Demographic Differences

Among the findings of the National Health Interview Study conducted in 1990 were that 92% of adults aged 25-44, 84% of adults aged 45-64, but only 72% of adults aged 65 and over evaluated their health as "Good to Excellent" (American Association of Retired Persons, 1996b; National Center for Health Statistics, 1991). To what extent is this age-related decline in ratings of personal health confirmed by patient information obtained by hospitals and physicians? Concerning the relationships of age to frequency and duration of treatment, data summarized by the American Association of Retired Persons (1996b) show that, in 1994, older adults accounted for 37% of all hospital stays and 47% of all days of care in hospitals. The average length of a hospital stay for older adults was 7.4 days, compared to only 4.8 days for those under 65. Older adults also averaged more contacts (11) with doctors compared with the average number of contacts (5) for those under 65. The average length of hospital stays and the number of physician contacts were greater for women than for men, for whites than for blacks, and for people with higher than lower incomes (National Center for Health Statistics, 1995).

Information on the relationship of age to disorders in general, as well as the 12 most frequent disorders, is provided by the 1994 national hospital discharge data summarized in Figure 3-1 (Graves & Gillum, 1996). For all except two of the categories listed—injury and poisoning and mental conditions—he numbers of individuals in the 65 + age groups are higher than those in the two younger age groups.

Chronological age is, of course, not the only demographic variable related to health and disease. Health status also varies with sex, race, socioeconomic status, nationality, and lifestyle. Arthritis, diabetes, and other less lethal conditions are more common in women, whereas more lethal conditions such as heart disease and cancer are more common in men. Type of health care received also varies with sex: Men with chronic disorders are more likely to be cared for at home by their wives, whereas older women with

Circulatory Diseases

Digestive Diseases

Respiratory Diseases

Injury and Poisoning

Mental Conditions

Neoplasms (Cancers)

Genitourinary Diseases

Musculoskeletal & Connective Tissue

Endocrine, Immunity & Nutritional/Metabolic

Infectious & Parasitic

Number in Thousands

Figure 3-1 Number of discharges from short-stay hospitals by first-listed diagnosis, sex, and age: United States, 1994. (Based on data from Graves & Gillum, 1996.)

chronic disorders are more likely to be widows and thus cared for in nursing homes. Perhaps not surprising is the fact that being unmarried increases the chances of being restricted for both older men and women suffering from long-term illnesses (Lentzner et al., 1992).

With respect to ethnicity, whites (and Asians) are typically healthier than blacks and are more likely to view their health as good. In the 1990 National Health Interview Study, for example, older blacks were much more likely to rate their health as fair or poor (44%) than were older whites (27%) (National Center for Health Statistics, 1991). Older blacks also average significantly more days in bed in which their usual activities are restricted because of illness or injury (American Association of Retired Persons, 1996b). Throughout adulthood, the death rates for blacks are significantly higher than those for whites, and the two ethnic groups have different death rates for specific conditions. For example, among the disorders with the highest death rates, blacks have higher rates than whites for cancer, HIV infection, and diabetes mellitus, whereas whites have higher rates than blacks for heart disease and respiratory diseases (Singh, Kochanek, & MacDorman, 1996).

The fact that socioeconomic status is associated with ethnicity should be taken into account in evaluating the relationships of race to health and disease. Not surprisingly, people of higher socioeconomic status tend to enjoy better health and to rate themselves as healthier than those of lower socioeconomic status. Self-assessments of health status in Americans over 65 become increasingly more positive as family income, one of the principal factors in determining socioeconomic status, increases. Not only are poorer health and physical disabilities more common in older adults of lower socioeconomic status, but they are also evident at an earlier age than in those of higher socioeconomic status.

Health status and the prevalence of specific diseases vary with both nationality and area of residence within a particular nation. Diet, climate, sanitation, and other variables that affect health also vary with geography and undoubtedly affect the relationships between health, nationality, and area of residence. The rate of heart disease, for example, tends to be greater in areas where the typical diet is high in fats, and the incidence of hypertension is higher in areas where there is a great deal of salt in the diet. One study found that death rates for alcohol-caused cirrhosis of the liver and venereal disease were higher in California and other Western states than in most Eastern states, but that the rate of deaths due to diabetes and heart disease were significantly higher in the eastern United States than elsewhere in the country. These results were attributed to regional differences in diet and lifestyle (Nelson, 1982).

Genetic differences may, of course, play a role in determining the relationships of health and disease to sex, race, socioeconomic status, nationality, and other demographic variables. Perhaps of even greater importance are pollution, diet, poor sanitation, and other environmental factors. A factor that presumably contributes to the poorer health of men than women is that men are more likely to be employed in industrial areas where a great deal of environmental pollution exists. The relationship between health and socioeconomic status may be attributable, at least to some extent, to the fact that people of meager economic resources tend to eat less nutritious food and enjoy less adequate health care than their more affluent contemporaries. Also associated with poorer health and higher death rates are smoking, alcohol and drug abuse, inadequate exercise, stress, and lack of social support (Bran-non & Feist, 1992).

Advances in medicine and living conditions during this century have led to a healthier population than ever before. Improvements in sanitation, nutrition, mass immunization, and antibiotics have contributed to the control of many diseases. For example, measles, diphtheria, influenza, pneumonia, and tuberculosis are no longer as threatening as they once were. However, heart disease, cancer, cerebrovascular disorders—the three more frequent killers of Americans, and many other diseases are still common. In addition to acute and chronic diseases, accidents, murder, and suicide continue to take their toll in causing distress, disability, and death.

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