ETHNO-RACIAL DISPARITIES IN HEALTH OUTCOMES: EVIDENCE FROM THE AGING POPULATION

This dissertation assesses racial and ethnic disparities in health outcomes of the aging population, with focus on improving functional health, health status and quality of life at both individual and community levels. Chapter 2 examines racial and ethnic disparities in willingness to pay (WTP) for improved health among an aging population sample while also examining the impact of health status and risky health behaviors. Results indicate that racial and ethnic minorities are more likely to have a positive WTP for improved health than non-Hispanic Whites. However, WTP for minorities is found to be significantly lower than for non-Hispanic Whites. However, when compared with non-Hispanic Whites, WTP for minorities constitute a higher percentage of household income. Further analyses also examine the impact of health status and risky health behaviors on WTP for improved health. The third chapter examines racial and ethnic disparities in the trajectories of functional health limitations among older adults. Analyses stratified by race indicate that Blacks and Hispanics are more likely to have functional limitations at the initial time period than non-Hispanic whites. However net of educational attainment and wealth, a “racial crossover” is observed in the baseline odds of functional limitations where Whites are found to have a higher level of functional limitations compared to both minority groups. In addition, non-Hispanic Whites tend to have faster increases in the rate of change in functional limitations over time. This chapter also analyses how health status and health-related behaviors contribute to the baseline level and rate of change in functional limitations over time. Chapter 4 provides a cost effectiveness analysis of a physical activity and nutrition program, the Texercise Select program implemented in some Texas counties to improve functional health, nutritional habits and quality of life among the older population. Program effectiveness is measured using Quality adjusted life year (QALY) gain as well as health outcomes such as healthy days, weekly physical activity days and Timed Up-and-Go (TUG) test scores. Results indicate that the program is a cost-effective strategy for increasing physical activity and improving healthy nutrition practices among the older population as compared to other similar health promotion interventions and also in comparison to the common cost-effectiveness threshold of $50, 000 for a gained QALY.EconomicsDoctoralUniversity of New Mexico. Dept. of EconomicsValdez, RobertBinder, MelissaBerrens, RobertOry, Marci