Contextualizing Educational Disparities in Health: Variations by Race/Ethnicity, Nativity, and County-Level Characteristics

Mortgage Borrowing and Chronic Disease Outcomes in Older Age: Evidence From Biomarker Data in the Health and Retirement Study

OBJECTIVES

The medical diagnosis of a disease is common in older age and can carry significant financial costs. For many older adults, equity in a home is their primary component of wealth; however, housing wealth is illiquid. We analyze the relationship between the liquidation of housing wealth through mortgage borrowing on older homeowners' ability to successfully control a disease.

METHODS

We use data on homeowners aged 65 and older from the 1998-2016 waves of the Health and Retirement Study (N = 3,457). We use biomarkers and physical health indicators to measure disease control following a medical diagnosis of diabetes, heart condition, high blood pressure, lung disease, or cancer. Random effects linear probability and instrumental variable regressions estimate the associations of housing wealth, new mortgage borrowing, and disease control.

RESULTS

Descriptively, 28% of older homeowners who borrow against home equity are not controlled on their disease, compared to 33% of non-borrowers. Panel data instrumental variable regressions show that each $10,000 borrowed from home equity after diagnosis is associated with a 17-percentage-point reduction in the probability of the disease not being controlled.

DISCUSSION

Many older adults are not able or willing to liquidate housing wealth, and the ability to borrow also depends on changes in home values. Thus, housing wealth is not a uniform social determinant of health but is shaped by older adults' participation in financial markets.

Institutional Context Shapes the Physical Health of College Graduates Differently for U.S. White, Black, and Hispanic Adults

Greater educational attainment is generally associated with healthier and longer lives. However, important heterogeneity in who benefits from educational attainment, how much, and why remains underexplored. In particular, in the United States, the physical health returns to educational attainment are not as large for minoritized racial and ethnic groups compared with individuals racialized as White. Yet, our current understanding of ethnoracial differences in educational health disparities is limited by an almost exclusive focus on the quantity of education attained without sufficient attention to heterogeneity within educational attainment categories, such as different institution types among college graduates. Using biomarker data from the National Longitudinal Study of Adolescent to Adult Health (Add Health), we test whether the physical health of college graduates in early adulthood (aged 24-32) varies by institution type and for White, Black, and Hispanic adults. In considering the role of the college context, we conceptualize postsecondary institutions as horizontally stratified and racialized institutional spaces with different implications for the health of their graduates. Finally, we quantify the role of differential attendance at and returns to postsecondary institution type in shaping ethnoracialized health disparities among college graduates in early adulthood.

Patterns and Life Course Determinants of Black-White Disparities in Biological Age Acceleration: A Decomposition Analysis

Despite the prominence of the weathering hypothesis as a mechanism underlying racialized inequities in morbidity and mortality, the life course social and economic determinants of Black-White disparities in biological aging remain inadequately understood. This study uses data from the Health and Retirement Study (n = 6,782), multivariable regression, and Kitagawa-Blinder-Oaxaca decomposition to assess Black-White disparities across three measures of biological aging: PhenoAge, Klemera-Doubal biological age, and homeostatic dysregulation. It also examines the contributions of racial differences in life course socioeconomic and stress exposures and vulnerability to those exposures to Black-White disparities in biological aging. Across the outcomes, Black individuals exhibited accelerated biological aging relative to White individuals. Decomposition analyses showed that racial differences in life course socioeconomic exposures accounted for roughly 27% to 55% of the racial disparities across the biological aging measures, and racial disparities in psychosocial stress exposure explained 7% to 11%. We found less evidence that heterogeneity in the associations between social exposures and biological aging by race contributed substantially to Black-White disparities in biological aging. Our findings offer new evidence of the role of life course social exposures in generating disparities in biological aging, with implications for understanding age patterns of morbidity and mortality risks.

