Examining the Racial Crossover in Mortality between African American and White Older Adults: A Multilevel Survival Analysis of Race, Individual Socioeconomic Status, and Neighborhood Socioeconomic Context
We examine whether individual and neighborhood socioeconomic context contributes to black/white disparities in mortality among USA older adults. Using national longitudinal data from the Americans' Changing Lives study, along with census tract information for each respondent, we conduct multilevel survival analyses. Results show that black older adults are disadvantaged in mortality in younger old age, but older black adults have lower mortality risk than whites after about age 80. Both individual SES and neighborhood socioeconomic disadvantage contribute to the mortality risk of older adults but do not completely explain race differences in mortality. The racial mortality crossover persists even after controlling for multilevel SES, suggesting that black older adults experience selective survival at very old ages. Addressing the individual and neighborhood socioeconomic disadvantage of blacks is necessary to reduce mortality disparities that culminate in older adulthood. 1. Introduction Black older adults (ages 65+) have higher all-cause mortality rates than white older adults in the USA [1, 2]. A growing body of literature attempts to understand the mechanisms explaining these persisting race differences in mortality [3–5] so that we can understand how such race disparities might be reduced or eliminated. Substantial disparities in individual socioeconomic status (SES) by race have been observed in the USA, and research has shown that individual SES (e.g., income and education) partly mediates but does not eliminate the relationship between race and mortality [6–8]. In addition, neighborhood context has been identified as a key factor that contributes to race disparities in morbidity [9–11]. However, few studies have examined how neighborhood context contributes to race difference in mortality [12, 13], particularly at older ages. The current study employees mixed effect survival analysis to investigate whether SES, measured at both the individual and neighborhood levels, explains black/white differences in mortality among older adults in the USA, using longitudinal national data. A number of theoretical perspectives, including economic deprivation [14] and social disorganization theory [15, 16], suggest that neighborhood context is associated with health and mortality. Some studies have shown that living in a poor neighborhood is related to increased cause-specific mortality among adults [17–20], after controlling for individual SES variables. However, other studies have shown that there is no significant association between neighborhood context and
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