Department of Public Health Sciences, School of Medicine, University of Connecticut, Farmington.
Department of Psychiatry, School of Medicine, Yale University, New Haven, Connecticut.
J Gerontol A Biol Sci Med Sci. 2021 Mar 31;76(4):735-740. doi: 10.1093/gerona/glaa264.
To characterize cumulative risk scores of social and behavioral determinants of health (SDoH) and examine their association with self-rated general health and functional limitations between non-Hispanic black and white older adults in the United States.
We used data from the 2013-2014 National Health and Nutrition Examination Survey (NHANES), with a nationally representative sample of black and white adults aged 65 or older (n = 954 unweighted). We quantified the cumulative risk scores of SDoH (eg, food insecurity, education and poverty), ranging from 0 (no risk at all) to 8 (highest risk), and used multivariable-adjusted logistic and Poisson regression analyses to assess the association of SDoH by racial group with self-rated health and functional limitations, adjusting for other covariates.
Black older adults had a higher mean cumulative risk score than white counterparts (2.3 ± 2.1 vs 1.5 ± 1.0; p < .001). Black older adults were more likely to report lower self-rated health than white older adults in each of SDoH domains (p < .01 for each). In multivariable-adjusted analyses, black older adults were more likely to report lower self-rated health than white older adults (p < .01 for all) regardless of SDoH risk factors. However, those with high SDoH risk factors (ie, ≥3 risk factors) were more likely to report functional limitations than those in the low-risk group (ie, <3 risk factors) in both racial groups (p < .01 for all).
SDoH-related black-white disparities remain persistent in older age. In particular, SDoH index scores for black and white older adults were differentially associated with functional limitations. Addressing SDoH should be an important consideration in reducing gaps in black-white disparities of functioning.
本研究旨在描述美国非裔和白人老年人群体健康相关社会行为决定因素（SDoH）的累积风险评分，并探讨其与自报一般健康和功能限制之间的关联。
我们使用了来自 2013-2014 年全国健康与营养调查（NHANES）的数据，该调查包含了具有全国代表性的 65 岁及以上的黑人和白人成年人样本（未加权 n = 954）。我们量化了 SDoH（例如，食物不安全、教育和贫困）的累积风险评分，范围从 0（完全没有风险）到 8（最高风险），并使用多变量调整的逻辑回归和泊松回归分析，根据种族群体评估 SDoH 与自报健康和功能限制的关联，同时调整了其他协变量。
与白人相比，黑人老年人群体的平均累积风险评分更高（2.3 ± 2.1 与 1.5 ± 1.0；p <.001）。在每个 SDoH 领域，黑人老年人群体报告自报健康状况较差的比例都高于白人（p <.01）。在多变量调整分析中，无论 SDoH 风险因素如何，黑人老年人群体报告自报健康状况较差的比例均高于白人（p <.01）。然而，在两个种族群体中，高 SDoH 风险因素（即≥3 个风险因素）的人群比低风险组（即<3 个风险因素）更有可能报告功能限制（p <.01）。
在老年人群中，SDoH 相关的黑人和白人之间的差异仍然存在。特别是，SDoH 指数得分与黑人和白人老年人群体的功能限制有不同的关联。解决 SDoH 问题应该是缩小黑人和白人功能差异的重要考虑因素。
