A Longitudinal Study of Social Status,Perceived Discrimination,and Physical and Emotional Health Among Older Adults

Abstract

This study examines the relationships between social status, perceived discrimination, and physical and emotional health using a nationally representative sample of 6,377 older adults from the 2006 and 2008 waves of the Health and Retirement Study. About 63% of older adults reported at least one type of everyday discrimination and 31% reported at least one major discriminatory event during lifetime. Blacks, those separated, divorced, or widowed, and those with lower household assets have higher levels of perceived discrimination than Whites, the married or partnered, and those with more assets. Perceived discrimination is negatively associated with changes in health over 2 years, and everyday discrimination has stronger effects than major discriminatory events, especially on emotional health. The effects of perceived everyday discrimination on changes in depressive symptoms and self-rated health are independent of general stress. Efforts to reduce discrimination, including perceptions of discrimination, can be beneficial for health in old age.

Keywords

United States social status social inequality perceived discrimination physical health emotional health stress

A large body of research has shown that health outcomes are patterned across social statuses. Individuals with disadvantaged statuses have overall poorer physical and emotional health (Alwin & Wray 2005; Luo & Waite 2005; Marmot et al., 2008). Past research has shown that perceived discrimination—apparently unfair treatment attributed to status—contributes to this association (Williams & Mohammed, 2009; Williams, Neighbors, & Jackson, 2008). Perceived discrimination may act directly as a stressor, or it may mediate the health effects of social status. The present study considers both possibilities.

Perceived discrimination is a relatively common social experience; one third of U.S. adults report at least one major discriminatory event, and over three fifths report everyday discrimination (Kessler, Mickelson, & Williams, 1999). Although discrimination is reported by members of many social groups, research has documented consistent social status differentials in perceived discrimination (Barnes et al., 2004; Kessler et al., 1999), and evidence associates perceived discrimination with multiple indicators of poorer physical and mental health.

Most previous research in this area used cross-sectional designs (see exceptions by Barnes et al., 2008; Brown et al., 2000; Gee & Walsemann, 2009; Pavalko, Mossakowski, & Hamilton, 2003; Schulz et al., 2006), with data on young- and middle-aged adults; few focused on older people and studies of older adults were either cross-sectional (Lewis et al., 2009, 2010) or on mortality (Barnes et al., 2008). This is a significant gap in the literature given that the health vulnerabilities of older adults may amplify the health effects of discrimination, particularly among lower social status persons (Lewis et al., 2009). Questions of causal direction also remain open. This study employs a longitudinal design to better establish causal directions in the relationships between social status, perceived discrimination, and physical and emotional health among U.S. older adults. To our knowledge, no studies have looked at perceived discrimination and changes in health among older adults.

We ask four questions: (1) Do disadvantaged older adults perceive higher levels of discrimination than the more advantaged? (2) Is more perceived discrimination associated with poorer health? (3) Does perceived discrimination mediate the health effects of social status? (4) Do perceived discrimination and general stress show independent health effects?

Social Status, Perceived Discrimination, Inequality, and Health

Social statuses are facets of stratification sustained within complex structures of inequality. Statuses are demarked by both discrimination and patterned disparities in access to resources. Health differences associated with status derive from structured inequality and the effects of discrimination (Krieger, 1999).

Discrimination is harmful action taken against individuals or groups to protect customary relations of power and privilege (Feagin, 2000). It is not always intentional because stratification systems often produce routine actions with no current intention to harm but which can still be discriminatory. Perceived discrimination occurs when an individual infers he or she is the target of such actions, either intentional or unintentional (Pavalko et al., 2003). This perceptual process is influenced by social status, biographical experience, current emotions, and mental health condition (Blanchette & Richards, 2003; Schnittker & McLeod, 2005; Shelton & Sellers, 2000; Sellers & Shelton, 2003).

Because awareness makes perceived discrimination reportable, perceived discrimination is the mainstay measure in research where the individual is the unit of analysis. Despite the utility of perceived discrimination for research on health effects, the requirement of awareness implies potential for a discrepancy between the effect of an action and the comprehension of that action (Schmitt & Branscombe, 2002). Non-discriminatory action may be attributed to discrimination; actual discrimination may not be perceived as such. For the individual, however, perceived discrimination has well-documented health consequences.

Research confirms that perceived discrimination is linked with declines in self-rated health (Schulz et al., 2006; Williams et al., 1997), physical functioning (Gee, 2008; Pavalko et al., 2003), and mental health (Brown et al., 2000; Gee, 2008; Kessler et al., 1999; Pavalko et al., 2003; Schulz et al., 2006; Williams et al., 1997), and it is associated with increases in obesity (Hunte & Williams, 2009), chronic conditions (Gee, Spenser et al., 2007; Yoo, Gee, & Takeuchi, 2009), and mortality risk (Barnes et al., 2004). Evidence also connects perceived discrimination with unhealthy health behaviors (e.g., smoking, alcohol, and substance abuse; Chae et al., 2008; Gibbons et al., 2010), physiological conditions (e.g., high blood pressure; Lewis et al., 2009), and detrimental affective states (e.g., anxiety, anger; Gibbons et al., 2010; Pascoe & Richman, 2009; Williams et al., 2008).

