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Access Type

WSU Access

Date of Award

January 2021

Degree Type


Degree Name




First Advisor

Gail G. Jensen Summers


This dissertation examines racial and ethnic disparities in health and mortality among adults in late midlife in the U.S., how they have changed in recent years, and the determinants of the changes observed. Using longitudinal data from the Health and Retirement Study (HRS) on U.S. adults ages 50-64, two separate studies are conducted. In the first, we use the HRS to examine how the risk of death varies between non-Hispanic Whites (Whites), non-Hispanic Blacks (Blacks), and English- and Spanish-speaking Hispanics, ages 50–64, in two different periods, 1998-2004 (Period 1) and 2004–2010 (Period 2), whether and how the differences between groups changed between periods, and the determinants of the changes observed. Using survey-generalized linear regression techniques, we model death-by-end-of-period as a function of race/ethnicity, and then sequentially adjust for a series of period-specific baseline risk factors which include demographics, health status, health insurance, health behaviors, and social networks. Regression decomposition (RD) techniques are then used to assess the contribution of these factors to observed racial/ethnic differences in mortality. We find that the odds ratio for death (ORD) was not statistically different for Blacks (vs. Whites) in Period 1, but it was 33% higher in Period 2. The adjusted ORD among English-speaking Hispanics was not statistically different in both periods. The adjusted ORD among Spanish-speaking Hispanics (vs. Whites) was lower (ORD = 0.36) in Period 1 but indistinguishable in Period 2. Results from the RD only found statistical significance between Black-White mortality differences. In Period-1, 50.1% of those Black-White mortality differences were attributed to health status, 53.1% was due to financial factors. In Period-2, 55.8% of those Black-White mortality differences were attributed to health status, 40.0% due to financial factors, and 16.2% due to health insurance status. Thus, there has been no progress in reducing racial/ethnic differences in mortality in recent years. In the second study, HRS data are used to examine the nature of “trajectories in health and mortality,” how they vary across racial/ethnic groups, whether differences across racial/ethnic groups have changed through time, and the determinants of a person’s trajectory. Trajectories are examined for three different time periods, 1998-2004, 2004-2010, and 2010-2016. Latent growth modeling techniques are used to identify five distinct trajectory patterns for health and mortality among adults ages 50-64, which can loosely described as: “Poor Health-Rapid Mortality,” “Persistent Poor Health,” “Back & Forth Health,” “Good Health-Rapid Mortality,” and “Persistent Good Health.” We find that there are significant differences in the distribution of these trajectories across racial/ethnic groups, that these differences have changed little over time, and that significant differences between groups persist even after controlling for a wide range of health determinants, such as health behaviors, financial resources, social networks, and other characteristics. We find that non-Hispanic Blacks and Hispanics are less likely than Non-Hispanic Whites to experience “Sustained Good-Health,” and more likely to experience “Sustained Poor-Health” across all time periods. Non-Hispanic Blacks are also consistently more likely to experience “Poor-Health with Rapid Mortality.”

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