New NAS Volume: Racial and Ethnic Differences in Health of Older Americans10/20/97
[NOTE: The volume referenced below is on the web (with a 20% reduction for online purchases) at: http://www.nap.edu/readingroom/enter2.cgi?0309054893.html.]
RACIAL AND ETHNIC DIFFERENCES IN THE HEALTH OF OLDER AMERICANS Linda G. Martin and Beth J. Soldo, Editors CONTENTS Preface 1 Introduction Linda G. Martin and Beth J. Soldo 2 Racial and Ethnic Differences in Mortality at Older Ages Irma T. Elo and Samuel H. Preston 3 Health and Disability Differences Among Racial and Ethnic Groups Kenneth G. Manton and Eric Stallard 4 Race, Socioeconomic Status, and Health in Late Life James P. Smith and Raynard Kington 5 How Health Behaviors and the Social Environment Contribute to Health Differences Between Black and White Older Americans Lisa F. Berkman and Jewel M. Mullen 6 Black-White Differences in the Use of Medical Care by the Elderly: A Contemporary Analysis J. Escarce and Frank W. Puffer 7 Are Genetic Factors Involved in Racial and Ethnic Differences in Late-Life Health? James V. Neel 8 Differences in Rates of Dementia Between Ethno-Racial Groups Barry Gurland, David Wilder, Rafael Lantigua, Richard Mayeux, Yaakov Stern, Jiming Chen, Peter Cross, and Eloise Killeffer 9 Cardiovascular Disease Among Elderly Asian Americans Dwayne Reed and Katsukiko Yano 10 Health Status of Hispanic Elderly Kyriakos S. Markides, Laura Rudkin, Ronald J. Angel, and David V. Espino
Health Differences Among Racial and Ethnic Groups Persist; Multiple Causes May Be to Blame
Although white Americans still live longer than blacks, the gap in death rates has declined over the past 30 years. There is some evidence -- though controversial -- that blacks actually have a lower death rate in their 80s and 90s than whites. And older Americans who identify themselves as Hispanics, Asians, or Pacific Islanders have a lower death rate than either whites or blacks. Black men have a 20 percent greater incidence of prostate cancer than whites, and white women have a 30 percent greater incidence of breast cancer than blacks. Beyond simply documenting these differences, the challenge facing researchers is to pinpoint the extent to which the differences can be explained by genetics, socioeconomic status, health-promoting behaviors, access to health care, and other factors.
A new collection of papers from a workshop hosted by the National Research Council examines the differing rates of mortality, disability, dementia, cardiovascular disease, and use of medical care among various ethnic and racial groups. The papers say that although researchers have begun to piece together some of the explanations for these differences, research is limited by gaps in nationally representative data, by not having a full range of measures to compare life histories, and by ethical and legal obstacles to linking survey data with genetic information.
Among the papers' conclusions:
- At younger ages, the death rate for blacks exceeds that for whites by as much as 2-to-1, but the differences gradually narrow and may actually switch as both groups get older. A lack of reliable information on older people leads some researchers to question whether death rates actually reverse, or whether the death rate for whites remains lower throughout the life span.
- Historically, blacks in America have had less access to health care than whites. Blacks now spend as much as whites per capita on medical care, as measured in physician visits and inpatient hospital stays. However, surveys show that blacks are more likely to experience illness than whites, so they should actually be spending more, a fact that suggests that there still may not be equal access to care.
- Differences in rates of dementia, including Alzheimer's disease, appear to be related to education, as there is a lower level of dementia among those with higher education levels. There is no real difference in rates of dementia among racial and ethnic groups when researchers account for education levels.
- Studies have shown a twofold to threefold difference in the incidence of coronary heart disease between Japanese men living in the United States and Japanese men living in Japan. The higher rates in America can be explained largely by an increase in the major risk factors for heart disease, including higher cholesterol, glucose, and blood pressure levels, and greater consumption of alcohol and tobacco.
The papers underscore that race and ethnicity are not biological definitions, but fluid categories whose meanings vary according to the social and historical context. Much of how people are identified results from the way they respond to multiple-choice question in censuses and surveys and from classifications made for official government statistics. As understanding of the differences in health among various groups grows, researchers will need to develop ways of analyzing and testing how these differences emerge, and how intermarriage, socioeconomic integration, and other cultural changes affect them.
The project was funded by the National Institute on Aging. Copies of Racial and Ethnic Differences in the Health of Older Americans are available from the National Academy Press for $42.00 (prepaid) plus shipping charges of $4.00 for the first copy and $.50 for each additional copy; tel. (202) 334-3313 or 1-800-624-6242.