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Accelerated Health Declines among African Americans in the USA
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Abstract
The weathering hypothesis, an explanation for race disparities in the USA, asserts that the health of African Americans begin to deteriorate prematurely compared to whites as a consequence of long-term exposure to social and environmental risk factors. Using data from 2000-2009 National Health Interview Surveys (NHIS), we sought to describe differences in age-related health outcomes in 619,130 African Americans and whites. Outcome measures included hypertension, diabetes, stroke, and cardiovascular disease. Using a mixed models approach to age-period-cohort analysis, we calculated age- and race-specific prevalence rates that accounted for the complex sampling design of NHIS. African Americans exhibited higher prevalence rates of hypertension, diabetes, and stroke than whites across all age groups. Consistent with the weathering hypothesis, African Americans exhibited equivalent prevalence rates for these three conditions 10 years earlier than whites. This suggests that African Americans are acquiring age-related conditions prematurely compared to whites.
African Americans tend to develop age-related diseases in which racial health disparities have been observed at earlier ages than whites. Two key explanations exist. One explanation for this is the substantial evidence that African Americans experience differential exposure to chronic stressors such as discrimination, racism, and segregation, and have different life experiences compared to non-Hispanic whites. The second is stress—an social or environmental pressure that often requires at least one of the following responses: psychological, physiological, or behavioral.
Many diseases, especially those related to cardiovascular disease, have been linked to stress, adverse life events, and other factors related to stress such as allostatic load, social support, and discrimination. Thus, because of race differences in the social and environmental risk exposures and life experiences facilitated by residential segregation, African Americans could be expected to have an earlier onset of disease and disability than non-Hispanic whites
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