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. 2014 Aug;43(4):1294-313.
doi: 10.1093/ije/dyu047. Epub 2014 Mar 16.

50-year trends in US socioeconomic inequalities in health: US-born Black and White Americans, 1959-2008

Nancy Krieger  1 , Anna Kosheleva  2 , Pamela D Waterman  2 , Jarvis T Chen  2 , Jason Beckfield  2 , Mathew V Kiang  2
Affiliations

50-year trends in US socioeconomic inequalities in health: US-born Black and White Americans, 1959-2008

Nancy Krieger et al. Int J Epidemiol. 2014 Aug.

Abstract

Background: Debates exist over whether health inequities are bound to rise as population health improves, due to health improving more quickly among the better off, with most analyses focused on mortality data.

Methods: We analysed 50 years of socioeconomic inequities in measured health status among US-born Black and White Americans, using data from the National Health Examination Surveys (NHES) I-III (1959-70), National Health and Nutrition Examination Surveys (NHANES) I-III (1971-94) and NHANES 1999-2008.

Results: Absolute US socioeconomic health inequities for income percentile and education variously decreased (serum cholesterol; childhood height), stagnated [systolic blood pressure (SBP)], widened [body mass index (BMI), waist circumference (WC)] and in some cases reversed (age at menarche), even as on-average values rose (BMI, WC), idled (childhood height) and fell (SBP, serum cholesterol, age at menarche), with patterns often varying by race/ethnicity and socioeconomic measure; similar results occurred for relative inequities. For example, for WC, the adverse 20th (low) vs 80th (high) income percentile gap increased only among Whites (NHES I: 0.71 cm [95% confidence interval (CI) -0.74, 2.16); NHANES 2005-08: 2.10 (95% CI 0.96, 3.62)]. By contrast, age at menarche for girls in the 20th vs 80th income percentile among Black girls remained consistently lower, by 0.34 years (95% CI 0.12, 0.55) whereas among White girls the initial null difference became inverse [NHANES 2005-08: -0.49 years (95% CI -0.86, -0.12; overall P = 0.0015)]. Adjusting for socioeconomic position only modestly altered Black/White health inequities.

Conclusions: Health inequities need not rise as population health improves.

Keywords: National Health Examination Survey (NHES) - US; National Health and Nutrition Examination Survey (NHANES) - US; Social inequalities in health; race/ethnicity; secular trend; socioeconomic.

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Figures

Figure 1.
Figure 1.
Body build (body mass index, waist circumference) by income percentile and by education for US-born Black and White non-Hispanic participants (adults 25–74), National Health and Examination Survey I (1959–62) through National Health and Nutrition Examination Survey 2005–08.
Figure 1.
Figure 1.
Body build (body mass index, waist circumference) by income percentile and by education for US-born Black and White non-Hispanic participants (adults 25–74), National Health and Examination Survey I (1959–62) through National Health and Nutrition Examination Survey 2005–08.
Figure 2.
Figure 2.
Cardiovascular outcomes (systolic blood pressure, serum cholesterol) by income percentile and education for US-born Black and White non-Hispanic participants (adults 25–74), National Health and Examination Survey I (1959–62) through National Health and Nutrition Examination Survey 2005–08.
Figure 2.
Figure 2.
Cardiovascular outcomes (systolic blood pressure, serum cholesterol) by income percentile and education for US-born Black and White non-Hispanic participants (adults 25–74), National Health and Examination Survey I (1959–62) through National Health and Nutrition Examination Survey 2005–08.
Figure 3.
Figure 3.
Child development (height at age 6–8, age at menarche) by income percentile for US-born Black and White non-Hispanic participants (children 6–17), National Health and Examination Survey I (1959–62) through National Health and Nutrition Examination Survey 2005–08.
Figure 4.
Figure 4.
Black vs White differences for body build, cardiovascular, and child development outcomes for US-born Black and White non-Hispanic participants (adults 25–74; children –-17), National Health and Examination Survey I (1959–62) through National Health and Nutrition Examination Survey 2005–08: overall (adjusted for age and gender) and additionally adjusted for either income percentile or education. Analyses for children in relation to income percentile only, and analyses for menarche not adjusted by gender since include only girls.
Figure 4.
Figure 4.
Black vs White differences for body build, cardiovascular, and child development outcomes for US-born Black and White non-Hispanic participants (adults 25–74; children –-17), National Health and Examination Survey I (1959–62) through National Health and Nutrition Examination Survey 2005–08: overall (adjusted for age and gender) and additionally adjusted for either income percentile or education. Analyses for children in relation to income percentile only, and analyses for menarche not adjusted by gender since include only girls.
Figure 4.
Figure 4.
Black vs White differences for body build, cardiovascular, and child development outcomes for US-born Black and White non-Hispanic participants (adults 25–74; children –-17), National Health and Examination Survey I (1959–62) through National Health and Nutrition Examination Survey 2005–08: overall (adjusted for age and gender) and additionally adjusted for either income percentile or education. Analyses for children in relation to income percentile only, and analyses for menarche not adjusted by gender since include only girls.
Figure 4.
Figure 4.
Black vs White differences for body build, cardiovascular, and child development outcomes for US-born Black and White non-Hispanic participants (adults 25–74; children –-17), National Health and Examination Survey I (1959–62) through National Health and Nutrition Examination Survey 2005–08: overall (adjusted for age and gender) and additionally adjusted for either income percentile or education. Analyses for children in relation to income percentile only, and analyses for menarche not adjusted by gender since include only girls.
Figure 4.
Figure 4.
Black vs White differences for body build, cardiovascular, and child development outcomes for US-born Black and White non-Hispanic participants (adults 25–74; children –-17), National Health and Examination Survey I (1959–62) through National Health and Nutrition Examination Survey 2005–08: overall (adjusted for age and gender) and additionally adjusted for either income percentile or education. Analyses for children in relation to income percentile only, and analyses for menarche not adjusted by gender since include only girls.
Figure 4.
Figure 4.
Black vs White differences for body build, cardiovascular, and child development outcomes for US-born Black and White non-Hispanic participants (adults 25–74; children –-17), National Health and Examination Survey I (1959–62) through National Health and Nutrition Examination Survey 2005–08: overall (adjusted for age and gender) and additionally adjusted for either income percentile or education. Analyses for children in relation to income percentile only, and analyses for menarche not adjusted by gender since include only girls.
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