Physical-psychiatric comorbidity: patterns and explanations for ethnic group differences

Daily discrimination, church support, personal mastery, and psychological distress in black people in the United States

OBJECTIVE

This study used the stress process model to test the mediating effects of personal mastery and moderating effects of church-based social support on the relationship between daily discrimination and psychological distress across three age groups of African American and Afro-Caribbean adults.

METHODS

Using a national sample of 5008 African Americans and Afro-Caribbean adults from the National Survey of American Life Study, this study employs structural equation modeling to investigate the relationships between daily discrimination, personal mastery, church-based social support, and psychological distress.

RESULTS

Daily discrimination was an independent predictor of psychological distress across all groups. Group- and age-specific comparisons revealed significant differences in the experience of daily discrimination and psychological distress. Mastery was a partial mediator of the relationship between discrimination and psychological distress among Afro-Caribbeans while church support was a significant moderator only among the young and older African Americans.

IMPLICATIONS

Together, our study findings provide useful first steps towards developing interventions to reduce the adverse psychological impacts of daily discrimination on African Americans and Afro-Caribbeans. Intervention efforts such as individual psychotherapy aimed to improve Afro-Caribbean individuals' sense of mastery would be a partial solution to alleviating the adverse effects of discrimination on their psychological health.

Comorbidities and ethnic health disparities in the UK biobank

Objective

The goal of this study was to investigate the relationship between comorbidities and ethnic health disparities in a diverse, cosmopolitan population.

Materials and Methods

We used the UK Biobank (UKB), a large progressive cohort study of the UK population. Study participants self-identified with 1 of 5 ethnic groups and participant comorbidities were characterized using the 31 disease categories captured by the Elixhauser Comorbidity Index. Ethnic disparities in comorbidities were quantified as the extent to which disease prevalence within categories varies across ethnic groups and the extent to which pairs of comorbidities co-occur within ethnic groups. Disease-risk factor comorbidity pairs were identified where one comorbidity is known to be a risk factor for a co-occurring comorbidity.

Results

The Asian ethnic group shows the greatest average number of comorbidities, followed by the Black and then White groups. The Chinese group shows the lowest average number of comorbidities. Comorbidity prevalence varies significantly among the ethnic groups for almost all disease categories, with diabetes and hypertension showing the largest differences across groups. Diabetes and hypertension both show ethnic-specific comorbidities that may contribute to the observed disease prevalence disparities.

Discussion

These results underscore the extent to which comorbidities vary among ethnic groups and reveal group-specific disease comorbidities that may underlie ethnic health disparities.

Conclusion

The study of comorbidity distributions across ethnic groups can be used to inform targeted group-specific interventions to reduce ethnic health disparities.

Assessing the Validity of Self-rated Health Across Ethnic Groups: Implications for Health Disparities Research

OBJECTIVES

This study examines the association between morbidity (i.e., chronic health conditions) and self-rated health (SRH) with the aim of testing the within-group and across-group validity of SRH across nine ethnic groups: non-Latinx White, Mexican, Puerto Rican, Cuban, African American, Afro-Caribbean, Chinese, Filipino, and Vietnamese Americans. In addition, we assess whether acculturation (i.e., nativity, years of US residency, language of interview) and health-related factors (e.g., mental disorder) account for ethnic distinctions in SRH.

DESIGN

Data are from the National Survey of American Life (NSAL) and the National Latino and Asian American Study (NLAAS) (N = 8338). Weighted proportions and means for SRH and chronic conditions are reported. Ordered logistic regression analysis is used to determine ethnic group patterns in SRH.

RESULTS

Despite evidence of within-group validity of SRH for each ethnic group, our results seriously challenge the across-group validity of SRH. For example, Chinese and Vietnamese respondents report lower SRH despite having fewer chronic conditions relative to non-Latinx Whites. Moreover, Mexican Americans report fewer chronic health problems but lower SRH compared to non-Latinx Whites. Acculturation factors (e.g., language of interview) partially explain the Mexican-White difference in SRH. Among Chinese Americans, completing an interview in English is associated with higher SRH relative to those who completed an interview in Chinese.

CONCLUSION

These findings have implications for health disparities research that uses SRH as the dependent measure. Studies that compare the health profiles of diverse ethnic groups should use the SRH measure with caution, as SRH does not align with ethnic patterns of morbidity.

Examining multimorbidity differences across racial groups: a network analysis of electronic medical records

Health disparities across ethnic or racial groups are typically examined through single behavior at a time. The syndemics and multimorbidity health disparities have not been well examined by race. In this study, we study health disparities by identifying the networks of multimorbidities among individuals from seven population groups based on race, including White, African American, Asian, Hispanic, Native American, Bi- or Multi-racial and Pacific Islander. We examined a large electronic medical record (EMR) containing health records of more than 18.7 million patients and created multimorbidity networks considering their lifetime history from medical records in order to compare the network properties among seven population groups. In addition, the networks at organ system level depicting the relationship among disorders belonging to different organ systems are also compared. Our macro analysis at the organ-level indicates that African-Americans have a stronger multimorbidity network followed by Whites and Native Americans. The networks of Asians and Hispanics are sparse. Specifically, the relationship of infectious and parasitic disorders with respiratory, circulatory and genitourinary system disorders is stronger among African Americans than others. On the other hand, the relationship of mental disorders with respiratory, musculoskeletal system and connective tissue disorders is more prevalent in Whites. Similar other disparities are discussed. Recognition and explanation of such differences in multimorbidities inform the public health policies, and can inform clinical decisions as well. Our multimorbidity network analysis identifies specific differences in diagnoses among different population groups, and presents questions for biological, behavioral, clinical, social science, and policy research.

Racial Difference in the Relationship Between Health and Happiness in the United States

Background

Although health is a prerequisite for happiness, the salience of health for maintaining happiness may be diminished for Blacks when compared to Whites, a phenomenon which can be explained by the Black-White mental health paradox and minorities’ diminished returns.

Aim

To understand if Black and White adult Americans differ in the effects of self-rated health (SRH) on happiness.

Methods

This cross-sectional study used data from the General Social Survey (GSS; 1972–2018), a nationally representative survey in the US. Our analytical sample included 42,201 Black and White adults. The independent variable was SRH. Happiness was the dependent variable. Sociodemographic factors were covariates. Race was the moderator. Logistic regression was used to analyze the data without and with interaction terms between race and SRH.

Results

Overall, good SRH was positively associated with happiness, however, there was a significant interaction between race/ethnicity and good SRH on the outcome (i.e. happiness) . This finding suggested that the boosting effect of good SRH on happiness is weaker for Black than White people.

Conclusion

In the United States, due to a weaker concordance between good health and happiness, Blacks who have poor SRH are more likely to report happiness. At the same time, Whites who are healthy report happiness, however, Blacks who are healthy do not necessarily report happiness. Disjointed link between health and happiness may be due to different racial, ethnic, and cultural perceptions of physical health and happiness as well as salience of physical health as a component of happiness. This may be an adaptive response of Blacks to sociopolitical as well as health-related adversities over centuries as a result of the combination of oppression, injustice, and poverty.