Race by Gender Differences in the Protective Effects of Education and Income Against Subsequent Changes in Self-rated Health, Physical Activity, and Body Mass Index Among Older Americans.

Background: Educational attainment and income are central to maintenance of body mass index (BMI), physical activity, and self-rated health (SRH). However, less is known about how social groups differ in the role of educational attainment and income on subsequent changes in these health outcomes. This study compared race/ethnicity by gender groups of older Americans for the effects of baseline educational attainment and income on subsequent changes in BMI, physical activity, and SRH.

Methods: The Health and Retirement Study (HRS) followed 37,495 male and female White and African American people above age 50 for 6 years from 2004 to 2010. This number included 15,581 White women, 12,495 White men, 5,580 African American women, and 3,839 African American men. Physical activity, BMI, and SRH were measured every two years. Multi-group structural equation modeling (latent growth curve modeling) was used to compare race/ethnicity by gender groups for the protective effects of educational attainment and income in 2004 on a decline in physical activity, BMI, and SRH from 2004 to 2010.

Results: Major race/ethnicity by gender differences were observed in the effects of baseline educational attainment and income on changes in BMI, physical activity, and SRH. Educational attainment and income showed more salient roles for White men and women than African American men and women. To give some examples, baseline education (years) was associated with changes in physical activity of White women and changes in BMI of White men, while baseline income was associated with changes in SRH of White Women. We did not find evidence suggesting that baseline income fully mediates the effect of baseline educational attainment on health outcomes, as in many instances, educational attainment but not income was associated with health changes over time.

Conclusion: The intersection of race/ethnicity and gender alters how educational attainment and income protects against subsequent changes in physical activity, BMI, and SRH. Social groups may vary in operant mechanisms by which social determinants of health prevent health decline in the United States.