Race and self assessed health status: The role of socioeconomic factors in the USA

Study objective - To estimate relative odds ratios and to ascertain the relative contribution of each socioeconomic covariate in explaining racial disparities in self assessed health status (for example, global health perceptions and functional limitations of daily activities). Design - National representative data from the 1987-88 national survey of families and households, a multistage, stratified probability sample of non-institutionalised American adults age 19 and older, were used. Logistic regression models enabled a multistage building strategy to be used in the analyses. Participants and setting - The study included three racial groups: whites (n = 9419), blacks (n = 2391), and Hispanics (n = 1004). While face to face interviews were carried out with each respondent, some portions of the interview were self administered to collect sensitive information. Main results - Compared with whites, blacks and Hispanics were more likely to assess health as poor and report having functional limitations of daily activities. Socioeconomic factors tended to play a different role in explaining racial disparities in self assessed health status. In global health, education tended to play a significant role in accounting for health disparities between whites and Hispanics. In functional limitations, none of the covariates explained racial differences for blacks, whereas for Hispanics, education and marital status explained racial differences. Conclusions - The debate over whether race is a proxy for socioeconomic conditions or race influences health independent of socioeconomic factors depends on the measure of health and racial group included in the study. Future studies should examine separately the differential impacts of various socioeconomic factors on varying domains of health.