Distinct age and self-rated health crossover mortality effects for African Americans: Evidence from a national cohort study

Abstract

The predictive effects of age and self-rated health (SRH) on all-cause mortality are known to differ across race and ethnic groups. African American adults have higher mortality rates than Whites at younger ages, but this mortality disparity diminishes with advancing age and may “crossover” at about 75 to 80 years of age, when African Americans may show lower mortality rates. This pattern of findings reflects a lower overall association between age and mortality for African Americans than for Whites, and health-related mechanisms are typically cited as the reason for this age-based crossover mortality effect. However, a lower association between poor SRH and mortality has also been found for African Americans than for Whites, and it is not known if the reduced age and SRH associations with mortality for African Americans reflect independent or overlapping mechanisms. This study examined these two mortality predictors simultaneously in a large epidemiological study of 12,181 African Americans and 17,436 Whites. Participants were 45 or more years of age when they enrolled in the national REasons for Geographic and Racial Differences in Stroke (REGARDS) study between 2003 and 2007. Consistent with previous studies, African Americans had poorer SRH than Whites even after adjusting for demographic and health history covariates. Survival analysis models indicated statistically significant and independent race*age, race*SRH, and age*SRH interaction effects on all-cause mortality over an average 9-year follow-up period. Advanced age and poorer SRH were both weaker mortality risk factors for African Americans than for Whites. These two effects were distinct and presumably tapped different causal mechanisms. This calls into question the health-related explanation for the age-based mortality crossover effect and suggests that other mechanisms, including behavioral, social, and cultural factors, should be considered in efforts to better understand the age-based mortality crossover effect and other longevity disparities.

Development of algorithms for identifying fatal cardiovascular disease in Medicare claims

“…Most Medicare beneficiaries are ≥65 years of age; consequently, the mortality rate is high in this population. 7,8 One-third of CVD events among Medicare beneficiaries are fatal. 19 The hospital discharge diagnosis method has been used previously to define fatal MI and stroke.…”

“…Many analyses of Medicare claims data have investigated CVD as an outcome, but have relied on hospital discharge diagnoses and discharge disposition (ie, deceased or alive), an approach that fails to capture out‐of‐hospital CVD deaths and some in‐hospital CVD deaths . In 2013, 84% of Medicare beneficiaries were ≥65 years of age, and mortality is high in this population . Not having cause of death for Medicare beneficiaries can result in the inability to accurately estimate CVD event rates, as many events are fatal, and in biased exposure‐outcome associations due to censoring some CVD‐related deaths as nonevents.…”

“…[4][5][6] In 2013, 84% of Medicare beneficiaries were ≥65 years of age, and mortality is high in this population. 7,8 Not having cause of death for Medicare beneficiaries can result in the inability to accurately estimate CVD event rates, as many events are fatal, 9 and in biased exposure-outcome associations due to censoring some CVD-related deaths as nonevents. The goal of the current analysis was to develop claims-based algorithms to discriminate deaths that are fatal CVD, fatal CHD, and fatal stroke versus deaths from other causes.…”

Self‐rated health in mothers of children hospitalised for severe illnesses and mothers of healthy children: cross‐sectional study

“…It was demonstrated that the effect of the socio-economic status on SRH can be partially accounted for by lifestyle and psychological factors (16). Other factors that correlate with SRH are ethnic origin (17,18), place of residence (19) and the experience of single motherhood (20).…”

Mortality According to Gender, Ethnicity and Risk Factors in the Turkistan Region.

“…Despite on the adjustment on demographic indicators, estimation (self-estimation) of health, health status, mortality rates from all causes were significantly lower in African-American race than in those people with the white race. In older ages (75-80 years), race performance in African American individuals may be reduced [24].…”