Disparities In Self-rated Health Research Articles

Vitamin D Status Is a Biological Determinant of Health Disparities

BackgroundIn human beings, dark skin requires more exposure to ultraviolet light to synthesize the same amount of vitamin D as lighter skin. It is has been repeatedly shown that at the latitude of the United States there are vitamin D disparities related to skin color. Although inadequate vitamin D status and health disparities have been associated with many of the same diseases, neither nutrition policy nor public health policy in the United States currently recognizes any role at all for vitamin D as a determinant of health disparities. ObjectiveThis study investigated the relationship between health, skin color, and vitamin D nutriture in the US population. DesignThe design is cross-sectional, correlational, and can be generalized to the population of the United States. ParticipantsWe used data from 12,505 (unweighted) subjects (3,402 non-Hispanic blacks, 3,143 Mexican Americans, and 5,960 non-Hispanic whites), aged 13 years or older, from the continuous National Health and Nutrition Examination Survey 2003-2006. Main outcome measureSelf-rated health, a repeatedly validated indicator of objective health status, was used as a continuous measure of health. Statistical analyses performedUsing software appropriate for the complex survey design of the National Health and Nutrition Examination Survey, the study consisted of six regression models, one predicting vitamin D status and five predicting self-rated health. ResultsControlling for the covariates sex, interview language, country of birth, tobacco use, age, body mass index, and leisure exercise as well as the socioeconomic variables education and family income, remaining disparities in self-rated health are greatly reduced or eliminated by controlling for serum 25-hydroxyvitamin D levels. ConclusionsWe found that socioeconomic factors are the strongest determinant of skin-color based health disparities in the US population, but that it may not be possible to eliminate health disparities in the United States without eliminating the skin-color–related disparities in vitamin D nutriture.

Does Multiracial Matter? A Study of Racial Disparities in Self-Rated Health

How do self-identified multiracial adults fit into documented patterns of racial health disparities? We assess whether the health status of adults who view themselves as multiracial is distinctive from that of adults who maintain a single-race identity, by using a seven-year (2001-2007) pooled sample of the Behavioral Risk Factor Surveillance System (BRFSS). We explore racial differences in self-rated health between whites and several single and multiracial adults with binary logistic regression analyses and investigate whether placing these groups into a self-reported "best race" category alters patterns of health disparities. We propose four hypotheses that predict how the self-rated health status of specific multiracial groups compares with their respective component single-race counterparts, and we find substantial complexity in that no one explanatory model applies to all multiracial combinations. We also find that placing multiracial groups into a single "best race" category likely obscures the pattern of health disparities for selected groups because some multiracial adults (e.g., American Indians) tend to identify with single-race groups whose health experience they do not share.

Racial/Ethnic Disparities in Self-rated Health: The Mediating Role of Social Trust

This study examines racial/ethnic disparities in self-rated health and their underlying social bases. Using a series of nested models and data on 24,767 individuals from the 2000 Social Capital Community Benchmark Survey (Roper Center 2006), we assess initial differences among blacks, Latinos, and Asians in terms of their likelihood of reporting diminished health relative to whites. Subsequent models disaggregate Latino and Asian respondents by citizenship status and incorporate the traditional intervening factors of linguistic isolation and experience with discrimination. We then assess the respective roles of socioeconomic status (SES) and social trust in explaining racial/ethnic effects. Our findings point to important mediating roles for both SES and social trust, though their roles vary in importance across groups.

Determinants of health disparities between Italian regions

BackgroundAmong European countries, Italy is one of the countries where regional health disparities contribute substantially to socioeconomic health disparities. In this paper, we report on regional differences in self-reported poor health and explore possible determinants at the individual and regional levels in Italy.MethodsWe use data from the "Indagine Multiscopo sulle Famiglie", a survey of aspects of everyday life in the Italian population, to estimate multilevel logistic regressions that model poor self-reported health as a function of individual and regional socioeconomic factors. Next we use the causal step approach to test if living conditions, healthcare characteristics, social isolation, and health behaviors at the regional level mediate the relationship between regional socioeconomic factors and self-rated health.ResultsWe find that residents living in regions with more poverty, more unemployment, and more income inequality are more likely to report poor health and that poor living conditions and private share of healthcare expenditures at the regional level mediate socioeconomic disparities in self-rated health among Italian regions.ConclusionThe implications are that regional contexts matter and that regional policies in Italy have the potential to reduce health disparities by implementing interventions aimed at improving living conditions and access to quality healthcare.

