Racial differences in self-rated health at similar levels of physical functioning

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When asked by health care professionals about their health, older African-American adults consistently report poorer health than whites of the same age do - even if both groups are functioning extremely well, a new study finds.

“Asking how a person would rate his or her health remains one of the simplest tools that a health professional has to quickly learn about a person’s overall sense of well-being,” said lead author Mindi Spencer, Ph.D. “The results of our study indicate that we cannot assume all people are considering the same factors when they answer this question.”

Spencer is an assistant professor in the Department of Health Promotion, Education and Behavior and the Institute for Southern Studies at the University of South Carolina.

The study appears in the January issue of the Journal of Gerontology: Social Sciences .

The researchers evaluated data from 2,729 adults, ages 70 to 79, who participated in the Health, Aging and Body Composition study that took place in and around Pittsburgh, Pa. and Memphis, Tenn. between 1997 and 1998.

Researchers asked participants the single question: “How would you rate your overall health?” with response categories of excellent, very good, good, fair or poor. Participants later received a clinical health assessment that rated their walking and balance, how many medications they were taking, whether they had been diagnosed with a chronic condition and if they were depressed.

The authors found that whites are 3.8 times more likely than African-Americans are to report favorable self-rated health, even among those in both groups who performed the same on the physical assessments. A greater proportion of African-American participants (27.3 percent) rated their health as fair or poor compared to whites (8.2 percent). A greater proportion of whites (17.6 percent) rated their health as excellent compared with only 8.7 percent of African-Americans.

“We thought that older adults who were high-functioning would be much more likely to rate their health as ‘excellent’ or ‘very good,’ but this was not the case for black older adults,” Spencer said.

The authors attributed the disparity to many factors, one being that populations view the definition of what constitutes good or poor health differently.

However, Barbara Tilley, Ph.D., an expert on racial health disparities, suggested interpreting the study with caution.

“It appears that African-American men and women in the study had poorer performance on the Physical Performance Battery (PPB) test and reported they were less able to walk a mile than Caucasians and needed more social support,” said Tilley, with the Medical University of South Carolina.

“It may be that the analysis is picking up a problem with the scale rather than pessimism in African-Americans,” Tilley said. “No data are presented to indicate that the PPB scale used as the gold standard has been validated for African-Americans or validated in general.”

Journal of Gerontology: Social Sciences is published by the Oxford University Press. See:

Spencer SM, et al. Racial differences in self-rated health at similar levels of physical functioning: An examination of health pessimism in the Health, Aging and Body Composition Study. J Gerontol: Social Sciences 64(1), 2009.



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