Williams et al. (2008), in their review of the literature on discrimination and health, underscored the primary finding of this research. They acknowledged considerable variation in methodological quality, yet declared “the consistency of the finding that discrimination is associated with higher rates of disease is quite robust” (p. S31). Overall, mental health effects are more consistently revealed than physical health consequences. Our study assesses mental and physical health using multiple indicators of health status.

How Perceived Discrimination May Act on Health Among Older Adults

To understand how social experiences such as perceived discrimination “get under the skin” to influence health, some scholars suggest that psychological factors may play a fundamental role. Stress process theory is a useful framework for understanding this influence (Jackson et al., 2006; Pascoe & Richman, 2009; Taylor, Repetti, & Seeman, 1997; Williams & Mohammed, 2009). Stressful events of any kind initiate fight or flight processes that prepare the body for action. Repeated stressors overtax individuals’ ability to cope, and eventually do damage that increases the probability of injury, disease, and psychological disorder (Pearlin, 1989; Pearlin et al., 2005; Thoits, 2010; Turner, Wheaton, & Lloyd, 1995). Perceived discrimination is a stressor, which when frequent and chronic, has effects on health.

Our study assesses the health effects of perceived discrimination among older adults. In conceptualizing this process, we consider two alternative views. The first is the cumulative advantage-disadvantage perspective in social gerontology. This perspective notes the changed salience of certain life events with age as advantages or disadvantages associated with them have cumulative effects on health (Dannefer, 2003). The argument suggests that chronic exposure to perceived discrimination leads to negative consequences such as smoking, alcohol consumption, and the depletion of an individual’s physical and psychological reserves. Eventually a toll is exacted on physical health. The cumulative advantage-disadvantage perspective points to a negative association between perceived discrimination and health among older adults.

A second framework depicts aging as a process during which individuals gain in psychological maturity, experience, and skills (Mirowsky & Ross, 2001). Older individuals acquire better coping skills to deal effectively with stressful events, reducing the impact of perceived discrimination on health. This perspective implies a weak or null relationship between perceived discrimination and health outcomes among older adults.

These two perspectives also offer contrasting predictions for the role of perceived discrimination as a mediator of the association between social status and health. The cumulative advantage-disadvantage perspective suggests lower status individuals are more affected by chronic discrimination and, in turn, present more health problems. In contrast, the age-as-maturity perspective suggests perceived discrimination would not operate as a mediator of the effects of disadvantaged status on health.

Two studies showed that perceptions of age discrimination and work-related discrimination peak in the 50s, and then decline, but both studies were restricted to middle-aged samples of working women (Gee, Pavalko, & Long, 2007; Pavalko et al., 2003). A few studies of older adults found that perceived discrimination has a cross-sectional associated with high blood pressure and C-reactive protein levels among Blacks (Lewis et al., 2009, 2010) and is associated with increased mortality risk (Barnes et al., 2008).

Perceived Discrimination and General Stress

Some scholars seek to determine if perceived discrimination has an effect distinct from general social stress (Taylor & Turner, 2002; Williams et al., 2008). Experience of a particular acute stressor (e.g., losing one’s job due to actual discrimination or other reasons) may trigger a general chronic stressor (e.g., financial strain), change the impact of other ongoing chronic stressors, or exacerbate existing stresses (Williams et al., 2008). Thus, if the health effect of perceived discrimination remains after general stress is controlled, an independent effect of perceived discrimination is implied. To our knowledge, this argument has yet to be tested among a population of older adults.

Hypotheses

In this study, we test the following hypotheses about the relationships among social status, perceived discrimination, and health. First, we hypothesize that older adults with disadvantaged status perceive higher levels of discrimination than those with more advantaged status. Second, based on stress process theory and the cumulative advantage-disadvantage argument, we hypothesize that higher levels of perceived discrimination are associated with poorer health in old age. An alternative second hypothesis based on the age-as-maturity argument is that perceived discrimination and health is unrelated in old age. Third, if disadvantaged social status is associated with higher levels of perceived discrimination, and perceived discrimination is associated with poorer health, we hypothesize that the effects of social status on health are mediated by perceived discrimination. Fourth, we hypothesize that the effects of perceived discrimination on health are independent of the effects of general stress.

Method

Data for this study come from the 2006 and 2008 waves of the Health and Retirement Study (HRS). HRS is a nationally representative, longitudinal study of older adults in the United States. It was begun in early 1990s and now contains over 30,000 respondents entering the study as five birth cohorts and representing Americans born in 1953 or before. Respondents were re-interviewed every 2 years. The initial cohort response rates ranged from 70% to slightly over 80%; re-interview rates for all cohorts at each wave have been between 92% and 95% (Health and Retirement Study, 2011).

