Social Class: The Missing Link in U.S. Health Data

1994 ◽  
Vol 24 (1) ◽  
pp. 25-44 ◽  
Author(s):  
Nancy Krieger ◽  
Elizabeth Fee
Keyword(s):  
Social Class ◽  
Educational Level ◽  
The United States ◽  
Vital Statistics ◽  
Health Data ◽  
Inequalities In Health ◽  
Racial Ethnic ◽  
Gathering Data ◽  
Reporting Data ◽  
The U.S

National vital statistics in the United States are unique among those of advanced capitalist countries in reporting data only by race, sex, and age—not by class and income. This article reviews the limited U.S. data resources that may be used to document social class inequalities in health. Summarizing the strengths and weaknesses of the British approach to gathering data on social class and health, the authors discuss possible approaches to collecting data that could be feasible in the U.S. context. They argue that educational level is an insufficient marker for socioeconomic position and contend that appropriate measures must take into account not only individual but also household and neighborhood markers of social class. These additional types of social class data are especially important for accurately describing and understanding social class inequalities in health among women and across diverse racial/ethnic groups.

Man-Made Medicine and Women's Health: The Biopolitics of Sex/Gender and Race/Ethnicity

1994 ◽  
Vol 24 (2) ◽  
pp. 265-283 ◽  
Author(s):  
Nancy Krieger ◽  
Elizabeth Fee
Keyword(s):  
Social Class ◽  
Native Americans ◽  
White Men ◽  
The United States ◽  
Vital Statistics ◽  
Men And Women ◽  
Class Differences ◽  
Biological Variables ◽  
Race Ethnicity ◽  
19Th And 20Th Century

National vital statistics in the United States present data in terms of race, sex, and age, treated as biological variables. Some races are clearly of more interest than others: data are usually available for whites and blacks, and increasingly for Hispanics, but seldom for Native Americans or Asians and Pacific Islanders. These data indicate that white men and women generally have the best health and that men and women, within each racial/ethnic group, have different patterns of disease. Obviously, the health status of men and women differs for conditions related to reproduction, but it differs for many nonreproductive conditions as well. In national health data, patterns of disease by race and sex are emphasized while social class differences are ignored. This article discusses how race and sex became such all-important, self-evident categories in 19th and 20th century biomedical thought and practice. It examines the consequences of these categories for knowledge about health and for the provision of health care. It then presents alternative approaches to understanding the relationship between race/ethnicity, gender, and health, with reference to the neglected category of social class.

scholarly journals Dementia Care in Diverse Older Adults in the U.S. Deep South and the Rest of the United States

2021 ◽  
pp. 1-13
Author(s):  
Maria Pisu ◽  
Roy C. Martin ◽  
Liang Shan ◽  
Giovanna Pilonieta ◽  
Richard E. Kennedy ◽  
...  
Keyword(s):  
United States ◽  
Alzheimer’S Disease ◽  
Older Adults ◽  
Alzheimer's Disease ◽  
Drug Use ◽  
Ethnic Groups ◽  
The United States ◽  
Deep South ◽  
Racial Ethnic ◽  
The U.S

Background: Use of specialists and recommended drugs has beneficial effects for older adults living with Alzheimer’s disease and related dementia (ADRD). Gaps in care may exist for minorities, e.g., Blacks, and especially in the United States (U.S.) Deep South (DS), a poor U.S. region with rising ADRD cases and minority overrepresentation. Currently, we have little understanding of ADRD care utilization in diverse populations in this region and elsewhere in the U.S. (non-DS), and the factors that adversely impact it. Objective: To examine utilization of specialists and ADRD drugs (outcomes) in racial/ethnic groups of older adults with ADRD and the personal or context-level factors affecting these outcomes in DS and non-DS. Methods: We obtained outcomes and personal-level covariates from claims for 127,512 Medicare beneficiaries with ADRD in 2013–2015, and combined county-level data in exploratory factor analysis to define context-level covariates. Adjusted analyses tested significant association of outcomes with Black/White race and other factors in DS and non-DS. Results: Across racial/ethnic groups, 33%–43% in DS and 43%–50% in non-DS used specialists; 47%–55% in DS and 41%–48% in non-DS used ADRD drugs. In adjusted analyses, differences between Blacks and Whites were not significant. Vascular dementia, comorbidities, poverty, and context-level factor “Availability of Medical Resources” were associated with specialist use; Alzheimer’s disease and senile dementia, comorbidities, and specialist use were associated with drug use. In non-DS only, other individual, context-level covariates were associated with the outcomes. Conclusion: We did not observe significant gaps in ADRD care in DS and non-DS; however, research should further examine determinants of low specialist and drug use in these regions.