Social Capital, Gender and Educational Level Impact on Self-Rated Health~!2009-09-17~!2010-03-11~!2010-05-26~!

Objectives: Social capital has been recognized as one important social determinant for health, but we still have limited knowledge about how it can be used to explain inequality in health. This study investigated the links between individual social capital and self-rated health by gender and educational level, and analyzed if access to social capital might explain the observed disparities in self-rated health between men and women and different educational groups. Study design: A cross-sectional survey in Northern Sweden. Methods: A social capital questionnaire was constructed and mailed to 15 000 randomly selected individuals. Different forms of structural and cognitive social capital were measured. Self-rated health was used as the outcome measure. Crude and adjusted OR and 95% CI were calculated for good self- rated health and access to each form of social capital. Multivariate regression was used to analyze how sociodemographic factors and access to social capital might influence differences in self-rated health by gender and educational level. Results: Access to almost each form of social capital significantly increased the odds for good self-rated health for all groups. A higher education significantly increased the odds for access to each form of social capital, and being a man significantly increased the odds for having access to some forms of social capital. The health advantage for higher educated and men partly decreased when controlling for access to social capital. Conclusions: Access to social capital can partly explain the observed health inequality between men and women and different educational groups. Strengthening social capital might be one way of tackling health inequality. It is important to consider the structural conditions that create unequal opportunities for different groups to access social capital.

Educational inequalities in self-rated health within the Arab minority in Israel: explanatory factors

Studies on factors explaining the socioeconomic inequalities in health within ethnic minorities are scarce. This study examines the contribution of material conditions, and psychosocial, community, cultural and behavioural factors to explaining educational disparities in self-rated health (SRH) within the Arab minority in Israel. In 2005, a national random sample of 902 persons aged 30-70 was selected in a multistage sampling procedure for interviewing. We used multistage logistic regression modelling to examine the percent of attenuations in odds ratios (OR) of extreme categories for education (low vs. high) in the associations with SRH after inclusion of explanatory variables. Education was significantly associated with SRH [odds ratio (OR) = 3.86, 95% confidence interval (CI) = 2.30-6.47]. The separate inclusion of material conditions reduced the OR of poor SRH by 43%. Psychosocial, community or behavioural variables reduced it by 17%, 26% and 11%, respectively. Combining each group of factors with material conditions led to small additional reductions in OR. Integrating all explanatory variables reduced OR by 54%, with the association becoming non-significant. Cultural variables were not associated with SRH and were therefore not included in the multivariate analysis. Material conditions are a major factor in explaining the educational disparities in SRH among Arabs in Israel. Most of the impact of psychosocial and health behaviours, together with part of the community effects, operated through material conditions. Reduction of educational inequalities in SRH requires provision of educational attainment opportunities accompanied by employment opportunities assuring equivalent material gains. Further examination of factors explaining health inequalities among other minorities is warranted.

Self-rated Health and Social Capital Among Aging People Across the Urban–Rural Dimension

Previous studies have found self-rated health to be associated with social capital. However, there is lack of studies examining social capital among aging people and its impact on self-rated health in the urban-rural context. The purpose of this study was to investigate associations between self-rated health and indicators of social capital (trust, various social contacts, social participation, and access to help) among aging people living in urban and rural areas in Finland. A postal survey was conducted in 2002 among men and women born in 1926-1930, 1936-1940, or 1946-1950 and dwelling in 14 municipalities in the Päijät-Häme hospital district in Finland. A total of 2,815 participants represented 66% of the original stratified (by age, gender, and municipality) sample. Logistic regression analyses were used to examine the associations. Active social participation and easy access to help from others were associated with good self-rated health, especially in the urban and sparsely populated rural areas. Trust was a particularly important correlate of subjective health in the urban area, though its significance diminished after adjusting to all background variables. No overall disparities in self-rated health between the areas emerged. Social participation and access to help as indicators of social capital seem to be important resources when aging men and women assess their subjective health. Increasing efforts to encourage social participation and facilitate access to help from other persons should be included among the key priorities in community health promotion.

Cumulative violence exposure and self-rated health: longitudinal study of adolescents in the United States.

