Racial Differences in Employment and Poverty Histories and Health in Older Age

Abstract

Introduction: Black Americans encounter more barriers in the job market and earn less than White Americans. However, the extent to which racial disparities in employment and poverty histories impact health is not fully understood. This study characterized employment‒poverty histories for Black and White middle-aged adults and examined their association with health. Methods: Respondents born in 1948–1953 and enrolled in the 2004 Health and Retirement Study (NBlack=555, NWhite=2,209) were included. Sequence analysis grouped respondents with similar employment‒poverty trajectories from 2004 to 2016, and confounder-adjusted regression analyses estimated the associations between these trajectories and health in 2018. Analyses were conducted in 2021–2022. Results: More than 23% of Black respondents experienced both employment and poverty fluctuations, including bouts of extreme poverty (<50% of the federal poverty threshold), whereas no trajectory for White respondents included extreme poverty. Adversities in employment‒poverty were associated with worse health. For example, among Black respondents, those who experienced both employment and poverty fluctuations had worse cognition than those employed and not poor (β= –0.55 standardized units, 95% CI= –0.81, –0.30). Similarly, among White respondents, those who experienced employment fluctuations had worse cognition than those employed (β= –0.35, 95% CI= –0.46, –0.24). Notably, the employed and not poor trajectory was associated with worse survival among Black respondents than among White respondents. Conclusions: Employment fluctuations were associated with worse health, especially cognitive function, where the association was stronger among Black Americans who experienced both employment fluctuations and poverty. Findings highlight the importance of enhancing employment stability and of antipoverty programs, especially for Black Americans.