Document Type : Original Article


1 Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90059, USA

2 Department of Urban Public Health, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90059, USA

3 Marginalization-Relation-Diminished Returns (MDRs) Center, Los Angeles, CA 90059, USA

4 National Center for Health Insurance Research, Tehran, Iran


Background: Age is a major determinant of chronic respiratory disease (CRD). This is important because CRD have a main role in shaping morbidity and mortality of individuals and populations. However, less research is done on whether age-related changes in development of CRD differ across diverse racial groups.
Objectives: Using a conceptual model that considers race as a proxy of racism rather than genetics and attributing racial differences to sociological rather than biological differences, this study was conducted to explore racial differences in the effects of age on CRD. Based on Marginalization-related Diminished Returns (MDRs) framework, we expect diminished relevance of risk and resources for marginalized people due to racism, segregation, and social stratification.
Methods: Using data from baseline PATH-Adults data, we included 23761 adults. The independent variable was age treated as a categorical variable. The primary outcome was presence of any CRD including asthma, bronchitis, emphysema, and chronic obstructive pulmonary disease (COPD). Sex and education were the covariates. Race, as a proxy of racism, was the moderator. To analyze the data, we used logistic regression mode with and without interaction term between age and race.
Results: Higher age was associated with higher odds of CRD, while sex, and socioeconomic status (SES) was controlled. In line with the MDRs framework, the positive association between age and CRD was weaker for Black than White adults.
Conclusion: Under racism, age loses some of its effect as a major determinant of CRD across racialized groups.