Trends in Poor Health Indicators among Black and Hispanic Middle-aged and Older Adults in the United States, 1999-2018

Michelle Odlum, Nathalie Moise, Ian M. Kronish, Peter Broadwell, Carmela Alcántara, Nicole J. Davis, Ying Kuen K. Cheung, Adler Perotte, Sunmoo Yoon

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Abstract

Importance: 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. Objective: 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. Design, Setting, and Participants: In this repeated cross-sectional study, a total of 4856326 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. Exposure: The 1999 legislation to reduce racial/ethnic health disparities. Main Outcomes and Measures: Poor health indicators and disparities including major chronic diseases, physical inactivity, uninsured status, and overall poor health. Results: Among the 4856326 participants (2958041 [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). Conclusions and Relevance: This study suggests that Black-White disparities increased in diabetes, hypertension, and asthma, while Hispanic-White disparities remained in diabetes, hypertension, and uninsured status..

Original languageEnglish
Article numbere2025134
JournalJAMA network open
Volume3
Issue number11
DOIs
StatePublished - 11 Nov 2020
Externally publishedYes

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