How to mask vague racial categories of health vulnerabilities

Good health care decisions depend on good data – whether you are making a federal health policy or treating a single patient.

But the data is often incomplete-particularly when it comes to defining a group that still forms the majority of the American population-one “non-Spanish white” person. That is the primary reference category that is used in health data.

“Nobody wonders who is white, but that should be,” said Jen’nan Read, recently a Duke sociologist and main author of New Research published in the diary Demography. “The white category contains various ethnic subgroups, but because we merge them all, we miss important health vulnerabilities for millions of Americans.”

Read and co-author Fatima Fairfax, a Duke doctorate student in sociology, analyzed data from the waves of the National Health Interview survey from 2000 to 2018 to compare the health of white adults in the US, Europe, the Middle East and the First Soviet Union.

Separating groups collapsed in the white category, they found that whites born abroad have a smaller health benefit compared to the US born in the US than usual, and immigrants from the former Soviet Union are particularly disadvantaged. Those immigrants report poorer health, including higher percentages of high blood pressure, compared to whites born in the US and people from Europe and the Middle East.

These findings illustrate how worldwide events, such as the wars in Ukraine and Syria, have contributed over time to changes in the composition of white immigrants.

Insight into these changes and the different experiences of white immigrant subgroups-is of vital importance for understanding long-term patterns in health differences in the broad white category, the authors claim.

“If we really care about reducing health differences in this country, we need to know where the differences are. And they are hidden when people are combined in broad categories,” Read said. “Ukrainian immigrants, for example, we see what they leave in the news. Death, destruction, their children may have gone without training for years now.

“This has lifelong consequences for their well-being. The physical consequences of stress are enormous that stress increases all kinds of physical health problems. High blood pressure, cholesterol, the list continues.”

And science is clear. The more accurate the care providers of the information have on their patients, the better the results.

“We miss health patterns here,” said Read. “Our country is extremely diverse and not talking about diversity does not change that fact. Health inequality costs us a lot – it costs the health care system and society as a whole.”

“Health is perhaps the most important indicator of how a society is doing, and it will enable us to pay more attention to diversity within broad categories.”

Provided by Duke Research Blog