In 2004, HRS added a new feature for data collection in the form of self-administered questionnaires that were left with a random subsample of respondents upon the completion of an in-person core interview. In 2006, the Leave-Behind Questionnaire was expanded to include a rich set of questions on psychosocial issues (Clarke et al., 2007). Perceived discrimination and other psychosocial measures used in this study were taken from this self-administered questionnaire. There were 7,062 respondents born in 1953 or before included in the 2006 subsample for the self-administered questionnaire, and 6,858 of them were not missing on discrimination and demographic variables. Between 2006 and 2008, 314 died and 167 dropped out, resulting in an analytical sample of 6,377 respondents who were interviewed in both waves.

Perceived Discrimination

Both perceptions of everyday discrimination and lifetime experiences of major discriminatory events were reported in 2006. The present study uses both measures. Previous research shows that routine and chronic discrimination estimates are consistently more negative than those for major discriminatory events (Kessler et al., 1999; Pascoe et al., 2009; Williams et al., 1997).

Everyday discrimination taps into more chronic, routine, and relatively minor experiences of unfair treatment (Williams et al., 1997). Respondents were asked how often any of the following things have happened to them in their daily life: (i) “You are treated with less courtesy or respect than other people”; (ii) “You receive poorer service than other people at restaurants or stores”; (iii) “People act as if they think you are not smart”; (iv) “People act as if they are afraid of you”; and (v) “You are threatened or harassed.” The 6-point response scale to each item ranges from “never” to “almost every day.” Everyday discrimination is measured as the average of responses to these items; Cronbach’s alpha is .80. HRS also asked respondents to attribute reasons for the discrimination. Multiple ascriptions were allowed and included ancestry or national origin, gender, race, age, weight, physical disability, other aspects of physical appearance, sexual orientation, and other.

Lifetime experiences of major discriminatory events captures important experiences of unfair treatment (Kessler et al., 1999). The measure is a count of “yes” responses to six items: (i) “Have you ever been unfairly dismissed from a job?” (ii) “For unfair reasons, have you ever not been hired for a job?” (iii) “Have you ever been unfairly denied a promotion?” (iv) “Have you ever been unfairly prevented from moving into a neighborhood because the landlord or a realtor refused to sell or rent you a house or apartment?” (v) “Have you ever been unfairly denied a bank loan?” and (vi) “Have you ever been unfairly stopped, searched, questioned, physically threatened, or abused by the police?”

Health Outcomes

We examine four health outcomes. The advantages of including multiple outcomes in the same study are two-fold. First, effect strengths are made comparable. Second, design factors are removed as bases of effect strength. Both 2006 and 2008 self-reports of four health outcomes are included. All health measures are coded so that higher values are associated with poorer health. (1) Depressive symptoms: HRS includes a short version of the Center for Epidemiological Studies Depression Scale (CES-D) designed for telephone interviews with older adults (Turvey, Wallace, & Herzog, 1999). Respondents were asked if they had eight specific symptoms in the last week. The measure is a count of the affirmative responses with two items of positive affect reverse coded. (2) Self-rated health: Each respondent was asked for a subjective rating of his or her physical health. The 5-point scale ranges from excellent to poor. (3) Functional limitations: The number of functional limitations is calculated by summing “yes” responses to 11 items assessing the respondent’s difficulty with movements such as walking a block, climbing a flight of stairs, moving a large chair, or picking up a dime. (4) Chronic conditions: The number of chronic conditions is calculated by summing “yes” responses when asked about diagnoses of diabetes, heart disease, lung disease, cancer, hypertension, or stroke.

Social Status

Status variables consist of race/ethnicity, gender, age, marital status, education, household income, and household assets in the baseline year 2006. We distinguish four racial/ethnic categories: non-Hispanic White, non-Hispanic Black, Hispanic, and others. Age is measured in years. Marital status includes married/cohabitating, separated/divorced, widowed, and never married. Education is the highest year of schooling completed. We use the total household income and household assets with missing data imputed by the HRS staff. Household income and household assets were log transformed to adjust for skewness.

General Stress

Four indicators of general stress reported in 2006 are included. (1) Lifetime traumas counts positive responses to questions concerning 10 events: (i) “Has a child of yours ever died?” (ii) “Have you ever been in a major fire, flood, earthquake, or other natural disaster?” (iii) “Have you ever fired a weapon in combat or been fired upon in combat?” (iv) “Has your spouse, partner, or child ever been addicted to drugs or alcohol?” (v) “Were you the victim of a serious physical attack or assault in your life?” (vi) “Did you ever have a life-threatening illness or accident?” (vii) “Did your spouse or a child of yours ever have a life-threatening illness or accident?” (viii) “Before you were 18 years old, did you have to do a year of school over again?” (iv) “Before you were 18 years old, did either of your parents drink or use drugs so often that it caused problems in the family?” (x) “Before you were 18 years old, were you ever physically abused by either of your parents?” These items originated in a study of the health sequalae of trauma among older adults (Krause, Shaw, & Cairney, 2004).

(2) Experience of stressful life events is dummy coded with 1 if responses to any of the five questions regarding the last 5 years are “yes” and 0 if otherwise (Turner et al., 1995): (i) “Have you involuntarily lost a job for reasons other than retirement at any point?” (ii) “Have you been unemployed and looking for work for longer than 3 months at some point?” (iii) “Was anyone else in your household unemployed and looking for work for longer than 3 months?” (iv) “Have you moved to a worse residence or neighborhood?” and (v) “Were you robbed or did you have your home burglarized?”

