Racial inequities and biopsychosocial indicators in older adults

cross-sectional study conducted with a total of 941 older adults from a health micro-region in Brazil. Data were collected at home with instruments validated for the country. Descriptive analysis and binary, multinomial and linear logistic regression (p<0.05) were performed.

Results

Most older adults were self-declared white color/race (63.8%). Black color/race was a protective factor for negative (OR=0.40) and regular (OR=0.44) self-rated health perception and for the indicative of depressive symptoms (OR=0.43); and it was associated with the highest social support score (β=3.60) and the lowest number of morbidities (β=-0.78).

Conclusion

regardless of sociodemographic and economic characteristics, older adults of black color/race had the best outcomes of biopsychosocial indicators.

Descriptors:
Aged; Health of the Elderly; Health Status Disparity; Ethnic Group Distribution; Race Factors; Geriatric Nursing

Variables	Color/race
	White		Brown		Black		Total
	n	%	n	%	n	%	n	%
Gender
Female	411	68.5	157	66.0	61	59.2	629	66.8
Male	189	31.5	81	34.0	42	40.8	312	31.2
Age group (years old)
60 to 69	216	36.0	96	40.3	39	37.9	351	37.3
70 to 79	242	40.3	98	41.2	50	48.5	390	41.5
80 or more	142	23.7	44	18.5	14	13.6	200	21.2
Marital status
Never married	41	6.8	13	5.5	9	8.7	63	6.7
Married	260	43.3	103	43.3	41	39.8	404	42.9
Widower	240	40.0	92	38.7	37	35.9	369	39.2
Divorced	59	9.8	30	12.6	16	15.5	105	11.2
Education (years)
None	76	12.7	60	25.2	31	30.1	167	17.8
1 to 3	137	22.8	56	23.5	26	25.2	219	23.3
4 to 7	229	38.2	94	39.5	36	35.0	359	38.1
8 and more	158	26.3	28	11.8	10	9.7	196	20.8
Individual monthly income^*
no income	32	5.3	13	5.5	6	5.8	51	5.4
up to 1 wage	296	49.3	131	55.0	59	57.3	486	51.6
1 to 3	226	37.7	88	37.0	34	33.0	348	37.0
4 and more	46	7.7	6	2.5	4	3.9	56	6.0

Biopsychosocial indicators	Color/race
Biopsychosocial indicators	Whiten*(%)^†/mean(SD)^‡	Brownn*(%)^†/mean(SD)^‡	Blackn*(%)^†/mean(SD)^‡
Frailty condition
Frail	155 (25.8%)	48 (20.2%)	29 (28.2%)
Pre-frail	279 (46.5%)	119 (50.0%)	38 (36.9)
Not Frail	166 (27.7%)	71 (29.8%)	36 (35.0)
Health self-assessment
Very negative/negative	97 (16.2%)	45 (18.9%)	13 (12.6%)
Regular	246 (41.0%)	87 (36.6%)	31 (30.1%)
Positive/great	257 (42.8%)	106 (44.5%)	59 (57.3%)
Number of	6.50 (± 3.38)	6.83 (± 3.46)	5.72 (± 3.30)
BADL morbidities^§
Dependent	42 (7.0%)	19 (8.0%)	6 (5.8%)
Independent	558 (93.0%)	219 (92.0%)	97 (94.2%)
IADL^\|\|
Dependent	449 (74.8%)	177 (74.4%)	74 (71.8%)
Independent	151 (25.2%)	61 (25.6%)	29 (28.2%)
Physical performance	8.00 (± 3.24)	8.32 (± 3.06)	8.17 (± 3.27)
Indicative of depressive symptoms
Yes	147 (24.5%)	63 (26.5%)	103 (13.6%)
No	453 (75.5%)	175 (73.5%)	89 (86.4%)
Communication independence	6.46 (± 0.78)	6.36 (± 0.74)	6.31 (± 0.78)
Social support	88.02 (± 16.88)	87.76 (± 17.39)	90.15 (± 14.64)
Social network	5.07 (± 4.70)	5.40 (± 5.07)	4.83 (± 4.48)

Biopsychosocial indicators	Unadjusted regression analysis		Adjusted regression analysis*
	Color/race		Color/race
	Brown β^†/OR^‡(CI)^§	Black β^†/OR^‡(CI)^§	Brown β^†/OR^‡(CI)^§	Black β^†/OR^‡(CI)^§
Frailty condition
Frail	0.72 (0.47-1.11)	0.86 (0.51-1.47)	0.67 (0.42-1.07)	0.91 (0.50-1.65)
Pre-frail	0.99 (0.70-1.42)	0.63 (0.38-1.03)	0.96 (0.66-1.38)	0.61 (0.37-1.03)
Not Frail	1	1	1	1
Health self-assessment
Very negative/negative	1.12 (0.74-1.77)	0.58 (0.31-1.11)	0.85 (0.54-1.32)	0.40 (0.20-0.78) ^\|\|
Regular	0.86 (0.62-1.20)	0.55 (0.34-0.88) ^\|\|	0.72 (0.51-1.02)	0.44 (0.27-0.72) ^\|\|
Positive/great	1	1	1	1
Number of	0.33 (-0.17-0.84)	-0.78 (-1.49- -0.07) ^\|\|	0.22 (-0.28-0.72)	-0.78 (-1.47- -0.08) ^\|\|
BADL morbidities
Dependent	1.15 (0.66-2.03)	0.82 (0.34-1.99)	1.23 (0.68-2.22)	0.97 (0.39-2.40)
Independent	1	1	1	1
IADL**
Dependent	0.98 (0.69-1.38)	0.86 (0.54-1.37)	0.91 (0.63-1.33)	0.85 (0.51-1.40)
Independent	1	1	1	1
Physical performance	0.31 (-0.17-0.79)	0.16 (-0.51-0.83)	0.26 (-0.21-0.72)	-0.01 (-0.65-0.64)
Indicative of depressive symptoms
Yes	1.11 (0.79-1.56)	0.48 (0.27-0.88) ^\|\|	1.03 (0.71-1.45)	0.43 (0.23-0.79) ^\|\|
No	1	1	1	1
Communication independence	-0.09 (-0.21-0.02)	-0.15 (-0.31-0.01)	0.00 (-0.10-0.11)	-0.038 (-0.19-0.11)
Social support	-0.25 (-2.77-2.27)	2.13 (-1.38-5.64)	0.54 (-2.00-3.08)	3.60 (0.07-7.14) ^\|\|
Social network	0.33 (-0.39-1.05)	-0.24 (-1.24-0.76)	0.49 (-0.24-1.22)	-0.09 (-1.11-0.92)

Escola de Enfermagem de Ribeirão Preto / Universidade de São Paulo Av. Bandeirantes, 3900, 14040-902 Ribeirão Preto SP Brazil, Tel.: +55 (16) 3315-3451 / 3315-4407 - Ribeirão Preto - SP - Brazil
E-mail: rlae@eerp.usp.br

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[1] Corresponding author: Darlene Mara dos Santos Tavares E-mail: darlene.tavares@uftm.edu.br