Black–white difference in long-term predictive power of self-rated health on all-cause mortality in United States

Abstract

Purpose Despite the well-established association between self-rated health (SRH) and mortality, limited information exists on Black-White differences in this link. Using a nationally representative sample of adults in the United States, the current study had four aims: 1) to assess whether the association between baseline SRH and all-cause mortality over a long follow up differs for Blacks and Whites, 2) to test whether any race difference in the SRH – mortality link depends on how the SRH variable is treated (e.g., nominal, dichotomous, continuous), 3) to test if the SRH – mortality link or any differences in the association by race are explained by differences in objective health measures (chronic medical conditions [CMC]), and (4) to assess whether these associations vary by gender. Methods Data came from the Americans’ Changing Lives Study, a nationally representative longitudinal cohort of U.S. adults 25 and older with up to 25 years of follow up. The study followed 3,361 Blacks or Whites for all-cause mortality between 1986 and 2011. The predictor of interest was a single item measure of SRH in 1986, treated as a nominal, dichotomous (fair/poor versus excellent/very good/good) and continuous variable. Confounders included baseline age, education, income, depressive symptoms, and CMC. Race (Black versus White) was the focal effect modifier. We ran Cox proportional hazard models for the pooled sample, and also stratified by race and gender, before and after adjusting for CMC. Results Regardless of how SRH was treated and for both men and women, we found significant interactions between race and SRH, indicating a stronger predictive role of SRH for all-cause mortality among Whites compared to Blacks. Before adjustment for chronic medical conditions, lower SRH was associated with higher risk of mortality among Blacks and Whites, but after adjustment, the SRH – mortality association was no longer significant among Blacks. Conclusion Baseline SRH continues to predict long term mortality among White but not Black Americans after adjustment for chronic medical conditions at baseline, and these patterns are similar for men and women. Future research should test whether the differential predictive validity of SRH across race groups arises because SRH reflects different aspects of health of Black and White Americans.

Research in and Prospects for the Measurement of Health Using Self-Rated Health

“…Evidence for differences in evaluative frameworks across social groups is found in studies that highlight differences in SRH across groups among individuals that are otherwise similarly situated with respect to health factors, or differences in health outcomes (including mortality) across groups among individuals with similar SRH ratings. These differences have been found across groups defined by race and ethnicity (Ferraro and Kelley-Moore 2001;Assari, Lankarani, and Burgard 2016); indicators of acculturation such as language spoken at home, language spoken in the interview, and time in the United States (Finch et al 2002;Bzostek, Goldman, and Pebley 2007); gender Benjamins et al 2004); indicators of socioeconomic status such as education, occupation, and income Zajacova 2007, 2010;Layes, Asada, and Kephart 2012); marital status (Zheng and Thomas 2013); age (Idler 1993;Lindeboom and van Doorslaer 2004;Schnittker 2005b); and features of geographic location (Jürges 2007;Quesnel-Vallée 2007;Bjornstrom and Kuhl 2014).…”

Demographic and Socioeconomic Determinants of Physical and Mental Self-rated Health Across 10 Ethnic Groups in the United States

“…12,[25][26][27][28][29] The degree by which SRH reflects psychological distress 25 and chronic medical and mental disorders 1,2,12-14 may differ from one ethnic group to another. [30][31][32][33][34][35][36] The meaning and determinants of SRH are not universal, but population specific. 12,26,28 Factors associated with SRH also vary across diverse ethnic groups.…”

“…12,26,28 Factors associated with SRH also vary across diverse ethnic groups. [30][31][32][33][34][35][36] As a general rule, poor SRH better reflects health problems in non-Hispanic Whites compared to all ethnic minorities such as Blacks, Hispanics, and Asians. 12 Poor SRH also better predicts mortality in Whites than non-Whites.…”

“…12 Poor SRH also better predicts mortality in Whites than non-Whites. 30 Even within a single racial group, ethnicity changes how SRH correlates with health problems. 28,31 However, very few studies have investigated the heterogeneity of demographic and social determinants of physical and mental SRH across ethnic groups.…”

Gender Differences in Vulnerability to Socioeconomic Status on Self-Rated Health in 15 Countries

“…Crosscountry differences in the validity of measures used in the current study are also not known (47,57). SRH does not reflect the same health problems across genders (58)(59)(60)(61). Even inside one country, population differences exist in the protective effects of education and income on health (62)(63)(64).…”