The goal was to determine whether cumulative exposure to violence in childhood and adolescence contributes to disparities in self-rated health among a nationally representative sample of US adolescents. The National Longitudinal Survey of Youth 1997 is an ongoing, 8-year (1997-2004), longitudinal, cohort study of youths who were 12 to 18 years of age at baseline (N = 8224). Generalized estimating equations were constructed to investigate the relationship between cumulative exposure to violence and risk for poor health. At baseline, 75% of subjects reported excellent or very good health, 21.5% reported good health, and 4.5% reported fair or poor health. Cumulative violence exposures (witnessed gun violence, threat of violence, repeated bullying, perceived safety, and criminal victimization) were associated with a graded increase in risk for poor health and reduced the strength of the relationship between household income and poor health. In comparison with subjects with no violence exposure, risk for poor self-rated health was 4.6 times greater among subjects who reported >or=5 forms of cumulative exposure to violence, controlling for demographic features and household income. Trend analysis revealed that, for each additional violence exposure, the risk of poor health increased by 38%. Adjustment for alcohol use, drug use, smoking, depressive symptoms, and family and neighborhood environment reduced the strength of the relationships between household income and cumulative exposure to violence scores and poor self-rated health, which suggests partial mediation of the effects of socioeconomic status and cumulative exposure to violence by these factors. In this nationally representative sample, social inequality in risk for poor self-rated health during the transition from adolescence to adulthood was partially attributable to disparities in cumulative exposure to violence. A strong graded association was noted between cumulative exposure to violence and poor self-rated health in adolescence and young adulthood.

Does place explain racial health disparities? Quantifying the contribution of residential context to the Black/white health gap in the United States

The persistence of the black health disadvantage has been a puzzling component of health in the United States in spite of general declines in rates of morbidity and mortality over the past century. Studies that have focused on well-established individual-level determinants of health such as socio-economic status and health behaviors have been unable to fully explain these disparities. Recent research has begun to focus on other factors such as racism, discrimination, and segregation. Variation in neighborhood context—socio-demographic composition, social aspects, and built environment—has been postulated as an additional explanation for racial disparities, but few attempts have been made to quantify its overall contribution to the black/white health gap. This analysis is an attempt to generate an estimate of place effects on explaining health disparities by utilizing data from the U.S. National Health Interview Survey (NHIS) (1989–1994), combined with a methodology for identifying residents of the same blocks both within and across NHIS survey cross-sections. Our results indicate that controlling for a single point-in-time measure of residential context results in a roughly 15–76% reduction of the black/white disparities in self-rated health that were previously unaccounted for by individual-level controls. The contribution of residential context toward explaining the black/white self-rated health gap varies by both age and gender such that contextual explanations of disparities decline with age and appear to be smaller among females.

The Contributions of Race, Individual Socioeconomic Status, and Neighborhood Socioeconomic Context on the Self-Rated Health Trajectories and Mortality of Older Adults

Drawing on four waves of the Americans' Changing Lives Study, we examine the contributions of individual and neighborhood socioeconomic status to explain racial disparities in self-rated health trajectories over time, among Black and White older adults in the United States. Primary results of three-level growth curve analyses of self-rated health change, and multinomial logistic regression of mortality and attrition, indicate that (1) racial and socioeconomic disparities in health persist into old age, (2) Black older adults have greater declines in self-rated health over time than White older adults, and these disparities are explained by individual and neighborhood socioeconomic status (SES), (3) individual and neighborhood SES contribute to persisting self-rated health disparities at older ages, but may not contribute significantly to further declines in self-rated health at older ages, (4) Black disadvantage in mortality exists at older ages, and persists net of individual and neighborhood SES, and (5) individual SES is a significant predictor of 16-year mortality among older adults. Our results suggest that we should continue to be concerned about the existence and persistence of racial and socioeconomic disparities in self-rated health and mortality throughout old age, and the contribution of individual and neighborhood socioeconomic context in perpetuating these disparities.

Contextual factors and immigrants’ health status: Double jeopardy

Poor health among immigrants may be accounted for not only by socio-economic factors affecting individuals but also by the environment in which they live. We investigated the association of contextual factors with disparities in self-rated health between native and immigrant groups. The findings indicated that, compared with native-born Belgians, immigrant groups from Turkey and Morocco were more likely to have poorer self-rated health. When contextual factors and individual socio-economic status were allowed for, all immigrant groups had a health status that was similar to or even better than that of native-born Belgians. Immigrants face a double jeopardy at both the individual and the contextual level.