scholarly journals COVID-Related Victimization, Racial Bias and Employment and Housing Disruption Increase Mental Health Risk Among U.S. Asian, Black and Latinx Adults

2021 ◽  
Vol 9 ◽  
Author(s):  
Celia B. Fisher ◽  
Xiangyu Tao ◽  
Tingting Liu ◽  
Salvatore Giorgi ◽  
Brenda Curtis
Keyword(s):  
Mental Health ◽  
Health Risk ◽  
Ethnic Minorities ◽  
Online Survey ◽  
Racial Bias ◽  
The United States ◽  
Equation Modeling ◽  
Depression And Anxiety ◽  
Racial Ethnic ◽  
The U.S

Background: The mental health of racial/ethnic minorities in the U.S. has been disproportionately impacted by the COVID-19 pandemic. This study examined the extent to which disruptions in employment and housing, coronavirus-specific forms of victimization and racial bias independently and conjointly contributed to mental health risk among Asian, Black, and Latinx adults in the United States during the pandemic.Methods: This study reports on data from 401 Asian, Black, and Latinx adults (age 18–72) who participated in a larger national online survey conducted from October 2020–June 2021, Measures included financial and health information, housing disruptions and distress in response to employment changes, coronavirus related victimization distress and perceived increases in racial bias, depression and anxiety.Results: Asian participants had significantly higher levels of COVID-related victimization distress and perceived increases in racial bias than Black and Latinx. Young adults (<26 years old) were more vulnerable to depression, anxiety, and coronavirus victimization distress than older respondents. Having at least one COVID-related health risk, distress in response to changes in employment and housing disruptions, pandemic related victimization distress and perceived increases in racial bias were positively and significantly related to depression and anxiety. Structural equation modeling indicated COVID-related increases in racial bias mediated the effect of COVID-19 related victimization distress on depression and anxiety.Conclusions: COVID-19 has created new pathways to mental health disparities among racial/ethnic minorities in the U.S. by exacerbating existing structural and societal inequities linked to race. Findings highlight the necessity of mental health services sensitive to specific challenges in employment and housing and social bias experienced by people of color during the current and future health crises.

Gender, Race, Social Class, and Information Technology

2011 ◽  
pp. 705-710
Author(s):  
Myungsook Klassen ◽  
Russell Stockard Jr.
Keyword(s):  
Information Technology ◽  
Social Class ◽  
Gender Gap ◽  
Minority Groups ◽  
The United States ◽  
The Internet ◽  
It Workforce ◽  
Underrepresentation Of Women ◽  
Use Of The Internet ◽  
The U.S

The issue of the underrepresentation of women in the information technology (IT) workforce has been the subject of a number of studies, and the gender gap was an issue when the digital divide dominated discourse about women’s and minority groups’ use of the Internet. However, a broader view is needed. That perspective would include the relation of women and IT in the communities in which they live as well as the larger society. The information society that has emerged includes the United States (U.S.) and the globalized economy of which it is an integral part. Women and minorities, such as African Americans and Latinos, are underrepresented in computer science (CS) and other IT positions in the U.S. In addition, while they are no longer numerically underrepresented in access to computers and the Internet, as of 2000 (Gorski, 2001), they continue to enjoy fewer benefits available through the medium than white boys and men. The following article explores the diversity within women from the perspectives of race, ethnicity and social class in North America, mainly the U.S. The technology gender and racial gap persists in education and in the IT workforce. A broader and deeper look at women’s positions in relation to the increasingly techno-centric society reveals that women may have reached equality in access, but not in academic study and job opportunities.

Identifying the Later-Generation Descendants of U.S. Immigrants: Issues Arising from Selective Ethnic Attrition

2018 ◽  
Vol 677 (1) ◽  
pp. 131-138 ◽  
Author(s):  
Brian Duncan ◽  
Stephen J. Trejo
Keyword(s):  
The United States ◽  
Limited Information ◽  
Foreign Born ◽  
Subjective Measures ◽  
Socioeconomic Attainment ◽  
Standard Data ◽  
Socioeconomic Integration ◽  
Integration Of Immigrants ◽  
Racial Ethnic ◽  
The U.S

