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The 130th Annual Meeting of APHA |
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The 130th Annual Meeting of APHA |
Judith A. Long, MD, Internal Medicine, Philadelphia VA Center for Health Equity Research and Promotion, 1201 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104-6021, 215-898-4311, jalong@mail.med.upenn.edu and Katrina Armstrong, MD, Internal Medicine, University of Pennsylvania, 1233 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104.
Background. Despite growing concern, racial disparities in health persist. Mechanisms by which these disparities are created are postulated to be working at both the level of the individual as well as the neighborhood. However, few studies have evaluated if neighborhood characteristics help explain observed racial disparities in health. The objective of this study was to evaluate whether neighborhood characteristics help explain disparities in self-rated health between African Americans (AA) and Whites.
Methods. The data for these analyses come from two sources. Individual level data come from the 1998-99 Southeastern Pennsylvania Household Survey and neighborhoods were described using 1990 census ZIP code median family income. The outcome of interest was rating one’s own health as poor or fair in comparison to good or excellent. Hierarchical models were built to determine the independent contributions groups of variables had in explaining racial disparities in self-rated health. The study sample includes 1,766 AAs and 1,667 Whites living in Philadelphia.
Results. The study population came from 46 unique ZIP codes. As expected AAs were more likely to rate their health as poor or fair (26.5% of AAs versus 18.1% of Whites p <0.001). In addition, AAs were more likely to have both low individual SES and live in low income ZIP codes. 31.9% of AAs had low individual incomes compared to 18.6% of Whites, and 47.5% of AAs lived in the poorest neighborhoods compared to 8.8% of Whites. In multivariate analyses, after adjusting for individual level factors, AAs remained significantly more likely to rate their health as poor or fair compared to Whites (Table). Adding ZIP code median family income into the model explained an addition 17% of the variance, after which the difference between African Americans and Whites was no longer significant (Table).
Conclusions. Neighborhood charactersitics help explain racial disparites in self-rated health. To achieve the goal of reducing racial disparities in health we must start addressing the social environments in which people live.
| Table: Odds of Rating Health as Poor or Fair for African Americans Compared Whites | |
| Model | OR (95% CI) |
| 1: race | 1.63 (1.38-1.92) |
| 2: 1 plus age, sex, weight loss recommendation, having a chronic condition, having depressive symptoms and having been hospitalized in the last year | 1.65 (1.36-2.00) |
| 3: 2 plus smoking status and days of exercise per week, | 1.63 (1.34-1.99) |
| 4: 3 plus having medical insurance and having a regular source of care | 1.60 (1.32-1.95) |
| 5: 4 plus education completed and individual income | 1.35 (1.10-1.66) |
| 6: 5 plus ZIP code income | 1.24 (0.97-1.57) |
Learning Objectives:
Keywords: African American, Community
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.