Black–White Disparities in Social and Behavioral Determinants of Health Index and Their Associations with Self-rated Health and Functional Limitations in Older Adults

Abstract

Abstract Background 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. Method 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. Results 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). Conclusion 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.