(3) Chronic stressors is measured with the average of responses to eight questions asking about current problems with a duration of 12 months or longer. The response to each listed problem ranges from “no, didn’t happen” to “yes, very upsetting.” The eight items are (i) health problems (in respondent), (ii) physical or emotional problems (in spouse or child), (iii) problems with alcohol or drug use in family member, (iv) difficulties at work, (v) financial strain, (vi) housing problems, (vii) problems in a close relationship, and (viii) helping at least one sick, limited, or frail family member or friend on a regular basis (Troxel et al., 2003). The index ranges from 1 to 4 with higher values indicating greater stress; Cronbach’s alpha is .67.

(4) Financial strain is the average of responses to two items: (i) “How satisfied are you with your/your family’s present financial situation?” The 5-point response scale ranges from “completely satisfied” to “not at all satisfied.” (ii) “How difficult is it for you/your family to meet monthly payments on your/your family’s bills?” The 5-point response scale ranges from “not at all difficult” to “completely difficult.” The index has a range of 1 to 5, with higher values indicating more financial strain; Cronbach’s alpha is .80.

Control Variables

We control for whether the respondent is working and for the total number of persons in the household in multivariate analyses. Household size affects household income and assets, and it is also related to marital status. Work status affects exposure to discriminatory acts.

Statistical Procedures

Our analysis used STATA 11 (StataCorp, College Station, TX). We adjusted all results for complex survey design and sampling weights using svy methods. We first examined the prevalence of perceived discrimination among older adults. Then, two sets of regression analyses were performed. The first set included two Ordinary Least Squares (OLS) models for each type of perceived discrimination. In the first model, each type of perceived discrimination in 2006 was regressed on social status and control variables to examine the associations between social status and perceived discrimination. In the second model, measures of general stress were added to see whether the relationships between social status indicators and perceived discrimination are explained by their associations with general stress. In the second set of regression analyses, three OLS regression models were estimated for each physical and emotional health outcome. Model I regressed each health outcome in 2008 on social status indicators, corresponding health measure in 2006, and control variables to examine the relationship between social status in 2006 and changes in health between 2006 and 2008. Model II added measures of perceived discrimination in 2006 to Model I to examine the effects of perceived discrimination in 2006 on changes in health between 2006 and 2008, and whether perceived discrimination mediates the relationships between social status and changes in health. Model III added indicators of general stress to see whether the effects of perceived discrimination on changes in health are independent of general stress.

Preliminary analyses revealed no multicollinearity problem in these regression models. In addition, because 481 respondents died or dropped out between 2006 and 2008 surveys, our estimates of the effects of perceived discrimination using data from those re-interviewed in 2008 might be biased due to selective attrition (Berk, 1983). To account for this bias we conducted supplemental analyses using Heckman’s two-stage selection model; we first estimated the probability of staying in the sample in 2008 using 2006 measures of discrimination, social status, general stress, and control variables, and then re-estimated our regression models including the predicted probability of staying. These analyses showed similar patterns of the effects of perceived discrimination on health in the analyses adjusting for attrition as in those without adjusting for attrition. Additional diagnostic analysis indicated that the predicted probability of staying has a low tolerance score (.11), which may cause multicollinearity in model estimates. Thus, only results from the models without the adjustment are presented here.

Results

Descriptive Statistics

Table 1 presents descriptive statistics for all the variables. On a scale from 1 to 6, the average score for perceived everyday discrimination in 2006 is 1.72. About 63% of older adults reported at least one type of everyday discrimination. Forty-one percent reported one type only (not shown), and 22% reported multiple types of everyday discrimination. Among all named types, discrimination based on age was most common (30%), followed by gender discrimination (14%). About 14% reported discrimination based on race, ancestry, or national origin; 22% reported physical disability or appearance-related discrimination; and 17% reported other types of discrimination. The average number of self-reported major lifetime discriminatory events experienced is .50. About 31% reported at least one event: 19% reported one event only, 12% reported multiple events (not shown). Most of these events were related to employment; being unfairly dismissed from a job was most common (18%), followed by being unfairly denied a promotion (10%), and not being hired for a job for unfair reasons (10%) (not shown).

Table 1.

