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Racial/ethnic disparities in health-related quality of life and health status across pre-, early-, and mid-adolescence: a prospective cohort study

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Abstract

Purpose

To examine (1) racial/ethnic disparities in health-related quality of life (HRQOL) and overall health status among Black, Latino, and White youth during adolescence; (2) whether socioeconomic status (SES) and family contextual variables influence disparities; and (3) whether disparities are consistent from pre- to early- to mid-adolescence.

Methods

A population sample of 4823 Black (1755), Latino (1812), and White (1256) youth in three US metropolitan areas was prospectively assessed in a longitudinal survey conducted on three occasions, in 5th, 7th, and 10th grades, when youth reported their HRQOL using the PedsQL™ short-form Total, Physical and Psychosocial scales and youth and parents separately reported on youth’s overall health status. Parents reported their education and household income to index SES, family structure, and use of English at home.

Results

Based on analysis conducted separately at each grade, marked racial/ethnic disparities were observed across all measures of HRQOL and health status, favoring White and disfavoring Black, and especially Latino youth. More strongly present in 5th and 7th grade, HRQOL disparities decreased by 10th grade. Most disparities between White and Black youth disappeared when adjusting for SES. However, even after adjusting for SES, family structure, and English use, overall health status disparities disfavoring Latino youth remained across all three assessments.

Conclusions

Racial/ethnic disparities in adolescent HRQOL and health are substantial. These disparities appear consistent from pre- to early-adolescence but diminish for HRQOL by mid-adolescence. As disparities appear influenced by SES and other family contextual variables differently in different racial/ethnic groups, efforts to reduce health disparities in youth should address culturally specific conditions impinging on health.

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Abbreviations

HRQOL:

Health-related quality of life

OHS:

Overall health status

PedsQL™:

Pediatric Quality of Life Inventory

SES:

Socioeconomic status

GLM:

General linear model

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Acknowledgements

The Healthy Passages™ study was funded by the Centers for Disease Control and Prevention (Cooperative Agreements CCU409679, CCU609653, CCU915773, U48DP000046, U48DP000057, U48DP000056, U19DP002663, U19DP002664, and U19DP002665). The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the CDC. Dr. Fradkin was funded by a 2017–2018 Fulbright Scholar award. The contributions made to this research by study participants in the Birmingham, Houston, and Los Angeles areas, other Healthy Passages™ investigators, field teams at each site, and the CDC Division of Adolescent and School Health are gratefully acknowledged.

Author information

Authors and Affiliations

  1. Psychological Sciences and Health Sciences Research Institute, SSHA, University of California, 5200 N. Lake Rd, Merced, CA, 95343, USA

    Jan L. Wallander & Chris Fradkin

  2. Departamento de Psicologia, Pontifícia Universidade Católica do Rio de Janeiro, Rio de Janeiro, Brazil

    Chris Fradkin

  3. RAND Corp., Santa Monica, CA, USA

    Marc N. Elliott

  4. Center for Health Promotion and Prevention Research, University of Texas School of Public Health, Houston, USA

    Paula M. Cuccaro & Susan Tortolero Emery

  5. Kaiser Permanente School of Medicine, Pasadena, CA, USA

    Mark A. Schuster

  6. Division of General Pediatrics, Boston Children’s Hospital, Boston, USA

    Mark A. Schuster

  7. Department of Pediatrics, Harvard Medical School, Boston, USA

    Mark A. Schuster

Authors
  1. Jan L. Wallander
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  2. Chris Fradkin
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  3. Marc N. Elliott
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  4. Paula M. Cuccaro
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  5. Susan Tortolero Emery
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  6. Mark A. Schuster
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Correspondence to Jan L. Wallander.

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Wallander, J.L., Fradkin, C., Elliott, M.N. et al. Racial/ethnic disparities in health-related quality of life and health status across pre-, early-, and mid-adolescence: a prospective cohort study. Qual Life Res 28, 1761–1771 (2019). https://doi.org/10.1007/s11136-019-02157-1

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