Black seniors perceive health status differently

By Anne Harding

NEW YORK (Reuters Health) - Older African Americans more likely to rate their health as poor compared with older white Americans, even though when the two groups “are functioning extremely well, new research suggests.

In a group of healthy Medicare-eligible patients in their 70s, African Americans consistently rated their health worse than did whites, despite the fact that an objective test found their physical functioning was just as good. In fact, the racial disparity was largest among the study participants who scored the highest on physical functioning tests, the investigators report in The Journal of Gerontology: Social Sciences.

“It didn’t seem that physical functioning was really responsible for the overall rating of health,” Dr. S. Melinda Spencer of the University of South Carolina in Columbia, the lead researcher on the study, told Reuters Health. “We saw that as an indication that definitions of health are very much culturally constructed.”

Self-rated health is important because it has been shown to predict a person’s risk of dying over the next few years, as well as the likelihood that he or she will require nursing home placement, Spencer noted. Some researchers have hypothesized that older African Americans are more pessimistic about their health than their white peers, and more likely to rate their health poorly.

To investigate this “health pessimism hypothesis,” Spencer and her team compared self-rated health for 2,729 men and women ages 70 to 79 years to their performance on a series of four physical function tests, including ability to stand from a sitting position; balance in different standing positions; gait speed; and a walk on a narrow path to test balance. The subjects resided in or around the Pittsburgh or Memphis area. About 41 percent of the study participants were African American and just over half were female.

Overall, the African-American study participants scored worse on the physical function tests, and were less satisfied with their levels of social support. They were also less educated, on average, than were whites.

While 27.3 percent of the African American study participants rated their health as fair or poor, just 8.2 percent of whites did. Among whites, 17.6 percent said their health was excellent and 34 percent rated it as very good, compared to 8.7 percent and 25.3 percent of blacks, respectively. About 40 percent of both groups reported being in good health.

Black men and women with better physical functioning were less likely to rate their health unfavorably, but the racial disparity in health perceptions persisted and was actually greater among the best-functioning study participants.

White people scoring in the lowest third based on their physical functioning were 2.2 times more likely to rate their health favorably than blacks, while whites with the highest physical functioning were 5.5 times more likely to have a favorable view of their health than the highest-functioning blacks.

The most likely explanation for the racial disparities seen in the current study, Spencer said, is that older African Americans have a different way of thinking about their health than do older whites. It’s also possible, she added, that the accumulated affects of racism could be driving down their perception of their own health.

“Fundamentally a person knows that what’s going on in their life, what’s going on in their body is true to them,” says Spencer. “It really takes a life course perspective to understand how health is at any given snapshot in time.”

SOURCE: Journal of Gerontology: Social Sciences, January 2008.

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