Racial, ethnic, and socioeconomic disparities in trajectories of morbidity accumulation among older Americans
Introduction: Multimorbidity, the presence of multiple chronic health conditions, generally starts in middle and older age but there is considerable heterogeneity in the trajectory of morbidity accumulation. This study aimed to clarify the number of distinct trajectories and the potential associatio...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2023-06-01
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| Series: | SSM: Population Health |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S235282732300040X |
| _version_ | 1797823691900321792 |
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| author | AnnaMarie S. O'Neill Jason T. Newsom Em F. Trubits Miriam R. Elman Anda Botoseneanu Heather G. Allore Corey L. Nagel David A. Dorr Ana R. Quiñones |
| author_facet | AnnaMarie S. O'Neill Jason T. Newsom Em F. Trubits Miriam R. Elman Anda Botoseneanu Heather G. Allore Corey L. Nagel David A. Dorr Ana R. Quiñones |
| author_sort | AnnaMarie S. O'Neill |
| collection | DOAJ |
| description | Introduction: Multimorbidity, the presence of multiple chronic health conditions, generally starts in middle and older age but there is considerable heterogeneity in the trajectory of morbidity accumulation. This study aimed to clarify the number of distinct trajectories and the potential associations between race/ethnicity and socioeconomic status and these trajectories. Methods: Data from 13,699 respondents (age ≥51) in the Health and Retirement Study between 1998 and 2016 were analyzed with growth mixture models. Nine prevalent self-reported morbidities (arthritis, cancer, cognitive impairment, depressive symptoms, diabetes, heart disease, hypertension, lung disease, stroke) were summed for the morbidity count. Results: Three trajectories of morbidity accumulation were identified: low [starting with few morbidities and accumulating them slowly (i.e., low intercept and low slope); 80% of sample], increasing (i.e., low intercept and high slope; 9%), and high (i.e., high intercept and low slope; 11%). Compared to non-Hispanic (NH) White adults in covariate-adjusted models, NH Black adults had disadvantages while Hispanic adults had advantages. Our results suggest a protective effect of education for NH Black adults (i.e., racial health disparities observed at low education were ameliorated and then eliminated at increasing levels of education) and a reverse pattern for Hispanic adults (i.e., increasing levels of education was found to dampen the advantages Hispanic adults had at low education). Compared with NH White adults, higher levels of wealth were protective for both NH Black adults (i.e., reducing or reversing racial health disparities observed at low wealth) and Hispanic adults (i.e., increasing the initial health advantages observed at low wealth). Conclusion: These findings have implications for addressing health disparities through more precise targeting of public health interventions. This work highlights the imperative to address socioeconomic inequalities that interact with race/ethnicity in complex ways to erode health. |
| first_indexed | 2024-03-13T10:27:44Z |
| format | Article |
| id | doaj.art-414fc0a8876d4770ba3002d9774dfb14 |
| institution | Directory Open Access Journal |
| issn | 2352-8273 |
| language | English |
| last_indexed | 2024-03-13T10:27:44Z |
| publishDate | 2023-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | SSM: Population Health |
| spelling | doaj.art-414fc0a8876d4770ba3002d9774dfb142023-05-19T04:45:46ZengElsevierSSM: Population Health2352-82732023-06-0122101375Racial, ethnic, and socioeconomic disparities in trajectories of morbidity accumulation among older AmericansAnnaMarie S. O'Neill0Jason T. Newsom1Em F. Trubits2Miriam R. Elman3Anda Botoseneanu4Heather G. Allore5Corey L. Nagel6David A. Dorr7Ana R. Quiñones8VA Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, USA; Corresponding author. VA Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, USA.Department of Psychology, Portland State University, OR, USADepartment of Psychology, Portland State University, OR, USAOHSU-PSU School of Public Health, Oregon Health and Science University, Portland, OR, USADepartment of Health and Human Services, University of Michigan, Dearborn, MI, USADepartment of Internal Medicine, School of Medicine, Yale University, New Haven, CT, USACollege of Nursing, University of Arkansas for Medical Sciences, Little Rock, AR, USADepartment of Medical Informatics and Clinical Epidemiology, OHSU, Portland, OR, USADepartment of Family Medicine, Oregon Health & Science University, Portland, OR, USAIntroduction: Multimorbidity, the presence of multiple chronic health conditions, generally starts in middle and older age but there is considerable heterogeneity in the trajectory of morbidity accumulation. This study aimed to clarify the number of distinct trajectories and the potential associations between race/ethnicity and socioeconomic status and these trajectories. Methods: Data from 13,699 respondents (age ≥51) in the Health and Retirement Study between 1998 and 2016 were analyzed with growth mixture models. Nine prevalent self-reported morbidities (arthritis, cancer, cognitive impairment, depressive symptoms, diabetes, heart disease, hypertension, lung disease, stroke) were summed for the morbidity count. Results: Three trajectories of morbidity accumulation were identified: low [starting with few morbidities and accumulating them slowly (i.e., low intercept and low slope); 80% of sample], increasing (i.e., low intercept and high slope; 9%), and high (i.e., high intercept and low slope; 11%). Compared to non-Hispanic (NH) White adults in covariate-adjusted models, NH Black adults had disadvantages while Hispanic adults had advantages. Our results suggest a protective effect of education for NH Black adults (i.e., racial health disparities observed at low education were ameliorated and then eliminated at increasing levels of education) and a reverse pattern for Hispanic adults (i.e., increasing levels of education was found to dampen the advantages Hispanic adults had at low education). Compared with NH White adults, higher levels of wealth were protective for both NH Black adults (i.e., reducing or reversing racial health disparities observed at low wealth) and Hispanic adults (i.e., increasing the initial health advantages observed at low wealth). Conclusion: These findings have implications for addressing health disparities through more precise targeting of public health interventions. This work highlights the imperative to address socioeconomic inequalities that interact with race/ethnicity in complex ways to erode health.http://www.sciencedirect.com/science/article/pii/S235282732300040XRacial health disparitiesChronic illnessMorbiditySocioeconomic statusEducationWealth, Older adults |
| spellingShingle | AnnaMarie S. O'Neill Jason T. Newsom Em F. Trubits Miriam R. Elman Anda Botoseneanu Heather G. Allore Corey L. Nagel David A. Dorr Ana R. Quiñones Racial, ethnic, and socioeconomic disparities in trajectories of morbidity accumulation among older Americans SSM: Population Health Racial health disparities Chronic illness Morbidity Socioeconomic status Education Wealth, Older adults |
| title | Racial, ethnic, and socioeconomic disparities in trajectories of morbidity accumulation among older Americans |
| title_full | Racial, ethnic, and socioeconomic disparities in trajectories of morbidity accumulation among older Americans |
| title_fullStr | Racial, ethnic, and socioeconomic disparities in trajectories of morbidity accumulation among older Americans |
| title_full_unstemmed | Racial, ethnic, and socioeconomic disparities in trajectories of morbidity accumulation among older Americans |
| title_short | Racial, ethnic, and socioeconomic disparities in trajectories of morbidity accumulation among older Americans |
| title_sort | racial ethnic and socioeconomic disparities in trajectories of morbidity accumulation among older americans |
| topic | Racial health disparities Chronic illness Morbidity Socioeconomic status Education Wealth, Older adults |
| url | http://www.sciencedirect.com/science/article/pii/S235282732300040X |
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