Evaluating the long-term socioeconomic integration of immigrants in the United States requires analyses of differences between foreign-born and U.S.-born residents, as well as analyses across generations of the U.S.-born. Regrettably, though, standard data sources used to study these populations provide very limited information pertaining to generation. As a result, research on the U.S.-born descendants of immigrants often relies on the use of subjective measures of racial/ethnic identification. Because ethnic attachments tend to fade across generations, these subjective measures might miss a significant portion of the later-generation descendants of immigrants. Moreover, if such “ethnic attrition” is selective on socioeconomic attainment, it can distort assessments of integration and generational progress. We discuss evidence that suggests that ethnic attrition is sizable and selective for the second- and third-generation populations of key Hispanic and Asian national-origin groups, and that correcting for the resulting biases is likely to raise the socioeconomic standing of the U.S.-born descendants of most Hispanic immigrants relative to their Asian counterparts.

scholarly journals Multinational Population-Based Health Surveys Linked to Outcome Data: An Untapped Resource

2017 ◽  
Vol 1 (1) ◽  
Author(s):  
Stacey Fisher ◽  
Carol Bennett ◽  
Claudia Sanmartin ◽  
Doug Manuel
Keyword(s):  
Physical Activity ◽  
United States ◽  
Population Health ◽  
National Health ◽  
Health Surveys ◽  
The United States ◽  
Vital Statistics ◽  
Health Data ◽  
Hazard Ratios ◽  
National Health Surveys

ABSTRACTObjectivesIncreasingly, national health surveys are being linked to vital statistics and health care information, providing a new and unique source of individual population health data. Given that nationally-representative health surveys are performed in over a hundred countries, these linkages create comprehensive data sets that are potentially larger than most existing cohort studies. To date, this resource has not been utilized. ApproachThe purpose, study base, content and methods of the Canadian Community Health Survey (CCHS) cycles 2.1 (2003-04) and 3.1 (2005-06) and the United States 2000 and 2005 National Health Interview Survey (NHIS) were examined for comparability and consistency. Smoking, alcohol, physical activity and diet questions were identified, question construct and response categorization were compared, and variable constructions possible for both national health surveys were created. All respondents 20+ years of age were identified and stratified by country and sex. Cox proportional hazard models were used to estimate 5-year hazards of mortality associated with the common smoking, alcohol, physical activity and diet variables. ResultsThe CCHS and NHIS are highly consistent and comparable. Health behaviour questions are similar and permit the creation of smoking, alcohol, physical activity and diet variables that are comparable across surveys. A total of 284 475 survey respondents from Canada and the United States (CCHS, N= 226 731; NHIS, N= 57 744) were included. The largest mortality hazards were associated with female heavy smokers in both Canada (HR: 2.91; 95% CI: 2.52, 3.37) and the United States (Female HR: 2.96; 95% CI: 2.59, 3.38), compared to non-smokers. Moderate variation in the age adjusted all-cause mortality hazard ratios was observed; both smoking and physical activity hazard ratios were consistently higher in the United States than in Canada. ConclusionThis study provides initial support for the methodological feasibility of pooling linked population health surveys however, challenges introduced by dissimilarities will require the use of innovative methodologies, and discussions regarding how to manage jurisdictional data restrictions and privacy issues are needed. Pooled population health data has the potential to improve national and international health surveillance and public health.

Health Data Disparities in Opioid-Involved Overdose Deaths From 1999 to 2018 in the United States

2021 ◽  
pp. e1-e9
Author(s):  
Adam J. Milam ◽  
Debra Furr-Holden ◽  
Ling Wang ◽  
Kevin M. Simon
Keyword(s):  
United States ◽  
African American ◽  
Temporal Trends ◽  
The United States ◽  
Vital Statistics ◽  
Health Data ◽  
Using Data ◽  
Death Investigation ◽  
Overdose Deaths

Objectives. To examine temporal trends in the classification of opioid-involved overdose deaths (OODs) and racial variation in the classification of specific types of opioids used. Methods. We analyzed OODs coded as other or unspecified narcotics from 1999 to 2018 in the United States using data from the National Vital Statistics System and the Centers for Disease Control and Prevention. Results. The total proportion ofOODs fromunspecified narcotics decreased from 32.4% in 1999 to 1.9% in 2018. The proportion of OODs from unspecified narcotics among African American persons was approximately 2-fold greater than that of non-Hispanic White persons until 2012. Similarly, the proportion of OODs from unspecified narcotics among Hispanic persons was greater than that of White persons until 2015. After we controlled for death investigation system, African American persons had a higher incidence rate of OODs from unspecified narcotics compared with White persons. Conclusions. There have been significant improvements in the specification OODs over the past 20 years,and there has been significant racial disparity in the classification of OODs until about 2015. The findings suggest a health data disparity; the excessive misclassification of OODs is likely attributable to the race/ethnicity of the decedent. (Am J Public Health. Published online ahead of print June 29, 2021: e1–e8. https://doi.org/10.2105/AJPH.2021.306322 )

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