Racial Burden of Chronic Disease

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DESCRIPTION (provided by applicant): Both the length of life and the quality of life lived are stratified along race/ethnic lines in the United States. Blacks can expect to live fewer years than whites and Hispanics. and they can anticipate more years of life with a disabling health problem. In stark contrast, Hispanics can expect to live remarkably few years with a disabling health condition. These race/ethnic differences in years with and without disability point to the importance of investigating disparities in chronic diseases -- the health problems that underlie disability and death. Drawing on the Health and Retirement Survey, the proposed study will take advantage of a 12-year observation period to follow persons as they experience the onset of fatal chronic conditions, develop co-morbid conditions, and ultimately die from major causes. We will use this information to develop demographic models of chronic disease experience quantifying the scope of race/ethnic disparities and the lifecycle processes through which disparities arise. The demographic models, in turn, lay a much needed foundation for developing analytic models incorporating socioeconomic conditions, lifestyle behaviors, health care use, and biomedical factors in accounting for race/ethnic differences in chronic disease processes. Specifically, the aims of this project are to: Develop demographic models of race/ethnic disparities in health allowing us to quantify: How race/ethnic differences in chronic disease experience give rise to disparities in the burden of chronic disease (i.e., the years lived with and without disease). Whether sex differences in chronic disease experience are consistent across race/ethnic groups, and similarly, whether the educational gradient in chronic disease is consistent across race/ethnic groups. Develop multivariate analytic models of race/ethnic differences in chronic disease processes (i.e., disease incidence, co-morbidity, and mortality), focusing on the role of socioeconomic resources from childhood through old age. Key questions are: To what degree are race/ethnic differences in chronic disease morbidity and mortality rooted in the race/ethnic stratification of socioeconomic resources? To what degree do socioeconomic resources equally benefit the health of each of the major race/ethnic groups? The proposed study represents a substantial step forward in quantifying disparities in chronic disease experience and in examining a broad range of SES mechanisms influencing the morbidity and mortality experiences of older blacks, whites, and Hispanics.