce an authoritative guide to new directions in demography of aging. The papers published in this report were originally presented and discussed at a public workshop held in Washington, D.C., August 17-18, 2017.

The workshop discussion made evident that major new advances had been made in the last two decades, but also that new trends and research directions have emerged that call for innovative conceptual, design, and measurement approaches. The report reviews these recent trends and also discusses future directions for research on a range of topics that are central to current research in the demography of aging. Looking back over the past two decades of demography of aging research shows remarkable advances in our understanding of the health and well-being of the older population. Equally exciting is that this report sets the stage for the next two decades of innovative research–a period of rapid growth in the older American population.

  1. ×

    Welcome to OpenBook!

    You're looking at OpenBook, NAP.edu's online reading room since 1999. Based on feedback from you, our users, we've made some improvements that make it easier than ever to read thousands of publications on our website.

    Do you want to take a quick tour of the OpenBook's features?

    No Thanks Take a Tour »
  2. ×

    Show this book's table of contents, where you can jump to any chapter by name.

    « Back Next »
  3. ×

    ...or use these buttons to go back to the previous chapter or skip to the next one.

    « Back Next »
  4. ×

    Jump up to the previous page or down to the next one. Also, you can type in a page number and press Enter to go directly to that page in the book.

    « Back Next »
  5. ×

    Switch between the Original Pages, where you can read the report as it appeared in print, and Text Pages for the web version, where you can highlight and search the text.

    « Back Next »
  6. ×

    To search the entire text of this book, type in your search term here and press Enter.

    « Back Next »
  7. ×

    Share a link to this book page on your preferred social network or via email.

    « Back Next »
  8. ×

    View our suggested citation for this chapter.

    « Back Next »
  9. ×

    Ready to take your reading offline? Click here to buy this book in print or download it as a free PDF, if available.

    « Back Next »
Stay Connected!