Socioeconomic Status and Health in Blacks and Whites: The Problem of Residual Confounding and the Resiliency of Race

Kaufman, Jay S.; Cooper, Richard S.; McGee, Daniel

doi:10.1097/00001648-199711000-00006

Cited by 285 publications

(347 citation statements)

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“…In considering the causes of this association, the evaluation of intrinsic (e.g., genetic) association of race/ ethnicity with disparate health outcomes can be confounded by multiple comorbid and socioeconomic conditions. 22,23 As an example, increased BMI is associated with greater degrees of loss of joint ROM in boys with hemophilia, as noted in the previous text. 7 In the general population (aged 2-19 years), Mexican-American boys and non-Hispanic African-American boys are each more likely than non-Hispanic white boys to have a BMI above the 97th percentile.…”

Section: Discussionmentioning

confidence: 77%

Physical Functioning in Boys with Hemophilia in the U.S.

Monahan¹,

Baker²,

Riske³

et al. 2011

American Journal of Preventive Medicine

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Section: Discussionmentioning

confidence: 77%

Physical Functioning in Boys with Hemophilia in the U.S.

Monahan¹,

Baker²,

Riske³

et al. 2011

American Journal of Preventive Medicine

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“…Consequently, the overlap between race and socioeconomic status complicates efforts to determine whether it is "race and class" or "race or class" that produces disparities in health status. 17,18,24,26,27 In a previous set of analysis, we have demonstrated that the typical approach to dealing with race/SES confounding may not be adequate. 22 That is, simply adjusting for socioeconomic status in multivariate models may not be sufficient to produce truly comparable samples across race groups.…”

Section: Introductionmentioning

confidence: 97%

“…22,23 Many previously published studies have commented on confounding of race with socioeconomic status. 13,17,18,22,24,25 In short, health status varies by race. Health status varies by socioeconomic status.…”

Section: Introductionmentioning

confidence: 99%

“…Multivariate modeling may not be adequate to account for these sources of heterogeneity. 17,24,28 In addition to race/SES confounding, much of the health disparities research literature is likely biased because of racial segregation. 17,[29][30][31] The U.S. is a highly racially segregated society, whereby African Americans and whites have quite different health risk exposures.…”

Section: Introductionmentioning

confidence: 99%

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Exploring Health Disparities in Integrated Communities: Overview of the EHDIC Study

et al. 2007

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Progress in understanding the nature of health disparities requires data that are race-comparative while overcoming confounding between race, socioeconomic status, and segregation. The Exploring Health Disparities in Integrated Communities (EHDIC) study is a multisite cohort study that will address these confounders by examining the nature of health disparities within racially integrated communities without racial disparities in socioeconomic status. Data consisted of a structured questionnaire and blood pressure measurements collected from a sample of the adult population (age 18 and older) of two racially integrated contiguous census tracts. This manuscript reports on baseline results from the first EHDIC site, a low-income urban community in southwest Baltimore, Maryland (EHDIC-SWB). In the adjusted models, African Americans had lower rates of smoking and fair or poor self-rated health than whites, but no race differences in obesity, drinking, or physical inactivity. Our findings indicate that accounting for race differences in exposure to social conditions reduces or eliminates some health-related disparities. Moreover, these findings suggest that solutions to the seemingly intractable health disparities problem that target social determinants may be effective, especially those factors that are confounded with racial segregation. Future research in the area of health disparities should seek ways to account for confounding from SES and segregation.

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“…22 The present study focuses on the SES measures used most frequently in the US literature-education and income-and considers them in relation to four important health indicators-low birthweight, delayed prenatal care, unintended pregnancy, and breastfeeding intention-to provide guidance for the measurement and interpretation of SES in studies of racial/ethnic disparities. A specific objective was to use data from a large and ethnically diverse, statewiderepresentative population-based survey to examine empirically whether the SES factor selected (education or income) and the manner of specifying it (e.g., maternal education vs paternal education; household income vs the ratio of household income to the federal poverty level vs household income divided by family size; continuous vs grouped variable) could affect conclusions regarding racial/ethnic disparities in these health indicators.…”

mentioning

confidence: 99%

Measuring socioeconomic status/position in studies of racial/ethnic disparities: Maternal and infant health

Braveman¹,

Cubbin²,

Marchi³

et al. 2001

Public Health Reports

139

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SYNOPSISObjective. Theoretical and empiric considerations raise concerns about how socioeconomic status/position (abbreviated here as SES) is often measured in health research. The authors aimed to guide the use of two common socioeconomic indicators, education and income, in studies of racial/ethnic disparities in low birthweight, delayed prenatal care, unintended pregnancy, and breastfeeding intention.Methods. Data from a statewide postpartum survey in California (N = 10,055) were linked to birth certificates. Overall and by race/ethnicity, the authors examined: (a) correlations among several measures of education and income; (b) associations between each SES measure and health indicator; and (c ) racial/ ethnic disparities in the health indicators "adjusting" for different SES measures.Results. Education-income correlations were moderate and varied by race/ ethnicity. Racial/ethnic associations with the health indicators varied by SES measure, how SES was specified, and by health indicator.Conclusions. Conclusions about the role of race/ethnicity could vary with how SES is measured. Education is not an acceptable proxy for income in studies of ethnically diverse populations of childbearing women. SES measures generally should be outcome-and population-specific, and chosen on explicit conceptual grounds; researchers should test multiple theoretically appropriate measures and consider how conclusions might vary with how SES is measured. Researchers should recognize the difficulty of measuring SES and interpret findings accordingly.

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Socioeconomic Status and Health in Blacks and Whites: The Problem of Residual Confounding and the Resiliency of Race

Cited by 285 publications

References 0 publications

Physical Functioning in Boys with Hemophilia in the U.S.

Physical Functioning in Boys with Hemophilia in the U.S.

Exploring Health Disparities in Integrated Communities: Overview of the EHDIC Study

Measuring socioeconomic status/position in studies of racial/ethnic disparities: Maternal and infant health

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