Black-White Differences in the Protective Effects of Income against Perceived Financial Difficulties in the United States

One of the components of the protective effects of overall high socioeconomic status (SES) on health is high subjective SES. As SES has shown weaker health effects for marginalized groups, a phenomenon called Marginalization-related Diminished Returns (MDRs), we conducted this study to test differential associations between two objective SES indicators, namely education and household income, with a subjective SES indicator (perceived financial difficulties) by race. For this cross-sectional analysis, we used the Health Information National Trends Survey (HINTS 2020) data. Participants included 1403 individuals who identified as either non-Latino Black or non-Latino White. Age, sex, marital status, and employment were used as control variables, while education and income were used as independent variables. Perceived financial difficulties were the outcome. Binary logistic regression was used for main data analysis. Linear regression was used for sensitivity analysis. Overall, high education and household income were associated with lower odds of perceived financial difficulties. We documented a statistical interaction between race and income on subjective SES indicating a weaker inverse association between household income and perceived financial difficulties for non-Latino Black than non-Latino White individuals. The results remained similar using linear or logistic regression models. We did not find racial differences in the association between education and perceived financial difficulties. In the US, and under structural racism, the link between objective SES indicators such as income and perceived financial difficulties differs for non-Latino Black and non-Latino White people. Income may better reduce perceived financial difficulties for non-Latino Black than non-Latino White individuals. This finding is in line with the MDRs framework and suggests a mechanism for why we observe weaker health effects of objective SES indicators, such as income, for racial minorities in the US, and why we observe racial health disparities across class lines