Trends in Poor Health Indicators Among Black and Hispanic Middle-aged and Older Adults in the United States, 1999-2018.
Trends in Poor Health Indicators Among Black and Hispanic Middle-aged and Older Adults in the United States, 1999-2018.
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DOI：
10.1001/jamanetworkopen.2020.25134
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发表时间：
2020-11-02
影响因子：
13.8
通讯作者：
Yoon S
中科院分区：
文献类型：
--
作者：
Odlum M;Moise N;Kronish IM;Broadwell P;Alcántara C;Davis NJ;Cheung YKK;Perotte A;Yoon S
在过去的20年里，黑人和西班牙裔中年人和老年人的哪些健康指标有所增加或减少？在这项对4 856 326名参与者的横断面研究中，黑人人口的健康指标一直呈上升趋势，与白色成年人相比，大多数疾病的患病率最高，导致差异增加;对于西班牙裔人口，糖尿病，高血压和无保险率的差异正在增加。然而，这两个群体中缺乏身体活动的健康差距已大大改善。这些研究结果表明，持续的循证策略，以促进体力活动可能与慢性病管理;新的研究策略是必要的，以减少健康差距。在美国，属于种族/少数民族群体的成年人比白色成年人更有可能接受慢性病诊断。评估自2000年少数民族健康和健康差异研究和教育法案以来，黑人和西班牙裔中年人和老年人的健康指标有所改善或恶化。在这项重复的横断面研究中，从1999年1月至2018年12月的行为风险因素监测系统中提取了4856326条记录，这些记录来自自认为是黑人（非西班牙裔），西班牙裔（非白色）或白色且年龄在45岁或以上的人。1999年关于减少种族/民族健康差距的立法。健康指标和差距不佳，包括主要慢性病、缺乏身体活动、无保险状况和总体健康状况不佳。在4 856 326名参与者中，（2 958 041 [60.9%]名妇女;平均[SD]年龄，60.4 [11.8]岁），黑人成年人总体下降，表明无保险状况有所改善（β =-0.40%; P <.001）和缺乏身体活动（β =-0.29%; P <.001），而总体增加表明高血压恶化（β = 0.88%; P <.001）、糖尿病（β = 0.52%; P <.001）、哮喘（β = 0.25%; P <.001）和中风（β = 0.15%; P <.001）。黑白差距（即组间β的变化）显示改善（2条趋势线汇合）处于无保险状态（-0.20%; P <.001）和缺乏身体活动（-0.29%; P <.001），而黑白差距恶化糖尿病（2条趋势线发散）（0.14%; P <.001）、高血压（0.15%; P <.001）、冠心病（0.07%; P <.001）、中风（0.07%; P <.001）和哮喘（0.11%; P <.001）。西班牙裔成年人的身体活动减少（β =-0.28%; P = 0.02）和健康状况不佳（β =-0.22%; P = 0.001）有所改善，而高血压（β = 0.79%; P <0.001）和糖尿病（β = 0.50%; P <0.001）总体恶化。西班牙裔-白人差距显示冠心病改善（− 0.15%; P <.001），中风（− 0.04%; P <.001），肾脏疾病（-0.06%; P <.001），哮喘（− 0.06%; P =.02），关节炎（-0.26%; P <.001），抑郁症（-0.23%; P <.001），缺乏身体活动（-0.10%; P =.001），而西班牙裔白人在糖尿病（0.15%; P <.001），高血压（0.05%; P =.03）和无保险状态（0.09%; P <.001）方面的差距恶化。这项研究表明，黑人-白人在糖尿病、高血压和哮喘方面的差异增加，而西班牙裔-白人在糖尿病、高血压和无保险状态方面的差异仍然存在。这项横断面研究评估了自2000年少数民族健康和健康差异研究和教育法案以来，黑人和西班牙裔中年人和老年人的健康指标有所改善或恶化。
Which health indicators have increased or decreased among Black and Hispanic middle-aged and older adults in the last 20 years? In this cross-sectional study of 4 856 326 participants, poor health indicators have consistently trended upward among the Black population, with the highest prevalence ever for most diseases compared with White adults, resulting in increased disparities; for the Hispanic population, disparities in diabetes, hypertension, and uninsured rates are increasing. However, health disparities for physical inactivity in both groups have substantially improved. These findings suggest that continued evidence-based strategies to promote physical activity may be associated with chronic disease management; novel research strategies are necessary to reduce health disparities. Adults who belong to racial/ethnic minority groups are more likely than White adults to receive a diagnosis of chronic disease in the United States. To evaluate which health indicators have improved or become worse among Black and Hispanic middle-aged and older adults since the Minority Health and Health Disparities Research and Education Act of 2000. In this repeated cross-sectional study, a total of 4 856 326 records were extracted from the Behavioral Risk Factor Surveillance System from January 1999 through December 2018 of persons who self-identified as Black (non-Hispanic), Hispanic (non-White), or White and who were 45 years or older. The 1999 legislation to reduce racial/ethnic health disparities. Poor health indicators and disparities including major chronic diseases, physical inactivity, uninsured status, and overall poor health. Among the 4 856 326 participants (2 958 041 [60.9%] women; mean [SD] age, 60.4 [11.8] years), Black adults showed an overall decrease indicating improvement in uninsured status (β = −0.40%; P < .001) and physical inactivity (β = −0.29%; P < .001), while they showed an overall increase indicating deterioration in hypertension (β = 0.88%; P < .001), diabetes (β = 0.52%; P < .001), asthma (β = 0.25%; P < .001), and stroke (β = 0.15%; P < .001) during the last 20 years. The Black-White gap (ie, the change in β between groups) showed improvement (2 trend lines converging) in uninsured status (−0.20%; P < .001) and physical inactivity (−0.29%; P < .001), while the Black-White gap worsened (2 trend lines diverging) in diabetes (0.14%; P < .001), hypertension (0.15%; P < .001), coronary heart disease (0.07%; P < .001), stroke (0.07%; P < .001), and asthma (0.11%; P < .001). Hispanic adults showed improvement in physical inactivity (β = −0.28%; P = .02) and perceived poor health (β = −0.22%; P = .001), while they showed overall deterioration in hypertension (β = 0.79%; P < .001) and diabetes (β = 0.50%; P < .001). The Hispanic-White gap showed improvement in coronary heart disease (−0.15%; P < .001), stroke (−0.04%; P < .001), kidney disease (−0.06%; P < .001), asthma (−0.06%; P = .02), arthritis (−0.26%; P < .001), depression (−0.23%; P < .001), and physical inactivity (−0.10%; P = .001), while the Hispanic-White gap worsened in diabetes (0.15%; P < .001), hypertension (0.05%; P = .03), and uninsured status (0.09%; P < .001). This study suggests that Black-White disparities increased in diabetes, hypertension, and asthma, while Hispanic-White disparities remained in diabetes, hypertension, and uninsured status. This cross-sectional study evaluates which health indicators have improved or worsened among Black and Hispanic middle-aged and older adults since the Minority Health and Health Disparities Research and Education Act of 2000.
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