Racial, ethnic, and socioeconomic disparities in trajectories of morbidity accumulation among older Americans.
Racial, ethnic, and socioeconomic disparities in trajectories of morbidity accumulation among older Americans.
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DOI：
10.1016/j.ssmph.2023.101375
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发表时间：
2023-06
影响因子：
4.7
通讯作者：
Quinones, Ana R.
中科院分区：
文献类型：
--
作者：
O'Neill, AnnaMarie S.;Newsom, Jason T.;Trubits, Em F.;Elman, Miriam R.;Botoseneanu, Anda;Allore, Heather G.;Nagel, Corey L.;Dorr, David A.;Quinones, Ana R.
关键词：
多发性疾病，即存在多种慢性健康状况，通常始于中年和老年，但发病率积累的轨迹存在相当大的异质性。本研究旨在阐明不同轨迹的数量以及种族/民族和社会经济地位与这些轨迹之间的潜在关联。1998年至2016年期间，健康与退休研究中的13，699名受访者（年龄≥51岁）的数据使用增长混合模型进行了分析。将9种自我报告的患病率（关节炎、癌症、认知障碍、抑郁症状、糖尿病、心脏病、高血压、肺病、中风）汇总为发病率计数。确定了发病率累积的三种轨迹：低[开始发病率很少，慢慢累积（即，低截距和低斜率）;样品的80%]，增加（即，低截距和高斜率; 9%），和高（即，高截距和低斜率; 11%）。在协变量调整模型中，与非西班牙裔（NH）白色成人相比，NH黑人成人存在劣势，而西班牙裔成人具有优势。我们的研究结果表明，教育对NH黑人成年人有保护作用（即，在低教育水平观察到的种族健康差异得到改善，然后在教育水平提高时消除），西班牙裔成年人的模式相反（即，教育水平的提高削弱了西班牙裔成年人在低教育水平下的优势）。与NH白色成年人相比，更高水平的财富对NH黑人成年人都有保护作用（即，减少或逆转在低财富时观察到的种族健康差异）和西班牙裔成年人（即，增加在低财富时观察到的初始健康优势）。这些研究结果对通过更精确地确定公共卫生干预措施的目标来解决健康差距问题具有影响。这项工作强调了解决社会经济不平等的必要性，这种不平等以复杂的方式与种族/族裔相互作用，损害健康。在老年人中确定了三种发病率累积的轨迹。发病率轨迹为：高、增加和低。种族、民族和教育与发病率轨迹相关。教育和财富以不同的方式与种族/民族相互作用，以预测轨迹。随着财富的增加，种族健康差异得到改善甚至逆转。
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. 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. 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). 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. Three trajectories of morbidity accumulation were identified among older adults. The morbidity trajectories were: high, increasing and low. Race, ethnicity, and education were associated with morbidity trajectory. Education and wealth interacted in distinct ways with race/ethnicity to predict trajectory. Racial health disparities ameliorated or even reversed with increasing wealth.
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影响因子：
2.9
作者：
Ashworth, Mark;Durbaba, Stevo;Dodhia, Hiten
通讯作者：
Dodhia, Hiten
影响因子：
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作者：
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DOI：
10.1111/j.1751-9004.2007.00054.x
发表时间：
2008-01-01
影响因子：
4.6
作者：
Jung, Tony;Wickrama, K. A. S.
通讯作者：
Wickrama, K. A. S.
DOI：
10.1080/10705510701575396
发表时间：
2007-01-01
影响因子：
6
作者：
Nylund, Karen L.;Asparoutiov, Tihomir;Muthen, Bengt O.
通讯作者：
Muthen, Bengt O.
DOI：
10.1093/jurban/jti061
发表时间：
2005-06-01
影响因子：
6.6
作者：
LaVeist, TA
通讯作者：
LaVeist, TA