are considerably less healthy than older whites, others, particularly Hispanics and Asians, are generally healthier. Yet these broad observations require qualifications: subgroups of each of these racial or ethnic groups vary in health status, and different indicators of health status also give different results. For example, age-adjusted mortality rates reinforce the general conclusions that Hispanics are healthier, on average, than whites, but from self-reported measures of health, Hispanics appear less healthy than whites.

Specific causes of death and specific morbidities lead to somewhat different rankings of racial and ethnic groups. For example, although blacks die more often than whites from most causes, their death rates from respiratory infections and pneumonia are lower than those for whites. Similarly, although Hispanics die less often than whites from most causes, they experience higher mortality from diabetes. Furthermore, looking across age groups, the contrasts are not consistent: most notably, the black disadvantage in old age is reversed at the oldest ages, when black mortality rates converge with those of whites and apparently fall below them.

Further complicating the study of racial and ethnic differences in health is the fluid nature of the social construct of race. Both academic and popular understandings of racial and ethnic identities have not been fixed and the picture of racial and ethnic differences in health has been heavily influenced by how these understandings have changed over time and how data on race and ethnicity have been collected.

To date, little of the research on racial and ethnic differences in health has been directed specifically towards the elderly, despite population projections that show that the population aged 65 and over is becoming increasingly diverse. Current projections suggest that, by 2050, while the total number of non-Hispanic whites aged 65 and over will double, the number of blacks aged 65 and over will more than triple, and the number of Hispanics will increase eleven-fold.

Recognizing the need for continuing research on racial and ethnic differences in health, as well as the increasing diversity of the U.S. population, the National Institutes of Aging asked the National Academies to (a) organize a 2-day workshop to bring together leading researchers from a variety of disciplines and professional orientations to summarize current research and to identify future direction for research in these areas and (b) to prepare a summary of the state of knowledge incorporating this information and providing recommendations for further work.

FINDINGS

Health differences involve a complexity of factors, including various processes of selection. Some racial and ethnic groups have high proportions of immigrants, some of whom are self-selected to be healthier than the



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