Racial/Ethnic Disparities in Health: The Role of Lifestyle, Education, Income, and Wealth

Article excerpt

This article addresses the persistent relationship between race/ethnicity, SES, health-related lifestyle behaviors, and self-reported health using data from the 1995 National Health Interview Survey and its topical supplements. Through a series of models, we found that both SES (education, income, home ownership, and house and business monetary value) and health-related lifestyle behaviors (physical activity, nutrition awareness, and smoking) contribute to racial/ethnic disparities in self-reported health. Further, the impact of education on smoking behavior and self-reported health differs by race/ethnicity, with non-Hispanic whites receiving greater health benefits from education than African Americans and Hispanics. Although SES and lifestyle behaviors are indirect paths through which race/ethnicity affects health, the relationship between SES and health also is shaped by racial/ethnic status.

In the United States, health disparities between African Americans and non-Hispanic whites are persistent and well documented, though racial differences in health vary depending on which health outcome is considered. For example, although heart disease and emphysema appear to be more common among nonHispanic whites than African Americans (Pleis and Lethbridge-Çejku 2006), African Americans have higher rates of tuberculosis (Centers for Disease Control and Prevention 2007) and diabetes (Pleis and Lethbridge-Çejku 2006) than nonHispanic whites. Differences in cancer risks also vary across racial groups depending on the type of cancer. National Health Interview Survey (NHIS) data for 2005 indicate that prostate cancer is more common in African American males than their nonHispanic white counterparts, though white women are more likely to experience breast cancer than are African American women (Pleis and Lethbridge-Çejku 2006). In contrast, Hispanics tend to have health outcomes fairly similar to non-Hispanic whites. For example, data for 2004 reported by the National Center for Health Statistics (2007) indicate that whereas the mortality rate for African Americans is 1 .3 times higher than that for non-Hispanic whites, the ratio of the mortality rates for Hispanics to whites is 0.7.

It is widely accepted that inequality in socioeconomic status (SES) contributes to disparities in health between whites and African Americans (Hayward et al. 2000; Williams 2005), though less is understood about its contribution to health among Hispanics versus other racial/ethnic groups. Some studies have found that when controlling for SES, the effect of race on health disappears (Baquet et al. 1991; Rogers 1992) or at least diminishes substantially (e.g., Cooper 1993; Krieger and Fee 1994). Other studies have found that race and SES interact in their effects on health (Geronimus 1992, 1996; Pamuket al. 1998; Williams, Takeuchi, and Adair 1992).

In this article, we investigate the relationships among race/ethnicity, SES, and health, considering the role of lifestyle behaviors in health disparities. Our study is guided by three questions: What aspects of SES are important in explaining racial/ethnic differences in self-reported health? To what extent do race/ethnicity and SES effects on health operate through health-promoting and health risk-taking lifestyle behaviots? Do the health effects of SES and lifestyle behaviors differ by race/ethnicity? We address these questions by analyzing data from the 1995 National Health Interview Survey and its topical supplements. An advantage of drawing on the 1995 NHIS to address health disparities is that it provides a large sample with extensive data on a range of lifestyle behaviors and different dimensions of SES. Our analysis demonstrates that racial/ethnic differences in SES and health-related lifestyle behaviors, along with SES differences in lifestyle behaviors, are important in accounting for racial/ethnic disparities in self-reported health.

SOCIOECONOMIC STATUS AND HEALTH

SES is a multidimensional concept encompassing an individual's standing in terms of completed education, employment (e. …