Race differences in self-assessed health: The role of job strain
Christopher Michael Messenger
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A firmly established and frequently reported pattern in the distribution of health status in the U.S. is that non-Hispanic blacks (NHB) have higher rates of morbidity and mortality than do non-Hispanic whites (NHW). Although much research has examined the relationships between race and health many questions pertaining to the processes that lead to such persistent disparities remain. There is accumulating evidence showing that the psychosocial environment at work affects the mental and physical health of workers. Specifically, work characterized by heavy demands and low decision latitude have the greatest negative effect on health. Using data from a nationally representative cross-sectional survey of U.S. adults 18 years and older, a sample of NHB and NHW who were regular, permanent employees having been with their current job for at least 9 months were selected for analysis (N = 2,255). The outcome for this project, self-assessed health (SAH), has been shown to be a valid and reliable measure of overall health status and a valid measure across racial/ethnic groups. There is a strong association between poor SAH and morbidity, mortality, and physical disability. Logistic regression was used to determine the odds of reporting differences in SAH on a 5-item Likert scale ranging from excellent to poor. Those above the median score for job demands and below the median score for decision latitude were classified as having a high strain job and were compared to three other categories; low, passive, and active strain jobs. NHB were significantly more likely to report poorer SAH (OR: 1.26, 95% CI: 1.04-1.54) and were more likely to be in a high strain job (OR: 1.34, 95% CI: 1.04-1.72) than NHW. The racial odds disparity of reporting poorer SAH was partially mediated by the addition of job strain to the model (OR: 1.18, 95% CI: 0.97-1.45). After adjustment for potentially confounding variables, race differences in SAH were further mediated (OR: 0.94, 95% CI: 0.75-1.16) while those having a high strain job remained significantly more likely to report poorer SAH compared to those with other job types. These results demonstrate that differences in SAH by race can be mediated to non-statistical significance by accounting solely for work environment characteristics.