Racial/ethnic differences in multimorbidity development and chronic disease accumulation for middle-aged adults

Abstract

Background Multimorbidity–having two or more coexisting chronic conditions–is highly prevalent, costly, and disabling to older adults. Questions remain regarding chronic diseases accumulation over time and whether this differs by racial and ethnic background. Answering this knowledge gap, this study identifies differences in rates of chronic disease accumulation and multimorbidity development among non-Hispanic white, non-Hispanic black, and Hispanic study participants starting in middle-age and followed up to 16 years. Methods and findings We analyzed data from the Health and Retirement Study (HRS), a biennial, ongoing, publicly-available, longitudinal nationally-representative study of middle-aged and older adults in the United States. We assessed the change in chronic disease burden among 8,872 non-Hispanic black, non-Hispanic white, and Hispanic participants who were 51–55 years of age at their first interview any time during the study period (1998–2014) and all subsequent follow-up observations until 2014. Multimorbidity was defined as having two or more of seven somatic chronic diseases: arthritis, cancer, heart disease (myocardial infarction, coronary heart disease, angina, congestive heart failure, or other heart problems), diabetes, hypertension, lung disease, and stroke. We used negative binomial generalized estimating equation models to assess the trajectories of multimorbidity burden over time for non-Hispanic black, non-Hispanic white, and Hispanic participants. In covariate-adjusted models non-Hispanic black respondents had initial chronic disease counts that were 28% higher than non-Hispanic white respondents (IRR 1.279, 95% CI 1.201, 1.361), while Hispanic respondents had initial chronic disease counts that were 15% lower than non-Hispanic white respondents (IRR 0.852, 95% CI 0.775, 0.938). Non-Hispanic black respondents had rates of chronic disease accumulation that were 1.1% slower than non-Hispanic whites (IRR 0.989, 95% CI 0.981, 0.998) and Hispanic respondents had rates of chronic disease accumulation that were 1.5% faster than non-Hispanic white respondents (IRR 1.015, 95% CI 1.002, 1.028). Using marginal effects commands, this translates to predicted values of chronic disease for white respondents who begin the study period with 0.98 chronic diseases and end with 2.8 chronic diseases; black respondents who begin the study period with 1.3 chronic diseases and end with 3.3 chronic diseases; and Hispanic respondents who begin the study period with 0.84 chronic diseases and end with 2.7 chronic diseases. Conclusions Middle-aged non-Hispanic black adults start at a higher level of chronic disease burden and develop multimorbidity at an earlier age, on average, than their non-Hispanic white counterparts. Hispanics, on the other hand, accumulate chronic disease at a faster rate relative to non-Hispanic white adults. Our findings have important implications for improving primary and secondary chronic disease prevention eff...

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“…Issues of economic disadvantage intersect with issues of race and ethnicity. Members of minority communities (such as blacks, Latinos and American Indians/Alaska Natives in the US) are disproportionately found among the homeless 59 , the detained, the workers in high public contact but low-benefit occupations 65 , and those with prior health conditions that make them more vulnerable 66,67 . Because social networks tend to be racially differentiated 68 , members of minority communities who contract the disease may become vectors of transmission to others in their racial and ethnic communities 69 .…”

Using social and behavioural science to support COVID-19 pandemic response

“…Issues of economic disadvantage intersect with issues of race and ethnicity. Members of minority communities (such as blacks, Latinos, and American Indians/Alaska Natives in the U.S.) are disproportionately found among the homeless 59 , the detained, the workers in high public contact but low-benefit occupations 65 , and those with prior health conditions that make them more vulnerable 66,67 . Because social networks tend to be racially differentiated 68 , members of minority communities who contract the disease may become vectors of transmission to others in their racial and ethnic communities 69 .…”

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