Income, education, years worked, and insurance parity are key social detriments of health (SDoH) that contribute to racial and ethnic disparities in cognition, health, and depression among older adults. These findings were published in The American Journal of Psychiatry.
In the United States, White adults are more likely than Hispanic adults and less likely than Black adults to live with multiple chronic diseases. In addition, Black adults develop multimorbidity earlier than White adults, and both Black and Hispanic adults are more likely to live with severe and persistent functional disability than White adults.
Given these ethnic and racial disparities, this cross-sectional study evaluated whether SDoH contributed to these trends using data sourced from the Health and Retirement Study.
The White (n=7244), Black (n=2306), and Hispanic (n=1593) cohorts comprised individuals with mean ages of 71.43, 65.99, and 65.48 years (P <.001); 43%, 40%, and 44% were men (P =.007); they had attended an average of 13.49, 12.59, and 10.07 years of education (P <.001); they worked for 34.82, 26,54, and 21.06 years (P <.001); and they had a median annual household income $47,673, $28,975, $25,200, respectively.
In the analysis comparing the Black and White groups, if both cohorts had similar characteristics, 138% of the disparity in depressive symptoms, 85% of the disparity in self-rated health, and 14% of the disparity in cognition would be attenuated. These values indicated that most of the disparity in depression and cognition between groups was explained by demographics, physical health, mental health, health behaviors, and health care utilization characteristics and SDoH specifically explained 51%, 37%, and 39% for depression, self-rated health, and cognition, respectively.
The largest proportion of these disparities was explained by marital status, number of years worked, education, income, Medicare coverage, and Medicaid coverage.
In the comparison of Hispanic and White groups, 105% of the disparity in depression, 92% of the disparity in self-rated health, and 64% of the disparity in cognition would be attenuated if the 2 groups had similar characteristics, of which SDoH accounted for 28%, 75%, and 76%, respectively. The largest SDoH contributors to disparities included education, mother’s education, father’s education, income, number of years worked, Medicare coverage, and Medicaid coverage.
Unlike in the comparison between Black and White individuals, in the comparison between Hispanic and White individuals, the largest share of the disparities in depressive symptomology was due to non-SDoH characteristics, such as age and physical health.
In a sensitivity analysis that focused on the nativity status of individuals in the Hispanic cohort, results were consistent with the main analysis.
The major limitation of this study was the cross-sectional design which did not allow for causal relationships to be evaluated.
“[W]e found strong evidence that selected SDoH accounted for larger proportions of Black–White disparities in depressive symptomatology, cognition, and self-rated health than each of the other 4 domains (demographics, physical health, mental health and cognition, and health behaviors and health care utilization). Conversely, selected SDoH were associated with larger proportions of the Hispanic/Latinx–White disparities in cognition and self-rated health,” concluded the study authors.
Jester DJ, Kohn JN, Tibiriçá L, et al. Differences in social determinants of health underlie racial/ethnic disparities in psychological health and well-being: study of 11,143 older adults. Am J Psychiatry. 2023;appiajp20220158. doi:10.1176/appi.ajp.20220158