Descriptive Statistics

Variables	Unweighted M/%	Weighted M/%	SD
Perceived discrimination in 2006
Everyday discrimination (1-6)	1.66	1.72	(0.72)
Types of everyday discrimination
Race	9.6	8.5
Ancestry or national origin	5.9	5.5
Gender	12.6	13.9
Age	30.6	30.1
Weight	7.4	8.6
Physical disability	6.2	6.6
Other aspect of physical appearance	5.7	6.7
Sexual orientation	1.5	1.5
Other	13.2	15.2
Multiple types	20.6	21.6
Discriminatory events (0-6)	0.44	0.50	(0.85)
Health^a
Depressive symptoms in 2006 (0-8)	1.35	1.41	(1.90)
Depressive symptoms in 2008 (0-8)	1.36	1.37	(1.89)
Self-rated health in 2006 (1-5)	2.76	2.70	(1.07)
Self-rated health in 2008 (1-5)	2.88	2.83	(1.07)
Functional limitation in 2006 (0-11)	2.73	2.54	(2.85)
Functional limitation in 2008 (0-11)	2.85	2.63	(2.89)
Chronic conditions in 2006 (0-6)	1.33	1.20	(1.11)
Chronic conditions in 2008 (0-6)	1.47	1.33	(1.15)
Social Status
Race/ethnicity
Non-Hispanic White	78.9	83.0
Non-Hispanic Black	12.5	8.7
Hispanic	7.2	6.8
Other	1.4	1.5
Female	58.1	54.5
Age (53-104)	68.36	65.52	(9.45)
Marital status
Married/partnered	68.7	68.7
Separated/divorced	10.7	12.8
Widowed	18.3	15.4
Never married	2.2	3.1
Education (0-17)	12.70	12.96	(3.03)
HH income (log) (0-17)	10.54	10.64	(1.20)
HH total assets (log) (0-19)	11.50	11.49	(3.33)
General stress
Lifetime traumas (0-10)	1.55	1.56	(1.41)
Stressful life events last 5 yrs	17.0	20.6
Chronic stressors (1-4)	1.49	1.51	(0.46)
Financial strain (1-5)	2.36	2.42	(0.93)
Control variables
Number of HH members (1-13)	2.10	2.17	(0.95)
Working	32.9	43.2

Note: N = 6,377. All variables were measured in 2006 unless otherwise indicated.

Calculations were based on the respondents who reported a particular health outcome in both 2006 and 2008. Number of cases is 6,177 for depressive symptoms, 6,368 for self-rated health, 6,374 for functional limitations, and 6,336 for chronic conditions.

The older adults’ physical health declined from 2006 to 2008, but their emotional health was stable. The average scores on all three physical health outcomes significantly increased: self-rated health changed from 2.70 to 2.83 (p < .001), functional limitations increased from 2.54 to 2.63 (p < .01), and chronic conditions increased from 1.20 to 1.33 (p < .001). Depressive symptoms declined slightly, but the change was not significant.

Social Status and Perceived Discrimination

Table 2 presents results from OLS regressions of perceived discrimination on social status indicators, general stress, and control variables. Model I includes social status and control variables. Supportive of Hypothesis 1, Blacks reported marginally higher levels of everyday discrimination and more major discriminatory events than Whites. Older adults of “other” race/ethnicity reported marginally higher levels of everyday discrimination than Whites. Compared to the married/partnered, the separated/divorced and the widowed reported higher levels of everyday discrimination. The separated/divorced also reported more discriminatory events than the married/partnered. Among socioeconomic status indicators, household assets are negatively associated with both perceived everyday discrimination and major discriminatory events. Contrary to Hypothesis 1, Hispanics reported a marginally lower level of everyday discrimination than Whites. Women reported less everyday discrimination and fewer major discriminatory events than men. There is a strong negative association between age and both types of discrimination; with increasing age, levels of both types of discrimination decrease. Education is not significantly associated with everyday discrimination, but it is positively associated with reports of major discriminatory events.¹

Table 2.

Unstandardized Coefficients From Regressions of Perceived Discrimination on Social Status and General Stress in 2006

	Everyday Discrimination		Discriminatory Events
	Model I	Model II	Model I	Model II
Social status
Race/ethnicity
(Ref = Non-Hispanic White)
Non-Hispanic Black	0.08+	0.08*	0.41**	0.43**
Hispanic	−0.12+	−0.10	0.11	0.13+
Other	0.19+	0.19+	0.12	0.15
Female	−0.18**	−0.20**	−0.22**	−0.21**
Age	−0.02**	−0.01**	−0.01**	−0.01**
Marital status
(Ref = married/partnered)
Separated/divorced	0.08*	0.05	0.23**	0.15**
Widowed	0.08*	0.05	0.02	−0.04
Never married	−0.02	0.02	0.07	0.12
Education	−0.01	−0.01	0.03**	0.03**
HH income log	0.01	0.02**	0.003	0.02+
HH total assets log	−0.02**	−0.003	−0.02**	−0.001
General stress
Lifetime traumas		0.04**		0.12**
Stressful life events last 5 years		0.06+		0.36**
Chronic stressors		0.39**		0.20**
Financial strain		0.04*		0.06**
Control variables
Number of HH members	0.004	−0.01	−0.03	−0.05**
Working	0.02	0.04	−0.01	0.01
Constant	3.13**	1.77**	1.31**	−0.20
R ²	0.08	0.16	0.09	0.20

Note: Based on OLS regressions. Results are weighted and adjusted for complex sampling design.

p < .1. *p < .05. **p < .01 (two-tailed tests).

