Cumulative inequality and racial disparities in health: private insurance coverage and black/white differences in functional limitations

J Gerontol B Psychol Sci Soc Sci. 2014 Sep;69(5):798-808. doi: 10.1093/geronb/gbu005. Epub 2014 Feb 25.


Objectives: To test different forms of private insurance coverage as mediators for racial disparities in onset, persistent level, and acceleration of functional limitations among Medicare age-eligible Americans.

Method: Data come from 7 waves of the Health and Retirement Study (1996-2008). Onset and progression latent growth models were used to estimate racial differences in onset, level, and growth of functional limitations among a sample of 5,755 people aged 65 and older in 1996. Employer-provided insurance, spousal insurance, and market insurance were next added to the model to test how differences in private insurance mediated the racial gap in physical limitations.

Results: In baseline models, African Americans had larger persistent level of limitations over time. Although employer-provided, spousal provided, and market insurances were directly associated with lower persistent levels of limitation, only differences in market insurance accounted for the racial disparities in persistent level of limitations.

Discussion: Results suggest private insurance is important for reducing functional limitations, but market insurance is an important mediator of the persistently larger level of limitations observed among African Americans.

Keywords: Cumulative inequality; Functional limitations; Insurance; Private insurance..

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Activities of Daily Living* / psychology
  • Aged
  • Aged, 80 and over
  • Black or African American / ethnology
  • Black or African American / psychology
  • Cross-Sectional Studies / economics
  • Female
  • Health Status Disparities*
  • Hispanic or Latino / ethnology
  • Hispanic or Latino / psychology
  • Humans
  • Insurance Coverage / economics*
  • Insurance Coverage / trends
  • Insurance, Health / economics*
  • Insurance, Health / trends
  • Longitudinal Studies / economics
  • Male
  • Medicare / economics
  • Medicare / trends
  • Socioeconomic Factors
  • United States / epidemiology