Trends in Poor Health Indicators Among Black and Hispanic Middle-aged and Older Adults in the United States, 1999-2018

Abstract

Importance: Adults who belong to racial/ethnic minority groups are more likely than White adults to receive a diagnosis of chronic disease in the United States.

Objective: To evaluate which health indicators have improved or become worse among Black and Hispanic middle-aged and older adults since the Minority Health and Health Disparities Research and Education Act of 2000.

Design, setting, and participants: In this repeated cross-sectional study, a total of 4 856 326 records were extracted from the Behavioral Risk Factor Surveillance System from January 1999 through December 2018 of persons who self-identified as Black (non-Hispanic), Hispanic (non-White), or White and who were 45 years or older.

Exposure: The 1999 legislation to reduce racial/ethnic health disparities.

Main outcomes and measures: Poor health indicators and disparities including major chronic diseases, physical inactivity, uninsured status, and overall poor health.

Results: Among the 4 856 326 participants (2 958 041 [60.9%] women; mean [SD] age, 60.4 [11.8] years), Black adults showed an overall decrease indicating improvement in uninsured status (β = -0.40%; P < .001) and physical inactivity (β = -0.29%; P < .001), while they showed an overall increase indicating deterioration in hypertension (β = 0.88%; P < .001), diabetes (β = 0.52%; P < .001), asthma (β = 0.25%; P < .001), and stroke (β = 0.15%; P < .001) during the last 20 years. The Black-White gap (ie, the change in β between groups) showed improvement (2 trend lines converging) in uninsured status (-0.20%; P < .001) and physical inactivity (-0.29%; P < .001), while the Black-White gap worsened (2 trend lines diverging) in diabetes (0.14%; P < .001), hypertension (0.15%; P < .001), coronary heart disease (0.07%; P < .001), stroke (0.07%; P < .001), and asthma (0.11%; P < .001). Hispanic adults showed improvement in physical inactivity (β = -0.28%; P = .02) and perceived poor health (β = -0.22%; P = .001), while they showed overall deterioration in hypertension (β = 0.79%; P < .001) and diabetes (β = 0.50%; P < .001). The Hispanic-White gap showed improvement in coronary heart disease (-0.15%; P < .001), stroke (-0.04%; P < .001), kidney disease (-0.06%; P < .001), asthma (-0.06%; P = .02), arthritis (-0.26%; P < .001), depression (-0.23%; P < .001), and physical inactivity (-0.10%; P = .001), while the Hispanic-White gap worsened in diabetes (0.15%; P < .001), hypertension (0.05%; P = .03), and uninsured status (0.09%; P < .001).

Conclusions and relevance: This study suggests that Black-White disparities increased in diabetes, hypertension, and asthma, while Hispanic-White disparities remained in diabetes, hypertension, and uninsured status.

Figure 1.. Trends in Health Disparities in the United States During the Past 20 Years (N = 4 856 326)

Figure 2.. Difference in Slope and the Prevalence of Health Outcomes Compared With White Individuals Among Middle-aged and Older Racial/Ethnic Minority Groups in the US

A, Slope difference compared with White individuals, 1999-2018. Red indicates diverging patterns (ie, widening gaps), and green indicates converging pattern (ie, narrowing gaps). The size of the dots corresponds to the magnitude of the slope difference to White adults. B, Prevalence difference compared with White individuals, 2009-2018. Red indicates results that are worse than for Whites adults, while green indicates results that are better than for White adults in terms of prevalence rates; for example, the trend lines for Black and White adults in physical inactivity are in the green light heading toward a right direction, but the prevalence of physical inactivity among Black adults remains unimproved. The β coefficient indicates the slope of yearly percentage of prevalence change. CHD indicates coronary heart disease; COPD, chronic obstructive pulmonary disease.