In the United States there exists a clear and disconcerting racial disparity in the distribution of good health, which can be seen in differential levels of morbidity and mortality affecting blacks and whites. Previous research has examined the role of SES in shaping racial health disparities and recent studies have looked specifically at the effect of education on health to explain the racial disparity in health. Higher levels of education are robustly associated with good overall health for both blacks and whites and this association has been examined over the life-course. This research explores racial differences in the effect of education on health in general as well as over the life-course. Specifically, this paper examines race differences in the effects of education on health over the life-course. Pooled data from the National Health Interview Survey were analyzed using multivariate logistic regression to estimate the effects of race, education and age on health. The results of these analyses indicate that blacks receive lower education returns on their health than whites. The effect of education on health was shown to grow in the beginning of the life-course and diminish at the end of the life course in accordance with the mortality-as-leveler hypothesis. The black white health disparity was shown to grow over the life-course among the highly educated, whereas the disparity was consistent over the life-course for the poorly educated.

Indiana University-Purdue University Indianapolis (IUPUI) / While the majority of chronic pain patients report receiving inadequate care, there is evidence that female and Black patients receive less analgesic medications and treatment for their chronic pain compared to male and White patients, respectively. While treatment disparities have been evidenced in the literature, there is little understanding of provider-factors, such as their decision-making awareness and attitudes, which may contribute to the differences in treatment. This investigation employed quantitative and qualitative procedures to examine the relationship between patient demographics and chronic pain treatment variability, providers’ awareness of these non-medical influences on their decisions, and the extent to which providers’ gender and racial attitudes associate with their treatment decisions. Twenty healthcare trainees made pain treatment decisions (opioid, antidepressant, physical therapy, pain specialty referral) for 16 computer-simulated patients presenting with chronic low back pain; patient sex and race were manipulated across vignettes. Participants then selected among 9 factors, including patient demographics, to indicate which factors influenced their treatment decisions for the simulated patients and completed gender and racial attitude measures. After online study completion, follow-up semi-structured interviews were conducted to discuss the medical/non-medical factors that influence trainees’ clinical treatment decisions. Quantitative analysis indicated that 5%-25% of trainees were actually influenced (p<0.10) by patient sex and race in their treatments, and on the whole, trainees gave higher antidepressant ratings to White than Black patients (p<.05). Fifty-five percent demonstrated concordance, or awareness, between their actual and reported use of patient demographics. Follow-up McNemar’s test indicated trainees were generally aware of the influence of demographics on their decisions. Overall, gender and racial attitudes did not associate with trainees’ treatment decisions, except trainees’ complementary stereotypes about Black individuals were positively associated with their opioid decisions for White patients. During qualitative interviews, aware and unaware trainees discussed similar themes related to sex and racial/ethnic differences in pain presentation and tailoring treatments. We found that (1) a subset of trainees were influenced by patient sex and race when making chronic pain treatment decisions, (2) trainees were generally aware of the influence of patient demographics, and (3) trainees discussed differences in pain presentation based on patients’ sex and ethnic origin. These findings suggest trainees’ are influenced by patient demographics and hold stereotypes about patient populations, which may play a role in their decision-making.