SDOH: Age and Race/ Ethnicity

17%

29% (highest)

24%

23%

22%, 21%

- US elder population is increasing
- US population has aged due to increased life expectancy and reduced fertility rate
- For the first time in US history, older adults are projected to outnumber children by 2034

- Signs of no significant health problems are an indicator of successful aging
- Often due to social support, diet, exercise, higher SES, low stress, low drug/ alcohol use

-Wrinkles
- Looser skin
- hair thinning and color change
- mobility
- hearing loss, eyesight loss

-Medical technologies
- Health information
- Pandemics (COVID-19)

Cumulative person- years

- Medicare: major health insurance program for the elderly
- Social security: Major national program that provides economic benefits to most elderly
- Worker-to- beneficiary ratio declining (to 2.0 in 2035)
- COVID contributing to fewer births, increased deaths, and fewer immigrants

- SES disparities in childhood accumulate to affect old age
- Also affects gender/ race/ ethnicity
- Obesity among lower SES women, esp. black women

- Early disadvantage related to later life health (exposure to health risks, fewer resources to maintain health, less healthy behaviors)
- Midlife resources can mitigate the effects
- Childhood adversity can accelerate biological aging and increase the likelihood of early childbearing/ nonmarital child birth

maintains that socioeconomic disadvantages originating in childhood accumulative over the life cycle to disadvantage health in old age

Healthier, more educated, in better shape, contract diseases in later years, live longer without chronic conditions, enjoy better recovery, COVID may jeopardize gains

- Higher infant mortality
- Lower life expectancy
- Earlier onset, greater disparity, faster progression of many diseases
- Greater comorbidity
- More disability

- Lowest among Asians, due partly to SES
- Similar for Hispanics and NH whites
- Highest among blacks

- Asians have the highest life expectancy by far
- Hispanics and NH whites have similar life expectancy
- NH blacks have lower life expectancy
- American Indians have some of the lowest life expectancies

- Socioeconomic factors: poverty, marginal employment, low education levels
- Psychosocial: stress
- Health behaviors: physical inactivity, poor diets, obesity
- Limited access to healthcare: fewer tests for heart disease, cancer, diabetes
- Environmental factors: disadvantaged neighborhoods

- Highest among blacks at 19.5%
- High among Hispanics
- Increased among all race and ethnic groups shown from 2019-2020

77 years

It contributes to...
- Inflammation
- Early mortality
- Type 2 diabetes
- Metabolic syndrome
- CVD risk factors
- Cognitive decline
- Telomere attrition higher oxidative stress

- Institutional racism: housing, employment opportunities, neighborhood/ education quality
- Cultural racism: negative stereotypes, discrimination
- Racism health effects: lower self-esteem/well-being, more distress, early onset of disease, greater disease severity and progression

Hispanics, compared to non-Hispanic whites, have lower mortality even with lower SES (and lack of health insurance)

- Migration effects (healthy immigrant effect, return migrant effect)
- Strong social support
- Beneficial cultural practices
- Healthy behaviors
- Data artifact (underreporting Hispanic at death, age misreporting)

suggests that immigrants have a health advantage over the domestic-born US citizens which vanishes with increased length of residency