Economic Strain Deteriorates While Education Fails to Protect Black Older Adults Against Depressive Symptoms, Pain, Self-rated Health, Chronic Disease, and Sick Days

Abstract

Background: A large body of empirical evidence on Minorities' Diminished Returns (MDRs) suggests that educational attainment shows smaller health effects for Blacks compared to Whites. At the same time, economic strain may operate as a risk factor for a wide range of undesired mental and physical health outcomes in Black communities. Aim:The current study investigated the combined effects of education and economic strain on the following five health outcomes in Black older adults in underserved areas of South Los Angeles: depressive symptoms, number of chronic diseases, pain intensity, self-rated health, and sick days. Methods:This cross-sectional study included 619 Black older adults residing in South Los Angeles. Data on demographic factors (age and gender), socioeconomic characteristics, economic strain, health insurance, living arrangement, marital status, health behaviors, depressive symptoms, pain intensity, number of chronic diseases, sick days, and self-rated health were collected. Five linear regressions were used to analyze the data.Results: Although high education was associated with less economic strain, it was the economic strain, not educational attainment, which was universally associated with depressive symptoms, pain intensity, self-rated health, chronic diseases, and sick days, independent of covariates. Similar patterns emerged for all health outcomes suggesting that the risk associated with economic strain and lack of health gain due to educational attainment are both robust and independent of type of health outcome. Conclusion:In economically constrained urban environments, economic strain is a more salient social determinant of health of Black older adults than educational attainment. While education loses some of its protective effects, economic strain deteriorates health of Black population across domains. There is a need for bold economic and social policies that increase access of Black communities to cash at times of emergency. There is also a need to improve the education quality in the Black communities.

Social Determinants of Mental, Physical, and Oral Health of Middle-Aged and Older African Americans in South Los Angeles

“…A larger sample size might show the effect of education and income in our study. However, our previous similar analysis in a larger sample showed similar findings [ 41 ]. Third, our study was cross-sectional.…”

“…In one study in South Los Angeles [ 117 ], financial strain predicted chronic disease, chronic pain, self-rated health, depression, and the usage of sick days. In another study, financial strain was a risk factor for poor self-rated health, chronic pain, sick days, chronic disease, and depression, while education failed to show any protective effect for the same community [ 41 ]. Similar to the current study, that study compared the role of financial strain with education and showed similar results [ 41 ].…”

“…Previous work has shown that SRH can be used as a continuous measure. As a result, many previous studies have used SRH as a continuous outcome [ 41 , 72 , 73 ].…”

“…For example, highly educated and high-income African Americans remain at a high risk of poor health [ 24 , 32 , 36 , 37 , 38 , 39 , 40 ]. Although this theory is commonly applied for comparative studies, it is also used by within-race studies that find weaker-than-expected effects of SES without having a White control group [ 41 , 42 ]. As White people are an arbitrary control group and should not be regarded as the norm (considering whiteness as the norm is in itself a reflection of racism), within-racial research has its own major implications [ 43 ].…”

Hope, Purpose, and Religiosity: The Impact of Psychosocial Resources on Trajectories of Depressive Symptoms Among Middle-Aged and Older Blacks

“…Depressive symptoms are associated with multiple indicators of poor mental and physical health, including major depressive disorder (Moazen-Zadeh & Assari, 2016), cardiovascular diseases (Xiang & An, 2015), declines in cognitive function (Turner et al, 2015), and specific- and all-cause mortality (Assari et al, 2016; Liwo et al, 2020). Middle-aged and older adults may be at an increased risk of experiencing depressive symptoms due to unexpected changes in employment (Abrams et al, 2021), financial strain (Assari et al, 2020), increased frailty (Mezuk et al, 2012), greater feelings of loneliness (Taylor & Nguyen, 2020), and increases in disability, sleep disturbances, and bereavement (Cole & Dendukuri, 2003). Older Black Americans experience relatively similar age-related risk factors for depressive symptoms as whites (Pickett et al, 2013) but are at an even greater risk for poor mental health due to their experiences of racism, discrimination, and socioeconomic disadvantage (Williams & Williams-Morris, 2000).…”