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Distinct age and self-rated health crossover mortality effects for African Americans: Evidence from a national cohort study.

TitleDistinct age and self-rated health crossover mortality effects for African Americans: Evidence from a national cohort study.
Publication TypeJournal Article
Year of Publication2016
AuthorsRoth, DL, Skarupski, KA, Crews, DC, Howard, VJ, Locher, JL
JournalSoc Sci Med
Volume156
Pagination12-20
Date Published2016 May
ISSN1873-5347
KeywordsAfrican Americans, Age Distribution, Aged, Aged, 80 and over, Cohort Studies, Diagnostic Self Evaluation, European Continental Ancestry Group, Female, Health Status Disparities, Humans, Male, Middle Aged, Mortality, United States
Abstract

The predictive effects of age and self-rated health (SRH) on all-cause mortality are known to differ across race and ethnic groups. African American adults have higher mortality rates than Whites at younger ages, but this mortality disparity diminishes with advancing age and may "crossover" at about 75-80 years of age, when African Americans may show lower mortality rates. This pattern of findings reflects a lower overall association between age and mortality for African Americans than for Whites, and health-related mechanisms are typically cited as the reason for this age-based crossover mortality effect. However, a lower association between poor SRH and mortality has also been found for African Americans than for Whites, and it is not known if the reduced age and SRH associations with mortality for African Americans reflect independent or overlapping mechanisms. This study examined these two mortality predictors simultaneously in a large epidemiological study of 12,181 African Americans and 17,436 Whites. Participants were 45 or more years of age when they enrolled in the national REasons for Geographic and Racial Differences in Stroke (REGARDS) study between 2003 and 2007. Consistent with previous studies, African Americans had poorer SRH than Whites even after adjusting for demographic and health history covariates. Survival analysis models indicated statistically significant and independent race*age, race*SRH, and age*SRH interaction effects on all-cause mortality over an average 9-year follow-up period. Advanced age and poorer SRH were both weaker mortality risk factors for African Americans than for Whites. These two effects were distinct and presumably tapped different causal mechanisms. This calls into question the health-related explanation for the age-based mortality crossover effect and suggests that other mechanisms, including behavioral, social, and cultural factors, should be considered in efforts to better understand the age-based mortality crossover effect and other longevity disparities.

DOI10.1016/j.socscimed.2016.03.019
Alternate JournalSoc Sci Med
PubMed ID27015163
PubMed Central IDPMC5084845
Grant ListK07 AG043588 / AG / NIA NIH HHS / United States
R01 AG039588 / AG / NIA NIH HHS / United States
U01 NS041588 / NS / NINDS NIH HHS / United States
P30DK056336 / DK / NIDDK NIH HHS / United States
K07AG043588 / AG / NIA NIH HHS / United States
P30 DK056336 / DK / NIDDK NIH HHS / United States
K23DK097184 / DK / NIDDK NIH HHS / United States