Trends in Poor Health Indicators Among Black and Hispanic Middle-aged and Older Adults in the United States, 1999-2018

Importance Adults who belong to racial/ethnic minority groups are more likely than White adults to receive a diagnosis of chronic disease in the United States. Objective To evaluate which health indicators have improved or become worse among Black and Hispanic middle-aged and older adults since the Minority Health and Health Disparities Research and Education Act of 2000. Design, Setting, and Participants In this repeated cross-sectional study, a total of 4856326 records were extracted from the Behavioral Risk Factor Surveillance System from January 1999 through December 2018 of persons who self-identified as Black (non-Hispanic), Hispanic (non-White), or White and who were 45 years or older. Exposure The 1999 legislation to reduce racial/ethnic health disparities. Main Outcomes and Measures Poor health indicators and disparities including major chronic diseases, physical inactivity, uninsured status, and overall poor health. Results Among the 4856326 participants (2958041 [60.9%] women; mean [SD] age, 60.4 [11.8] years), Black adults showed an overall decrease indicating improvement in uninsured status (beta = -0.40%; P < .001) and physical inactivity (beta = -0.29%; P < .001), while they showed an overall increase indicating deterioration in hypertension (beta = 0.88%; P < .001), diabetes (beta = 0.52%; P < .001), asthma (beta = 0.25%; P < .001), and stroke (beta = 0.15%; P < .001) during the last 20 years. The Black-White gap (ie, the change in beta between groups) showed improvement (2 trend lines converging) in uninsured status (-0.20%; P < .001) and physical inactivity (-0.29%; P < .001), while the Black-White gap worsened (2 trend lines diverging) in diabetes (0.14%; P < .001), hypertension (0.15%; P < .001), coronary heart disease (0.07%; P < .001), stroke (0.07%; P < .001), and asthma (0.11%; P < .001). Hispanic adults showed improvement in physical inactivity (beta = -0.28%; P = .02) and perceived poor health (beta = -0.22%; P = .001), while they showed overall deterioration in hypertension (beta = 0.79%; P < .001) and diabetes (beta = 0.50%; P < .001). The Hispanic-White gap showed improvement in coronary heart disease (-0.15%; P < .001), stroke (-0.04%; P < .001), kidney disease (-0.06%; P < .001), asthma (-0.06%; P = .02), arthritis (-0.26%; P < .001), depression (-0.23%; P < .001), and physical inactivity (-0.10%; P = .001), while the Hispanic-White gap worsened in diabetes (0.15%; P < .001), hypertension (0.05%; P = .03), and uninsured status (0.09%; P < .001). Conclusions and Relevance This study suggests that Black-White disparities increased in diabetes, hypertension, and asthma, while Hispanic-White disparities remained in diabetes, hypertension, and uninsured status. Question Which health indicators have increased or decreased among Black and Hispanic middle-aged and older adults in the last 20 years? Findings In this cross-sectional study of 4 856326 participants, poor health indicators have consistently trended upward among the Black population, with the highest prevalence ever for most diseases compared with White adults, resulting in increased disparities; for the Hispanic population, disparities in diabetes, hypertension, and uninsured rates are increasing. However, health disparities for physical inactivity in both groups have substantially improved. Meaning These findings suggest that continued evidence-based strategies to promote physical activity may be associated with chronic disease management; novel research strategies are necessary to reduce health disparities. This cross-sectional study evaluates which health indicators have improved or worsened among Black and Hispanic middle-aged and older adults since the Minority Health and Health Disparities Research and Education Act of 2000.