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African Americans

African Americans constitute roughly 12.9% (36.4 million) of the U.S. population. More than half of African Americans reside in the South (55%), equal percentages reside in the Northeast (18.0%) and Midwest (18.8%), and close to a tenth reside in the West. Although New York City and Chicago have the largest Black populations overall, 5 of the 10 cities with the largest Black populations are located in the South: Baltimore, Maryland; Houston, Texas; Memphis, Tennessee; Washington, D.C.; and New Orleans, Louisiana. Blacks are more likely than non-Hispanic Whites to reside in metropolitan areas/central cities and are less likely to reside in nonmetropolitan areas. Compared with the general population, the Black population is younger and has fewer persons age 65 years and older. Overall, Black women outnumber Black men, and this is especially true among persons age 65 years and older. Roughly a tenth of the overall Black female population is age 65 years and older, compared with 7% of Black males. For Blacks over 65 years of age, roughly 62% are women and 38% are men. As a group, Blacks are less likely to be married and more likely to be never married than are non-Hispanic Whites.

Epidemiology

As of 2002 in the United States, more than one half of the Black population age 65 years and older was either poor or near poor, with an overall poverty rate of 22%, compared with 8% among non-Hispanic Whites. Differences by gender underscore the poorer status of older Black women, who had a poverty rate of 26%, whereas older Black men had a rate of 20% (vs. 10% for non-Hispanic White women and 7% for non-Hispanic White men). By and large, African Americans are more likely than the general population to be native born. Of those who are foreign born, the vast majority come from either the Caribbean region or Africa and tend to reside on the East Coast.

Marital status and living arrangements have an important impact on the health and social status of older African Americans. Older Blacks are less likely to be married than are older persons generally. Overall, African Americans maintain larger families, particularly families with four or more members. In 2002, more than half of coresident Black grandparents (persons age 30 years and older) were also fully responsible for their grandchildren (i.e., were grandparent caregivers). Roughly 45% of Black grandparent caregivers had been in that role for 5 years or more, the highest number for any racial/ethnic group. Black grandparents were nearly twice as likely as White grandparents to have full responsibility as caregivers to their grandchildren. Grandparent caregiving was associated with higher poverty rates, particularly for those residing in the South (21%) and in specific states (30% in both Louisiana and Mississippi).

Morbidity and Mortality

Mortality, morbidity, and chronic disease profiles for contemporary African American elderly persons are shaped by their life course experiences. Today's older Blacks (age 65 years and older) were born and grew up during a time (1940 and earlier) when all major societal institutions in the United States practiced racial segregation either officially (de jure) or in practice (de facto). As a consequence, African Americans were severely restricted in their access to basic health care as well as routine health screenings and focused health promotion/disease prevention efforts. In addition to inferior (and often nonexistent) health care and services, Blacks were exposed to life conditions and circumstances that compromised their health status—in housing, education, employment, and working conditions. These myriad factors had both direct effects (e.g., occupational hazards and exposures) and indirect effects (e.g., limited education) on health that severely restricted their opportunities for healthful living. Early (including prenatal) and continued exposures to deleterious conditions such as these, across the life span, have a lasting impact on the development and health of populations well into adulthood and old age. These lifelong adverse exposures and circumstances have been implicated as an important factor in the poorer mortality, morbidity, and chronic disease profiles found among older Black adults. Nonetheless, questions remain regarding the overall relationships among aging, race, and health and whether cumulative disadvantage experienced earlier in life results in the selective survival of relatively healthier individuals among the oldest cohorts of African Americans (i.e., the “crossover” effect for mortality and health).

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