Social Determinants of Health Underlie Racial/Ethnic Disparities in Psychological Health and Well-Being

Abstract

This study sought to determine the impact of selected social determinants of health on psychological health and well-being (defined as depression, cognition, self-rated health) among Black and Hispanic/Latinx adults relative to White adults aged 51 to 89. We measured disparities in depression, cognition, and self-rated health among 2,306 Non-Hispanic/Latinx Black, 1,593 Hispanic/Latinx, and 7,244 Non-Hispanic/Latinx White adults from the Health and Retirement Study (n=11,143). Blinder-Oaxaca decomposition was used to examine whether differences in selected social determinants of health explained a larger share of the disparities than age, sex, measures of health, health behaviors, and healthcare utilization. Selected social determinants included education, parents’ education, number of years worked, marital status, veteran status, geographic residence, nativity status, income, and insurance coverage. Black and Hispanic/Latinx adults reported worse depression, cognition, and self-rated health compared to White adults. Selected social determinants of health explained a larger proportion of the Black-White disparities in depression (51%), cognition (39%), and self-rated health (37%) than did age, sex, measures of health, health behaviors, and healthcare utilization. Social determinants of health explained a larger proportion of the Hispanic/Latinx-White disparity in cognition (76%) and self-rated health (75%), but age and functional status primarily drove the disparity in depression (28%). Education, parents’ education, years worked, income, and insurance parity were social determinants associated with the disparities.In conclusion, differences in social determinants of health underlie racial/ethnic disparities in depression, cognition, and self-rated health among older adults. Education, income, number of years worked, and insurance parity are key social determinants of health.

Impact of educational attainment on time to cognitive decline among marginalized older adults: Cohort study of 20,311 adults

“…The beneficial effect of higher years of education on time to cognitive decline was different across racial and ethnic groups, such that White adults, on average, evidenced the longest benefit of 13 years, followed by Latinx adults with 12 years, and Black adults with 10 years. These findings were consistent after controlling for a variety of socioeconomic, medical, and psychosocial inequities 25,32 that are known to affect cognitive functioning among Black and Latinx adults in addition to selective attrition and decline due to all‐cause mortality.…”

“…Though our study attempted to control for potential confounding factors such as socioeconomic status 32 and medical comorbidity, 39,40 it is conceivable that other contextual factors such as educational quality, 41 literacy rates, 41 perceived discrimination, 36,37 stereotype threat, 35 test bias, 38 and inequities in psychosocial health and social determinants of health 25,32,42 influenced participants' cognitive performance. While previous studies have found similar rates of cognitive decline among Black, Latinx, and White adults in the HRS, 24 our study found different rates of decline using non‐linear modeling.…”

“…Understanding whether years of education differentially affect the age at which cognitive decline begins by race and ethnicity is important for the early deployment of services and supports to manage ADRD. In a recent study, inequities in educational attainment explained a greater proportion of the Latinx‐White disparity in cognitive performance (40%) than the Black‐White disparity (11%) 25 . This may suggest that the effect of attaining additional years of education may not be equivalent among Black, Latinx, and White older adults.…”

"Wellbeing and Emotions in Older Adults: An Investigation at the Permanent University of Adults in Alicante (Spain)"

“…Yet another examines the associations between social support from different types of relationships and psychological well-being, along with the mediating effects of satisfaction of basic psychological needs in these associations [47]. An attempt has even been made to determine the impact of specific social determinants of health on psychological health and well-being among older Black and Hispanic/Latino adults compared to White adults [48]. More focused on our educational context is research that evaluated the preliminary effects of a WeChat-based educational intervention on the social participation of older adults in China, finding significant improvements in social participation and self-worth [49].…”

Social connections as determinants of cognitive health and as targets for social interventions in persons with or at risk of Alzheimer’s disease and related disorders: a scoping review

“…Social determinants of health (SDoHs) are social and structural factors that affect incidence, prevalence, and course of diseases as well as health inequities and reportedly account for 30–55% of health outcomes, exceeding the contribution from medical factors (World Health Organization, 2008). SDoHs impact physical, mental, and cognitive function and longevity among all age groups including older adults (Jeste, 2022; Jester et al ., 2023). Over recent decades, the construct of social connections has acquired increasing attention as an SDoH.…”