When variables measuring general stress are added to Model I, all four general stress variables are positively associated with both perceived everyday discrimination and major discriminatory events in lifetime (Table 2, Model II). Also, the effects of marital status variables become non-significant for everyday discrimination, and the effect of divorce/separation on discriminatory events is substantially attenuated. The associations between household assets and both types of discrimination become non-significant. However, we do not see substantial changes in the associations between other social status indicators and perceived discrimination. Also surprising is that household income becomes significant and is positively associated with perceived discrimination once general stress is controlled.

Social Status, Perceived Discrimination, and Changes in Health

Results from OLS regressions of health outcomes in 2008 on perceived discrimination in 2006 while controlling for health status in 2006 are presented in Table 3. Model I examines the effects of social status indictors on changes in our four health measures net of other demographic variables (Columns 1, 4, 7, 10). These effects need to be established in order to test our hypothesis that perceived discrimination mediates the association between social status and health. Race/ethnicity does not have much effect on 2-year changes in health among older adults. Gender effects are inconsistent; holding health status in 2006 constant, older women have more functional limitations, but fewer chronic conditions in 2008 than older men. Increasing age is associated with worsening in all three physical health outcomes. Older adults who are divorced/separated have poorer health in 2008 than those who are married as indicated by self-rated health and depressive symptoms. More consistent results are found in measures of socioeconomic status. Holding constant the 2006 health status, lower education is associated with poorer health in 2008 as indicated by depressive symptoms, self-rated health, and functional limitations. Household income is associated with depressive symptoms and self-rated health, and household assets are associated with all four outcomes in the expected directions.

Table 3.

Unstandardized Coefficients From Regressions of Health Outcomes in 2008 on Social Status, Perceived Discrimination, General Stress and Heath Status in 2006

	Depressive Symptoms			Self-Rated Health			Functional Limitations			Chronic Conditions
	I (Column 1)	II (Column 2)	III (Column 3)	I (Column 4)	II (Column 5)	III (Column 6)	I (Column 7)	II (Column 8)	III (Column 9)	I (Column 10)	II (Column 11)	III (Column 12)
Social status
Race/ethnicity
(Ref = Non-Hispanic White)
Non-Hispanic Black	−0.04	−0.08	−0.06	−0.02	−0.03	−0.02	−0.20*	−0.22*	−0.21*	−0.02	−0.03	−0.03
Hispanic	0.13	0.14	0.18+	0.08	0.09	0.10+	0.07	0.07	0.09	0.01	0.02	0.02
Other	−0.19	−0.24	−0.23+	0.18+	0.16+	0.17+	0.20	0.18	0.18	0.002	−0.003	−0.005
Female	0.07	0.12*	0.08+	−0.03	−0.01	−0.03	0.17**	0.20**	0.17**	−0.05**	−0.05**	−0.05**
Age	−0.01+	−0.004	0.0003	0.003*	0.005**	0.01**	0.02**	0.02**	0.03**	0.002*	0.003**	0.003**
Marital status
(Ref = married/partnered)
Separated/divorced	0.03	0.004	−0.01	0.09*	0.08+	0.07+	0.17+	0.15	0.13	−0.01	−0.02	−0.02
Widowed	−0.04	−0.05	−0.07	−0.02	−0.03	−0.04	0.05	0.04	0.02	−0.03	−0.04	−0.04
Never married	−0.02	−0.01	0.07	0.06	0.07	0.08	0.20	0.19	0.24+	−0.01	−0.01	−0.01
Education	−0.03**	−0.03**	−0.03**	−0.01**	−0.01**	−0.02**	−0.03*	−0.03*	−0.03*	−0.004	−0.004	−0.004
HH income log	−0.08**	−0.09**	−0.06**	−0.03*	−0.03*	−0.02+	−0.05	−0.05	−0.03	0.001	0.001	0.004
HH total assets log	−0.02+	−0.01	0.004	−0.02**	−0.02**	−0.01*	−0.02+	−0.02	−0.003	−0.01*	−0.01*	−0.005
Perceived discrimination
Everyday discrimination		0.16**	0.09*		0.07**	0.04*		0.09+	0.03		0.02*	0.01
Discriminatory events		0.08*	0.02		0.01	−0.004		0.05+	0.01		0.01	0.01
General stress
Lifetime traumas			0.06**			0.01			0.04			0.0001
Stressful life events last 5 years			−0.03			−0.03			−0.17*			−0.005
Chronic stressors			0.39**			0.15**			0.28**			0.04+
Financial strain			0.17**			0.05**			0.17**			0.02*
Control variables
Number of HH members	−0.05*	−0.05+	−0.08**	0.0001	0.0002	−0.01	0.004	0.01	−0.01	−0.01	−0.01	−0.01+
Working	−0.23**	−0.24**	−0.24**	−.05+	−0.05+	−0.05+	−0.27**	−0.28**	−0.29**	−0.04*	−0.05*	−0.05*
Depressive symptoms in 2006	0.51**	0.49**	0.45**
Self-rated physical health in 2006				0.63**	0.62**	0.60**
Functional limitations in 2006							0.72**	0.71**	0.69**
Chronic conditions in 2006										0.93**	0.93**	0.93**
Constant	2.81**	2.28**	0.74+	1.62**	1.42**	0.95**	0.49	0.17	−1.09*	0.30**	0.22+	0.03
Observations	6,177	6,177	6,177	6,368	6,368	6,368	6,374	6,374	6,374	6,336	6,336	6,336
R ²	0.33	0.33	0.35	0.48	0.48	0.49	0.61	0.61	0.61	0.82	0.82	0.82

Note: Based on OLS regressions. Results are weighted and adjusted for complex sampling design.

p < .1. *p < .05. **p < .01 (two-tailed tests).

