Abstract 2513: An examination of socioeconomic status, race, and health outcomes in the 2009 CHIS adult population.
Authors: Nguyen Anh B. , Moser Richard , Chou Wen-Ying 
Published: August 2014

Abstract
Introduction:
The social gradient effect refers to incremental disparities in health status and conditions and extends beyond differential health status found in comparisons between those from the poorest groups and those from the wealthiest groups. The social gradient also results in differential health profiles among all levels of social class as members from the middle class also have poorer health profiles than those from the wealthiest class.A highly overlapping construct with social status, particularly in the U.S., is race and ethnicity. It is difficult to disentangle the effects of one from the other as ethnic and racial minorities are disproportionately represented in lower levels of SES.
Methods:
We examine the social gradient and its influence on different health outcomes (i.e., limited activity due to a chronic condition, high blood pressure, obesity, Type 2 diabetes, BMI, and perceived health) and preventive behaviors (i.e., smoking status, sedentary lifestyle, dietary behaviors, and drinking) among adults in the 2009 California Health Interview Survey (CHIS). We assess linear and non-linear trends of the relationship between SES and various outcomes for White, Black, Hispanic, Asian, and American Indian participants. We rely on two proxies of SES: education and family income. Educational attainment had four levels: less than a high school diploma, high school/GED completion, some college, and college degree and beyond. Family income as % of the federal poverty level (FPL) had four levels: 0-99%, 100-199%, 200-299%, and 300% and beyond.
Results:
In general, Whites reported more favorable health behaviors and health status in comparison to Blacks, Hispanics, Asians, and American Indians. In addition, the trends analyses indicated that educational attainment and family income significantly predicted all health status and health behavior variables for the total population, providing evidence for the social gradient after adjusting for age, gender, race, and acculturation. Race stratified analyses indicated that Whites demonstrated the most consistent effects of the social gradient collapsed across all outcomes and behaviors for both educational attainment and family income. The social gradient was observed the least for Blacks and American Indians, particularly when educational attainment was used to capture SES. In addition, Hispanics and Asians were the most likely to demonstrate non-linear effects of the social gradient in comparison to other racial and ethnic minority groups.
Conclusion:
The extent of income inequality contributes to the health of a nation as the average health status of a person is determined by income differences between the poorest and richest members of society. Future studies should examine temporal trends to track the impact of the social gradient for different racial and ethnic populations in tandem with indices of national income inequalities.
Citation Format: Anh B. Nguyen, Richard Moser, Wen-Ying Chou. An examination of socioeconomic status, race, and health outcomes in the 2009 CHIS adult population. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 2513. doi:10.1158/1538-7445.AM2013-2513