Race, Socioeconomic Status, and Health in Late Life
Citation: Smith, Kington (1997) Race, Socioeconomic Status, and Health in Late Life.
This paper has 2 goals: (1) to examine racial and ethnic disparities in health outcomes among older American using 2 important new data sets (the Health and Retirement Survey, HRS ages51-61, and the Asset and Health Dynamics Among the Oldest Old, AHEAD, ages 70+), and (2) to she light on the central issues of the underlying causes of the strong relationship between socioeconomic status and health outcomes.
Although their results are consistent with other research suggesting an important role for socioeconomic status as a factor accounting for racial and ethnic differences (most mortality and health differentials between blacks and whites disappear with the introduction of controls for socioeconomic characteristics), their results indicate that the relationship among race and ethnicity, socioeconomic status, and health is far more complex than many current analyses recognize. Smith and Kington found that blacks had substantially higher rats of hypertension, stroke, and diabetes (and in some cases, arthritis) and lower rates for diseases of the lung and for a heart attack within the previous 5 years (men only). Moreover, blacks have higher values on some "risk factors" that may explain the association between socioeconomic status and health such as smoking, drinking, lack of exercise, and obesity. (Whites, however, have higher rates of exposure to dangerous chemicals or other hazards at work.) In a number of models exploring the relationship between socioeconomic status and health, the authors find that education is highly associated with health (above and beyond income). Health risk factors are highly related to health (especially BMI). Income and wealth appear to have nonlinear relationships with health (the effects weaken as one moves up the income and wealth distribution). However, the effects of income and wealth differ depending on the source such as welfare, retirement, etc. There are 2 important dimensions of economic status income and wealth each with distinct conceptual and empirical associations with health. The association of some common measures of socioeconomic status with health status is highly nonlinear. For example, the association of both income and wealth with self-reported general health status is strongest among the poorest households and is relatively weak among the most affluent members of society. Both of these issues may affect how we account for racial and ethnic differences in health in later life. Finally, there is compelling evidence that the feedbacks from health to current socioeconomic status are quantitatively strong and should not be ignored in empirical investigations. In particular, the entire association between current household income and health among households with a member in his or her fifties appears to reflect causation from health to income rather than from income to health.