摘要：Objectives. We sought to determine whether childhood health disparities are best understood as effects of race, socioeconomic status (SES), or synergistic effects of the two. Methods. Data from the National Health Interview Survey 1994 of US children aged 0 to 18 years (n=33911) were used. SES was measured as parental education. Child health measures included overall health, limitations, and chronic and acute childhood conditions. Results. For overall health, activity and school limitations, and chronic circulatory conditions, the likelihood of poor outcomes increased as parental education decreased. These relationships were stronger among White and Black children, and weaker or nonexistent among Hispanic and Asian children. However, Hispanic and Asian children exhibited an opposite relationship for acute respiratory illness, whereby children with more educated parents had higher rates of illness. Conclusions. The traditional finding of fewer years of parent education being associated with poorer health in offspring is most prominent among White and Black children and least evident among Hispanic and Asian children. These findings suggest that lifestyle characteristics (e.g., cultural norms for health behaviors) of low-SES Hispanic and Asian children may buffer them from health problems. Future interventions that seek to bolster these characteristics among other low-SES children may be important for reducing childhood health disparities. Health disparities reflect differences in health because of sociodemographic variables, such as race, socioeconomic status (SES), and gender. 1 Both racial and socioeconomic disparities in health are profoundly evident in the United States, such that Healthy People 2010 —the national statement of health objectives—has made 1 of its 2 overarching goals the elimination of health disparities. 1 Low-SES individuals consistently have poorer health than high-SES individuals across a variety of morbidity and mortality outcomes. 2 – 5 Understanding these relations early in life is critical not only for maximizing children’s health but also for understanding the origins of adult disparities in health. Low SES has been associated with poorer health in childhood. 6 – 11 For example, lower-SES children are less likely to receive vaccinations and have contact with physicians at early ages. 7 , 12 Lower-SES children have poorer health behaviors, including higher injury rates at young ages and greater rates of smoking and sedentary behaviors. 6 , 7 Lower-SES children also suffer from chronic impairments, such as higher rates of hospitalizations for asthma, and greater activity limitations. 6 , 7 , 10 Disparities in childhood health have heavy costs. For example, on the basis of projected inability to work or lost time from work in adulthood because of illness, children living in poverty are projected to cost the United States $130 billion ($1996) in future economic output. 13 Similarly, children belonging to minority groups have poorer health. For example, Black families have higher rates of low-birthweight babies and infant mortality than do White families. 14 – 16 Black children have higher rates of elevated levels of blood lead 12 and are more likely to have fair/poor health than are White children. 17 Black mothers are less likely to receive prenatal care than are White mothers, and Black children are more likely to be hospitalized for conditions such as asthma. 7 Fewer data have historically been available on other ethnic groups, and heterogeneity within groups makes patterns more difficult to interpret. However, there is some evidence that Hispanic and Asian children are more likely to have fair/poor health than are White children, 18 and that cardiovascular risk factors such as body mass index and glycated hemoglobin levels are higher among Hispanics than among Whites. 19 The vast majority of research on health disparities has focused on either SES or race and often controls for 1 factor when testing the effect of the other. 5 Yet SES and race are closely intertwined, with members of many minority groups, on average, being lower in SES. 20 Thus, some researchers have argued that researchers should be testing for interaction effects between race and SES. 21 – 24 An interaction between race and SES could take a number of forms. Race and SES could interact synergistically to affect health. That is, the effects of low SES could be particularly pronounced among minority groups, perhaps if poverty effects are compounded by racism. 23 The notion that individuals who belong to multiple groups facing discrimination are the most disadvantaged has been termed the double jeopardy hypothesis. 25 , 26 Alternatively, the effects of low SES could be more pronounced among groups that are native born. This might occur because immigrants are more likely to have better health than those in the native-born population, even if they are lower in SES, a phenomenon termed the healthy immigrant effect. 27 , 28 If Whites and Blacks are less likely to be immigrants, they may exhibit stronger relations between SES and health than other minority groups. Alternatively, if base rates of many illnesses are higher among Blacks than among Whites, a ceiling effect may exist, such that the effect of SES on health is less apparent among Blacks than among Whites. Finally, certain SES indicators may be a poorer marker of SES among some minority groups. For example, minority group members on average do not receive the same financial gains for equivalent years of education as do Whites, 22 , 29 which could result in Whites having a stronger SES gradient than other racial groups. We tested our reasoning by analyzing race by SES (on the basis of parental education) interactions predicting health outcomes in a large, nationally representative sample of US children. These analyses could provide information about the utility of assessing health disparities using SES, race, or some combination of the 2.
