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The Color of Hospitalization Over the Adult Life Course: Cumulative Disadvantage in Black and White?

¹ Center on Aging and the Life Course and Departments of ² Sociology and ⁴ Statistics, Purdue University, West Lafayette, Indiana.
³ Division of Geriatric Medicine and Gerontology, Center on Aging and Health, and Center for Health Disparities Solutions, The Johns Hopkins Medical Institutions, Baltimore, Maryland.
⁵ Department of Sociology and Center for Aging Studies, University of Maryland, Baltimore County.
⁶ Fred Hutchinson Cancer Research Center, Seattle, Washington.

Address correspondence to Dr. K. F. Ferraro, Center on Aging and the Life Course, Purdue University, Young Hall, 302 Wood Street, West Lafayette, IN 47907-2108. E-Mail: ferraro{at}purdue.edu

Objectives. Drawing from cumulative disadvantage theory, this research addresses the following questions: Do hospital admission and discharge rates differ for White and Black adults? If yes, do the differences amplify in later life?

Methods. This study made use of hospital records abstracted from a long-term prospective study of adults in the National Health and Nutrition Examination Survey I: Epidemiologic Follow-up Study (N = 6,833). Semi-Markov models were specified to examine the likelihood of hospital admission and discharge for Black and White adults aged 25 to 74 years old at baseline.

Results. Black adults were less likely than White adults to be admitted to the hospital, but they had longer lengths of stay. The risk of death in the hospital was greater for both Black men and women than for White men and women. In addition, the observed racial differences in hospitalization experiences amplified in later life.

Discussion. Health inequality in America is manifest in how White and Black adults enter and exit hospitals. The findings demonstrate growing heterogeneity in later life by race.