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Of the vast opportunities in New York City, older adults from racial/ethnic minority groups face the challenges of social determinants on their health. This study applies the WHO’s Commission on Social Determinants of Health (CSDH) model to examine health inequities among older adults in New York City. The CSDH model holds that social capital spans the structural and intermediary determinants of health and plays a central role in health inequities. A deeper understanding of interrelationship of social capital and social determinants is crucial to promoting successful aging in an urban environment. Thus, this study applies structural equation modeling to examine the role of social capital in the form of neighborhood poverty and community support on the self-rated health of New York older adults.
Methods
Data were extracted from the NYC Community Health Survey to focus on older adults, aged 65 and over (N=1,862). Multivariate linear regression models were used to understand the racial and ethnic differences in self-reported health, after controlling for demographic characteristics and structural determinants (i.e., neighborhood poverty and lack of community support). To advance the knowledge in the literature, two separate structural equation modeling techniques were adopted to understand the potential mediations of neighborhood poverty and the lack of community support to the relationship between race/ethnicity and self-reported health.
Results
The sample consisted of 47.42% Non-Hispanic White, 21.75% Non-Hispanic Black/African American, 19.98% Hispanic, and 10.85% Non-Hispanic Asian older adults. The mean in self-reported health was 2.03 (range from 0-4). Multivariate analyses showed statistically significant racial/ethnic disparities in self-reported health, after controlling for demographics, neighborhood poverty, and the lack of community support. Specifically, older Asian adults were associated with poorer self-reported health, compared to Non-Hispanic White (b = -0.415, SE = 0.136). Older Black and Hispanics adults were also more likely to report poorer health, than non-Hispanic White (b = -0.206, SE = 0.097; b = -0.321, SE = 0.107, respectively). Mediation analyses showed that neighborhood poverty is a significant mediator to the relationship between racial/ethnic disparities in self-reported health between Non-Hispanic Whites, Hispanic, and Non-Hispanic Asians. A marginally significant mediation of the lack of community support was only found in self-reported health between Non-Hispanic Asians and Whites.
Conclusions and Implications
Overall, the results reveal a fuller picture of the impact of social determinants on health equity among older adults in New York City. Understanding the important role that neighborhood poverty and community support play in self-reported health for different racial/ethnic groups is necessary to provide adequate care and support for the growing aging population. Future research needs to further investigate the sociocultural and economic dimensions of health equity to provide empirical results that can inform practice and policy.