142nd APHA Annual Meeting and Exposition

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Self-Rated Health and Cumulative Biological Risk Profile: Impact on the Measurement of Racial/Ethnic Health Disparities in the U.S

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Monday, November 17, 2014

Leticia Nogueira, PhD MPH , Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
Benjamin Le Cook, PhD , Psychiatry, Cambridge Health Alliance, Somerville, MD
Britni Belcher, PhD , National Cancer Institute, Rockville, MD
April Oh, PhD, MPH , NCI Health Behaviors Research Branch, SAIC-F NCI Frederick, Rockville, MD
Yan Li , Joint Program in Survey Methodology, University of Maryland, College Park, MD
Jill Koshiol, PhD , National Cancer Institute, Rockville, MD
Barry Graubard, PhD , National Cancer Institute, Rockville, MD
David Berrigan, PhD, MPH , Applied Research Program, National Cancer Institute, Bethesda, MD
Self-rated health (SRH) is a widely used indicator of general health status in epidemiologic studies.  However, using SRH to estimate health disparities may be problematic if individuals from different race/ethnic groups have systematically different health expectations and/or reporting standards.

The aim of this study was to test whether associations between biomarkers and SRH vary by race/ethnicity. We used biomarkers as health indicators since they are not subject to reporting heterogeneity and reflect aggregate effects of a variety of health conditions.

Biomarker concentrations were first dichotomized into above or below clinically recommended levels; these indicators were then summed to generate a biomarker score. We used weighted cumulative ordinal logistic regression to compare the distribution of biomarker scores by SRH between non-Hispanic white (NHW) (n=6,346), non-Hispanic black (NHB) (n=2,263), and Mexican Americans (2,434) from the 2001-2006 National Health and Nutrition Examination Survey (NHANES). The Fairlie decomposition method was used to estimate the relative contributions of physiological and sociodemographic factors to race/ethnic differences in SRH.

NHB participants were more likely to have unhealthy biomarker scores than NHW participants, among persons who rated their health as “fair/poor” [OR=1.62 (CI=1.30, 2.02)], “good” [1.18 (1.01, 1.37)], and “excellent/very good” [1.29 (1.07, 1.56)]. Mexican Americans were more likely to have healthy scores than NHW participants among persons who rated their health as “fair/poor” [0.75 (0.61, 0.94)] and “good” [0.71 (0.60, 0.85)], with no difference for “excellent/very good” [1.11 (0.90, 1.38)]. Sociodemographic factors accounted for approximately 30% of the observed differences in SRH between white and minority participants.

These findings contrast with previous research describing “health pessimism” among black adults and highlight the need for caution in using SRH to guide policy and programmatic decisions involving multi-ethnic populations.

Learning Areas:

Diversity and culture
Public health or related research
Social and behavioral sciences

Learning Objectives:
Compare the relationship between self-rated health and objectively-measured health (biomarkers) in different racial/ethnic groups

Keyword(s): Health Disparities/Inequities, Risk Factors/Assesment

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a postdoctoral fellow developing my research in health disparities. I have designed the project, analysed the data, and written the submitted abstract.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.