Essays on race/ethnic variations in the dynamics of chronic diseases among middle and old aged Americans

TitleEssays on race/ethnic variations in the dynamics of chronic diseases among middle and old aged Americans
Publication TypeThesis
Year of Publication2010
AuthorsQuiñones, AR
AdvisorLiang, J
DegreePh.D.
Number of Pages139
Date Published2010
UniversityUniversity of Michigan
Thesis TypeDissertation
Call NumberAAT 3429238
KeywordsDemographics, Health Conditions and Status, Healthcare, Public Policy, Women and Minorities
Abstract

This dissertation is composed of three empirical papers on ethnic disparities in chronic disease morbidity. The first paper analyzes intra- and interpersonal differences in comorbidity burden reported by white, black and Mexican Americans. Data come from Health and Retirement Study (HRS) participants aged 51 and over from 1995-2006. Hierarchical linear models are employed to analyze ethnic variations in temporal changes of reported comorbidities. On average, participants have nearly two chronic diseases at the baseline, which increased to almost three conditions over 11 years. Mexican Americans demonstrate lower initial levels and slower accumulation of comorbidities relative to whites. In contrast, blacks show an elevated level of comorbidity, although their rate of change decelerated over time relative to whites. The second paper examines ethnic variations in the onset of hypertension diagnosis for white, black and Mexican Americans age 51 and over. Data came from HRS respondents who report being hypertension-free at the baseline for up to five time intervals (1995-2006). Discrete-time survival models are used to analyze ethnic variations in the probability of developing hypertension. We find the risk of newly diagnosed hypertension increased for all participants. Relative to white and Mexican Americans, black Americans had an elevated risk of incident hypertension throughout the 11-year period of observation. These variations persisted even when differences in health behaviors, socioeconomic status, demographic, and time-varying health characteristics were adjusted. The third paper examines the onset of diabetes mellitus diagnosis for HRS participants 51 and over who report being free of diabetes at the baseline. Discrete-time survival models are used to analyze ethnic variations in the probability of developing diabetes in up to five time intervals (1995-2006). We find the risk of newly diagnosed diabetes increased for all study participants. Relative to white and black Americans, Mexican Americans have a significantly elevated risk of diabetes. Increases in diabetes incidence for Mexican Americans persist through adjustment of health behaviors, socioeconomic status, demographic characteristics and changing health status. In contrast, increases in incident risk for black Americans relative to white Americans operate largely through changes in time-varying health status. Our findings of continued racial and ethnic disparities in chronic disease burden as well as hypertension and diabetes mellitus incidence suggest there are still improvements to be made in prevention efforts aimed at middle and older aged minorities. These empirical papers highlight the importance of social and structural factors as critical policy levers for mitigating chronic disease burden as well as reducing the elevated risk of two pervasive chronic diseases for minorities in the U.S.

Notes

ISBN 9781124278254

Endnote Keywords

MORBIDITY

Endnote ID

24250

Short TitleEssays on race/ethnic variations in the dynamics of chronic diseases among middle and old aged Americans
Citation Key6062