When measures of perceived discrimination are added in Model II (Columns 2, 5, 8, 11), everyday discrimination is associated with poorer health in 2008 for all four health outcomes. Number of major lifetime discriminatory events is associated with more depressive symptoms in 2008, and it also has a marginally significant effect on functional limitations. For depressive symptoms, the coefficient of female becomes significant and the coefficients of age and household assets are no longer significant; the effects of other social status indicators do not change substantially.

Perceived Discrimination and General Stress

Next we added indicators of general stress to Model II to examine whether the effects of perceived discrimination on health are independent of the effects of general stress (Table 3, Model III). Controlling for general stress reported in 2006, the coefficients of perceived discrimination measures on health outcomes are substantially attenuated, but everyday discrimination remains significant for depressive symptoms and self-rated health. Chronic stressors and financial strain are positively associated with changes in all four health outcomes and lifetime traumas are associated with depressive symptoms (Columns 3, 6, 9, 12). Stressful life events in the past 5 years have a significant effect on functional limitations, but it is in the direction opposite to our expectation. There are several noticeable changes in the coefficients of social status indicators: the effects of gender on depressive symptoms and functional limitations, the effects of household income on depressive symptoms and self-rated health, and the effects of household assets on functional limitations and chronic conditions are substantially attenuated.²

Discussion

This study examined the relationships between social status, perceived discrimination, and changes in physical and emotional health among older adults in the United States. The longitudinal survey design, large and representative sample, and rich information on different types of discrimination and on general stress allowed us to address some of the limitations in previous research. Our results show that about 63% of older adults reported at least one type of everyday discrimination and 31% reported at least one major lifetime discriminatory event. These proportions are similar to previous findings in younger samples (Kessler et al., 1999).

Our first hypothesis was that older adults with disadvantaged social status would perceive higher levels of discrimination than those with more advantaged status. Our results suggest this hypothesis was too general. We found only Blacks, those separated/divorced, widowed, and those with lower household assets reported higher levels of perceived discrimination. The results on gender, age, and education did not support this general hypothesis. Our second hypothesis was that higher levels of perceived discrimination would be associated with negative changes in health. This hypothesis received stronger support for everyday discrimination than for lifetime discriminatory events. We found little support for our third hypothesis that perceived discrimination would mediate the relationship between social status and changes in health. The results show that adding perceived discrimination to our model did not change the association between social status and health. Our fourth hypothesis stated that the effects of perceived discrimination on health are independent of general stress. It was supported for depressive symptoms and self-rated health.

Our findings on the relationship between social status and perceived discrimination demonstrate that perceived discrimination has delimited social patterning (see also Kessler et al., 1999; Pavalko et al., 2003). Some low-status groups reported higher rates of perceived discrimination, but others did not.

The finding that women report less discrimination than men, though counter to our hypothesis, has been reported in other research (Kessler et al., 1999). This result may reflect the different arenas in which men and women spend time and the different kinds of interactions they are likely to have. For example, particularly with this older cohort, women may have spent less time in the workforce than did men, limiting their exposure to work-related discrimination—additional analyses showed that older women were less likely than older men to report the three job-related discriminatory events. Women of all age categories are less likely to be involved with the police, thus reducing their chances of unfair treatment by the police (a major discriminatory event in which we saw the largest gender difference in additional analyses). Similarly, women may be seen as less aggressive than men and hence less likely to report the item of others “being afraid” of them (an everyday discrimination item in which we saw the largest gender difference in additional analyses). We should also note that supplementary analyses of the reasons attributed to everyday discrimination show that women, though less likely to report discrimination than men, are more likely than men to attribute the perceived discrimination to their sex. Future research on the specific circumstances surrounding discrimination experiences and how people perceive them may help clarify these findings.

Our finding of the negative associations between age and both types of discrimination is consistent with research by Pavalko et al. (2003) and Gee, Pavalko et al. (2007), which found that, among women, the likelihood of perceiving work discrimination and age discrimination peaks in the late 40s and early 50s and declines after that point. Our supplementary analysis also showed that selective attrition did not explain this result. However, given that there was only a 2-year gap between the waves, this possibility cannot be ruled out completely. The results with respect to everyday discrimination may reflect changes in social status that accompany aging; as with the results for gender, older people often occupy a narrower social arena than do the young. The results with respect to lifetime discrimination are more difficult to attribute in this way. However, one possibility is suggested by the age-as-maturity perspective—past events evolve in meaning as individuals move through the life course (Brandtstaedter & Baltes-Gotz, 1990). Were this applied to experiences of past discrimination, it is possible that meanings individuals ascribe to events have evolved in ways that reduced reports of discrimination among older adults. These results may also reflect a cohort effect; with increasing public awareness and policy interventions in recent decades, younger generations may be more conscious of discriminatory acts than older generations and more likely to report them. Panel studies that follow cohorts from their later working years (when major discrimination peaks) through old age will be useful for untangling these alternative explanations. We should also note that although older adults perceive lower levels of discrimination with increasing age, they are more likely to attribute the discrimination to their age in our supplementary analysis, which attests to the salience of age in the lives of older adults.

