Place could impact health disparities more than race

The researchers say their findings, published in the October/December 2015 issue of the journal Family & Community Health, indicate that differences in social and living environments may help to explain racial disparities that exist nationally for habits and lifestyle choices that play a key role in the health of U.S. men.

"Understanding racial differences in behaviors that affect men's health is an important step toward reducing health disparities among U.S. men," says study lead author Roland J. Thorpe Jr., PhD, an assistant professor in the Department of Health, Behavior and Society at the Johns Hopkins Bloomberg School of Public Health and director of the Program for Men's Health Research at the Johns Hopkins Center for Health Disparities Solutions. "But it's critical that we move beyond making these comparisons solely based on national-level data in order to consider the role of confounding factors such as socio-economic status and segregated living environments."

For their study, the researchers compared data from the 2003 National Health Interview Survey (NHIS), a cross-sectional survey of U.S. households conducted by the U.S. Centers for Disease Control and Prevention's National Center for Health Statistics, with data from a smaller survey of 628 African-American and non-Hispanic white men living in Baltimore. The smaller sample was drawn from the Southwest Baltimore site of the Exploring Health Disparities in Integrated Communities (EHDIC) study, an ongoing study by researchers at the Johns Hopkins Center for Health Disparities Solutions of race disparities within communities where approximately equal numbers of both African Americans and non-Hispanic whites live and where median incomes are similar. The NHIS data included 1,551 African American and 8,904 non-Hispanic white men who had been surveyed in 2003. The EHDIC group, also surveyed in 2003, included 381 African American and 247 white men.

In the national NHIS sample, which did not account for or include data on residential segregation, a larger proportion of African American men than white men had incomes under $35,000 (33 percent compared to 22.7 percent of white men), and a smaller proportion of African American men had incomes over $75,000 (12.8 percent compared to 24.4 percent for white men). Additionally, a smaller proportion of African American men had health insurance, identified as current drinkers and reported heart disease than their white counterparts, while a larger proportion of African American men in the national sample were physically inactive, obese, and reported fair/poor health, hypertension and diabetes. By contrast, in the EHDIC sample, a larger proportion of African American men than white men had health insurance, and there were no differences between African American and white men with respect to being physically inactive, being a current smoker, being a current drinker, being obese or reporting fair/poor health, hypertension, diabetes or heart disease.

After adjusting the national NHIS data for age, marital status, insurance, income, educational attainment, poor or fair health and obesity status, the researchers found that African American men in the national sample had greater odds of being physically inactive, reduced odds of being a current smoker and reduced odds of being a current drinker compared to white men. In the EHDIC sample, which accounted for social and environmental factors in the men's living conditions, there were no significant differences between African American and white men's odds of being physically inactive, being a current smoker or being a current drinker.

"The fact that economic disadvantage is so often a part of the experience of minorities in the U.S. has made it difficult to estimate the relative effects of race and socioeconomic status on behaviors that impact health," says Thorpe. "But our comparison of national data from the NHIS with data from the EHDIC study provides a more nuanced picture of the factors underlying these behavioral differences and suggests that the disparities found at the national level may be a function of social and environmental differences. These findings bring us a step closer to understanding and improving the health of minority men in this country."