Race, socioeconomic status, and health

Complexities, ongoing challenges, and research opportunities

Key Points

Highlight:

• Appreciation of the multiple factors that affect the racial patterning of the distribution of disease is necessary to understand the racial disparities in health.

Key points:

• Racial disparities in health have been long noted in the United States.
• However, race reflects multiple dimensions of social inequality, and understanding of the multiple factors is highly important for addressing racial disparities in health.
• One of the characteristics of the elevated rates of disease for minorities compared to whites is the earlier onset of illness, greater severity of the disease, and poorer survival.
• The incident heart failure before the age of 50 was 20 times more common in blacks than whites.
• Racial differences in socioeconomic status make a substantial contribution to racial disparities in health.
• From 1980 to 2006, both blacks and Hispanics had levels of overall poverty that are two to three times higher than those of whites.
• Migration makes an important contribution to the observed mortality rates.
• Understanding the biological differences between racial groups should be improved.
• There are differences in genetic susceptibility in human populations but they are unlikely to be patterned by race.
• The overall contribution of genetics to population health is likely to be modest.
• Contribution of medical care to racial and socioeconomic status disparities in health deserves renewed examination and research.

Conclusions:

• Social disparities in health are large, pervasive, and persistent over time.
• We need to better understand what happens when these social statuses interact.
• More efforts to reduce social inequalities in health should be combined with efforts to improve the health of all social groups.

Lay Summary

Racial disparities in health have been long noted in the United States. The differences in socioeconomic status across racial groups are a major contributor to racial disparities in health. However, race reflects multiple dimensions of social inequality. Understanding and effectively addressing racial disparities in health requires an appreciation of the contributing factors that importantly affect the racial patterning of the distribution of disease.

In this paper, Dr. Collins group provides an overview of recent research on racial disparities in health and the complex ways in which race, ethnicity, and socioeconomic status combine to affect patterns of the distribution of disease. This paper was published in the February 2010 issue of the journal “Annals of the New York Academy of Sciences”.

One of the characteristics of the elevated rates of disease for minorities compared to whites is the earlier onset of illness, greater severity of the disease, and poorer survival. A 20-year follow-up of the CARDIA study’s cohort of young adults found that incident heart failure before the age of 50 was 20 times more common in blacks than whites with the average age of onset being 39 years old.

Racial differences in socioeconomic status make a substantial contribution to racial disparities in health. National data for the United States reveal strikingly high levels of racial inequality in socioeconomic status and relatively little change over time. From 1980 to 2006, both blacks and Hispanics have levels of overall poverty that are two to three times higher than those of whites.

Migration makes an important contribution to the observed mortality rates. National data reveal that white, Black, Asian, and Latino immigrants have lower rates of adult and infant mortality than their native-born peers. A closer examination of the data on migration status and health reveals that increased maternal mortality in immigrants than the native-born. Also, Hispanic women groups have a higher risk of low birth weight and prematurity than whites.

In the 19th-early 20th century, racial disparities in health were presumed to reflect biological differences between racial groups. This view has been shown to be problematic because human genetic variation does not naturally aggregate into subgroups that match our racial categories. There are differences in genetic susceptibility in human populations but they are unlikely to be strongly patterned by race. Also, the overall contribution of genetics to population health is likely to be modest. Therefore, more research on the potential contribution of genetics will require broad guidelines to understand how social exposures combine with biology to affect patterns of disease.

Lastly, the contribution of medical care to racial and socioeconomic status disparities in health deserves renewed examination and research. There are large racial differences in insurance coverage. The reduced access of many racial minorities to educational and employment opportunities noted earlier leads them to be overrepresented in poor quality jobs that do not provide health insurance.

In conclusion, social disparities in health are large, pervasive, and persistent over time. These inequalities in health reflect larger inequalities in society. We need to better understand what happens when these social statuses interact. More efforts to reduce social inequalities in health should be combined with efforts to improve the health of all social groups.

Research Source: https://pubmed.ncbi.nlm.nih.gov/20201869/