Our finding that more educated older adults report higher levels of major discriminatory events is consistent with previous studies (Gee et al., 2007; Kessler et al., 1999; Pavalko et al., 2003). Some scholars have suggested that better educated workers may more readily perceive inequities and thus report discrimination at higher rates (Forman et al., 1997; Kessler et al., 1999). Alternatively, however, those whose jobs have low levels of control or job security could arguably be expected to perceive more frequent unfair treatment (Pavalko, 2003). Further research is needed to identify the social psychological bases of these relationships.

Consistent with previous studies on younger samples, we found strong associations between perceived discrimination and changes in health over 2 years among older adults, that perceptions of everyday discrimination have stronger effects than perceptions of major discriminatory events, and that perceived discrimination has stronger effects on emotional health than on physical health. Our finding on everyday discrimination lends support to stress process theory and the cumulative advantage/disadvantage argument, while our finding on major discriminatory events seems to be consistent with the age-as-maturity argument. Previous literature suggests that as an ongoing, chronic stressor, the effects of everyday discrimination can accumulate and eventually take a toll on health, and thus, it should be addressed along with major discriminatory events. It should be noted that changes in physical health may take longer to appear, which may explain why we see a stronger effect of perceived discrimination on emotional health than on physical health over a 2-year period. Future research with a longer time frame is needed to better understand the effect of perceived discrimination on physical health.

It is also interesting to note that the effects of social status on changes in health are not mediated by perceived discrimination. In other words, social status and perceived discrimination act as independent contributors to health changes in old age. Older adults with lower socioeconomic status, such as education, income, and assets, will have more negative changes in health, as will those who perceive higher levels of discrimination. Importantly, we found no evidence of an interaction between status and perceived discrimination. Some research has shown that social statuses can modify the impact of perceived discrimination on health (Hunte et al., 2009; Kessler et al., 1999; Lewis et al., 2009; William et al., 1997). We tested for this possibility but did not find any evidence of it in this analysis. Instead, we found greater support for the role of financial strain as a mediator of the association between some forms of low status (income and assets) and health (see Table 3). Taken together, these findings suggest that social policies targeted at reducing health inequality need to address social inequality and discrimination simultaneously.

Our results show that even after controlling for general stress, everyday discrimination still has significant independent effects on changes in emotional health, such as depressive symptoms and self-rated health. These results are consistent with Williams et al. (1997), but contrary to Taylor and Turner (2002). Taylor and Turner (2002) found that the association between discrimination and depression is no longer significant after general stress is controlled, and they attributed the differences between their findings and those in Williams et al. (1997) to the more comprehensive estimates of general stress exposure they used. If our findings hold in future research that includes more comprehensive estimates of general stress, it would further underscore the unique contributions of perceived discrimination to health and well-being in old age.

The current study has several limitations. First, although our measures of perceived discrimination are more comprehensive than a single-item measure of a particular type of discrimination, many aspects of discrimination that are rooted in daily interactions are not captured in these measures, and thus, the acts of discrimination measured in this study may only represent a small proportion of the actual instances of unfair treatment people experienced (Ridgeway, 1997). Second, the 2008 HRS also includes questions on perceived discrimination, but these questions were asked of a different subsample of respondents than those in 2006, and as a result, we cannot examine how changes in perceived discrimination is associated with changes in health or how health may affect changes in perceived discrimination. Third, as noted earlier, the time period for our study is 2 years, which may be too short for any noticeable changes in physical health to occur. Fourth, we do not have measures of depressive symptoms that were assessed after reports of discrimination and before reports of health changes which would allow us to test the possible mediating effect of emotional health on the relationship between perceived discrimination and physical health (Williams et al., 2008).

In sum, this study provides some evidence that people with disadvantaged social status are more likely to perceive discrimination, and perceived discrimination is associated with negative changes in health in old age. It adds to a growing literature documenting the significant impact of both actual discrimination and perceptions of discrimination on health. Discriminatory acts and events and the perceptions of such acts and events are a frequent source of stress linked to adverse health. To protect the well-being of those who face greater risks for discrimination in their lives, it is imperative that we do more to eliminate not only major unfair treatments, but also everyday discrimination on the basis of race/ethnicity, gender, education, income, and other social statuses.

Footnotes

Acknowledgements

An earlier draft was presented at the Annual Meeting of the American Sociological Association, in Atlanta, Georgia, August 13-16, 2010. We thank Dr. Jim Rick and the reviewers for their helpful comments.

Notes

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