Intersectional Approaches to Minority Aging Research

Purpose of Review

Growing racial/ethnic diversity among America's older adults necessitates additional research specifically focused on health and well-being among aging minoritized populations. Although Black and Latinx adults in the USA tend to face worse health outcomes as they age, substantial evidence points to unexpected health patterns (e.g., the race paradox in mental health, the Latino health paradox) that challenge our understanding of health and aging among these populations. In this review, we demonstrate the value of intersectionality theory for clarifying these health patterns and highlight the ways that intersectionality has been applied to minority aging research. To advance the field, we also make several recommendations for incorporating intersectional approaches in future scholarship on minority aging.

Recent Findings

Scholars have applied intersectional approaches to health and aging to unravel how social statuses and social conditions, such as race, ethnicity, gender, nativity, incarceration history, geographic region, and age, produce distinct shared experiences that shape health trajectories through multiple mechanisms.

Summary

We highlight common intersectional approaches used in minority aging research and underscore the value of this perspective for elucidating the complex, and often unexpected, health patterns of aging minoritized populations. We identify several key lessons and propose recommendations to advance scholarship on minority aging.

Structural racism in school contexts and adolescent depression: Development of new indices for the National Longitudinal Study of Adolescent to Adult Health and beyond

Racial discrimination is an important predictor of racial inequities in mental and physical health. Scholars have made progress conceptualizing and measuring structural forms of racism, yet, little work has focused on measuring structural racism in social contexts, which are especially relevant for studying the life course consequences of racism for health. Using the National Longitudinal Study of Adolescent to Adult Health, we take a biosocial, life course approach and develop two life stage-specific indices measuring manifestations of structural racism in school contexts in adolescence, a sensitive period of development. The first is a school contextual disadvantage index (CDI), which captures differences in resources and opportunities across schools that have been partly determined by socio-historic structural racism that has sorted Black students into more disadvantaged schools. The second is a school structural racism index (SRI), which measures differences in resources and opportunities between Black and white students within schools. Then, we relate these indices to adolescent depressive symptoms. We find that among both Black and white students of both genders, higher CDI levels are associated with more depressive symptoms. However, Black students are twice as likely to be in schools with a CDI above the median compared to white students. We also find that, controlling for the CDI, the SRI is positively associated with depressive symptoms among Black boys and girls only. Finally, the CDI and the SRI interact to produce a pattern where the likelihood of depressive symptoms increases as the SRI increases, but only among Black boys and girls in low-disadvantage schools. These findings underscore the importance of measuring structural racism in social contexts in multifaceted ways to study life course health inequities.

Educational disparities in adult health across U.S. states: Larger disparities reflect economic factors

Introduction

Education level is positively associated with adult health in the United States. However, new research shows that the association is stronger in some U.S. states than others, and that states with stronger associations also tend to have poorer overall levels of health. Understanding why educational disparities in health are larger in some states than others can advance knowledge of the major drivers of these disparities, between individuals and states. To that end, this study examined how key mechanisms (economic conditions, health behaviors, family, healthcare) help explain the education-health association in each state and whether they do so systematically.

Methods

Using data on over 1.7 million adults ages 25-64 in the 2011-2018 Behavioral Risk Factor Surveillance System, we estimated the association between education level and self-rated health in each state, net of age, sex, race/ethnicity, and calendar year. We then estimated the contribution of economic, behavioral, family, and healthcare mechanisms to the association in each state.

Results

The strength of the education-health association differed markedly across states and was strongest in the Midwest and South. Collectively, the mechanisms accounted for most of the association in all states, from 55% of it in North Dakota to 73% in Oklahoma. Economic (employment, income) and behavioral (smoking, obesity) mechanisms were key, but their contribution to the association differed systematically across states. In states with stronger education-health associations, economic conditions were the dominant mechanism linking education to health, but in states with weaker associations, the contribution of economic mechanisms waned and that of behavioral mechanisms rose.

Discussion

Meaningful reductions in educational disparities in health, and overall improvements in health, may come from prioritizing access to employment and livable income among adults without a 4-year college degree, particularly in Southern and Midwestern states.