Native American-White differences in adult health

The goal of this work is to document the health gaps between Native Americans and non-Hispanic Whites using a recent, consistent, and national-level dataset—the National Health Interview Survey. I find that Native Americans have poorer self-reported health and more activity limitations than Whites; Native Americans are more likely to have no doctor visits than Whites; Native Americans spend more days in bed than Whites. Further, Native American-White differences in activity limitations and bed days are completely mediated by socioeconomic factors. SES also accounts for a large portion of the racial gap in self-reported health and physician utilization. The racial gap in self-reported health between Native Americans and Whites narrows with age. However, similar patterns for activity limitations, bed days, and doctor visits are not observed. Although it is found that Native Americans living in metropolitan areas have better self-reported health than Native Americans living in non-metropolitan areas, non-MSA Native Americans are less likely to have an activity limitation and more likely to have no doctor visits than MSA Native Americans. With the exception of doctor visits, the health gaps between Native Americans and Whites in non-MSA areas are narrower than those in MSA areas. When SES or health variables are controlled, all racial gaps in non-MSA areas are narrower than those in MSA areas. With respect to mortality, Native Americans are found to have a higher risk than Whites and the risk of death for Native Americans versus Whites declines with age. Compared to Whites, Native Americans are less likely to drink but they are more likely to drink heavily. Generally, Native Americans are more likely to smoke than Whites; however, they do not necessarily smoke more heavily than Whites, especially after controlling for SES. Native Americans are more likely to be physically inactive compared to non-Hispanic Whites.