The role of social support and integration for understanding socioeconomic disparities in self-rated health and hypertension

This paper examines socioeconomic (socioeconomic status, SES) disparities in self-rated health and hypertension among 29,816 US adults aged 25 and older using data from the 2001 wave of the National Health Interview Survey. Our purpose is to examine how influential measures of social support and social integration are for each health outcome, and whether support and integration operate by mediating, or buffering, the effects of SES on health. Multivariate regression models show no significant influence of emotional support, but do indicate that many aspects of social integration are directly associated with self-rated health and hypertension, although these measures do not mediate the relationship between SES and health. However, interaction tests show substantial evidence that measures of social integration buffer some of the negative effects of low SES, particularly the negative influence of not working on self-rated health. In addition, findings indicate potential evidence of help-seeking behavior among adults who did not finish high school or who report financial barriers to medical care. Overall, our findings suggest that social programs designed to foster social integration (e.g., free or low-cost bus fare to promote visits with friends and family) may improve health among persons with low levels of education, who are not working, or who have problems accessing medical care because of financial problems.

Race/Ethnicity, Socioeconomic Status and the Health of Pregnant Women

We examined how traditional (income, education) and nontraditional (public assistance, material deprivation, subjective social standing) socioeconomic status (SES) indicators were associated with self-rated health, physical functioning, and depression in ethnically diverse pregnant women. Using multiple regression, we estimated the association of race/ethnicity (African American, Latino, Asian/Pacific Islander (PI) and white) and sets of SES measures on each health measure. Education, material deprivation, and subjective social standing were independently associated with all health measures. After adding all SES variables, race/ethnic disparities in depression remained for all minority groups; disparities in self-rated health remained for Asian/Pacific Islanders. Few race/ethnic differences were found in physical functioning. Our results contribute to a small literature on how SES might interact with race/ethnicity in explaining health.

Racial Segregation and Health Disparities Between Black and White Older Adults

In this study, we examined whether racial segregation is associated with poorer self-rated health among older adults, and whether racial segregation helps explain race disparities in self-rated health between Black and White older adults. We used multilevel data at the individual, neighborhood (tract), and county levels, from two national surveys-the Americans' Changing Lives (ACL) survey and the National Survey of Families and Households (NSFH). We used hierarchical linear models in order to regress self-rated health on county-, neighborhood-, and individual-level racial and socioeconomic variables. In the NSFH, there was an association between county racial segregation and poorer self-rated health among White but not Black older adults (net of county percent Black and percent poverty). In the ACL, there was no statistically significant association between racial segregation and self-rated health. In the NSFH, there was some indication that Black older adults had better self-rated health when living in neighborhoods with a higher percentage of Black residents than the county percentage. Although aggregate-level studies demonstrate associations between racial segregation and mortality rates, our multilevel analyses with two national data sets suggest only weak associations between racial segregation and self-rated health. However, socioeconomic status at multiple levels contributes to race disparities in health.

Racial Disparities in Self-Rated Health at Older Ages and the Dangers of Obfuscating Neighborhood Effects Research

WE THANK Prof. Golant for his comments concerning our work. Our aims in this brief response are to (a) discuss the role of omitted individual-level measures, particularly related to psychological indices; (b) address concerns about the sophistication of neighborhood-level measures; and (c) review the relevance of these comments for racial disparities in health. To reorient the reader, our article is about racial differences in self-rated health at older ages and the potential explanatory contribution of neighborhood social context. A multilevel approach, theoretically and empirically, is necessary to discuss and test any mechanisms that operate at the neighborhood level; we hypothesized that neighborhood-level factors might account for the racial difference in self-rated health observed at the individual level. First, a fundamental concern, raised here and elsewhere, is that neighborhood variables are simply picking up poorly measured or unmeasured individual-level characteristics. It is this concern that prompted our reliability analysis. Although the reliability analysis speaks to only one issue—the relationship between individual- and neighborhood-level economic status— and one form of mismeasurement—a construct poorly measured rather than one omitted altogether—we believe it provides additional evidence in support of our hypothesis that neighborhood factors uniquely affect health. That is, even under a scenario where individual-level income is measured with poor precision, we still see an impact from the aggregate level of income in the community. As for omitted variables, we agree that psychological factors such as optimism could be important. They could confound, mediate, or indeed be endogenous to the neighborhood–health relationship. We did not have the empirical opportunity to explore this pathway. That said, we do not believe our results can be explained by unmeasured psychological profiles exhibited in the aggregate. We were unable to find evidence in support of the hypothesis that optimistic persons, for instance, cluster geographically or that individual affluence itself leads to greater optimism. Indeed,

Racial Disparities in Self-Rated Health at Older Ages: What Difference Does the Neighborhood Make?

Racial differences in self-rated health at older ages are well documented. African Americans consistently report poorer health, even when education, income, and other health status indicators are controlled. The extent to which neighborhood-level characteristics mediate this association remains largely unexplored. We ask whether neighborhood social and economic resources help to explain the self-reported health differential between African Americans and Whites. Using the 1990 Decennial Census, the 1994-1995 Project on Human Development in Chicago Neighborhoods-Community Survey, and selected years of the 1991-2000 Metropolitan Chicago Information Center-Metro Survey, we examine the impact of neighborhood structure and social organization on self-rated health for a sample of Chicago residents aged 55 and older (N = 636). We use multilevel modeling techniques to examine both individual and neighborhood-level covariates. Findings indicate that affluence, a neighborhood structural resource, contributes positively to self-rated health and attenuates the association between race and self-rated health. When the level of affluence in a community is low, residential stability is negatively related to health. Collective efficacy, a measure of neighborhood social resources, is not associated with health for this older population. Analyses incorporating individual and neighborhood-level contextual indicators may further our understanding of the complex association between sociodemographic factors and health.

노인의 사회 경제적 수준과 주관적 건강수준과의 관계

The purpose of this paper is to examine the relationship between socio-economic factors and self-rated health among older people living in the community. In addition, the study tries to determine whether risk differentials by these socio-economic factors can be explained by other demographic factors, chronic diseases, and functional status. We surveyed to investigate the self-rated health of 397 study samples which had been selected by stratified randomized sampling, <TEX>$2.7\%$</TEX> by each Dong (district) of S-city in Gyeonggi-do. Our study found that the socioeconomic factors such as income, occupation, and insurance were significantly associated with self-rated health. The level of social economic status was positively associated with the level of self-rated health. Two-staged multivariate analysis demonstrated that this relationship was still significant even after adjustment for demographic factors, chronic diseases, and functional status. In conclusion, there are wide socio-economic disparities in self-rated health of older people in this community. It is important that government should know not only health status but also the health-associated factors in order to prepare for the aged society and improve the health status of the elderly. Further researches should uncover causality and mechanism by which SES affects changes in functional health among the elderly.

Racial residential segregation and geographic heterogeneity in black/white disparity in poor self-rated health in the US: a multilevel statistical analysis

Existing evidence demonstrating a relationship between racial residential segregation and health has been based on aggregate analysis. Using a multilevel analytical framework, we assess the extent of geographic variation in black/white disparities in self-rated health across US metropolitan areas, and whether racial residential segregation accounts for such variation. We estimated multilevel regression models of poor self-rated health among 51,316 non-Hispanic white and non-Hispanic black adults nested within 207 metropolitan areas to assess the multilevel relationship between segregation and racial disparities in health. We found statistically significant variation in the black/white disparity in poor self-rated health across metropolitan areas, after controlling for individual level factors (age, sex, marital status, education and income) and residential segregation. High black isolation was associated with increased odds of reporting poor health among blacks ( p < 0.05 ). While a similar pattern was observed for white/black dissimilarity and white isolation, they were not statistically significant. Our multilevel analysis only partially supports the previously reported aggregate findings linking segregation to health. Additional multilevel statistical investigations across different health outcomes are required to draw firmer conclusions regarding the adverse effects of segregation on health.

Explaining variation in health status across space and time: implications for racial and ethnic disparities in self-rated health

We use the Metropolitan Community Information Center-Metro Survey—a serial cross section of adults residing in the City of Chicago, USA, conducted from 1991 through 1999—in combination with 1990 census data to simultaneously examine the extent to which self-rated health varies across Chicago neighborhoods and across time. Three-level hierarchical logit models are employed to decompose individual, spatial, and temporal variance in self-rated health. Results indicate that variation in self-rated health across neighborhoods is explained, in part, by variation in the level of neighborhood affluence. Neighborhood level poverty, however, is not a significant predictor of self-rated health. Community level affluence, moreover, accounts for a substantial proportion of the residual health deficit experienced by African-Americans when compared with Whites (after controlling for individual level SES). The effects of affluence hold when controlling for spatial autocorrelation and when considered in primarily African-American neighborhoods. Findings also indicate that individuals living in the City of Chicago became significantly healthier over the decade of the 1990s, and that this improvement in health is explained largely by the increasing education and income levels of Chicago residents.