A wealth of research has demonstrated that there are health disparities between Black and White Americans that are enduring over time and pervasive into almost all health domains. With few exceptions, differences in income, education level, and insurance status has narrowed, but not accounted for the entire health gap between Black and White older adults. One possible reason why these individual-level measurements have failed to explain the racial health gap is that many health outcomes are influenced by one's environment. However, to date, research has primarily considered only individual characteristics such as personal economic resources and has virtually ignored the relative impact of """"""""place"""""""" on the racial health disparity. The intent of this proposed study is to systematically examine both individual and community influences on the health disparity between Black and White adults ages 65 and older. This research will examine community-level measures (measured at the Census tract level) that have been linked with the North Carolina Established Populations for the Epidemiologic Study of the Elderly (EPESE), which is a multi-stage sample of 4,162 Black and White older adults from five counties in North Carolina, and employ multi-level models to estimate the relative influence of individual- and community-level characteristics on the subsequent physical functioning of Black and White older adults. This proposed project is one of the first to integrate broader context into the study of individual health outcomes for the purposes of examining the racial health disparity between Black and White older adults. There are three specific aims of this study: 1. Test the impact of community context, composition, and stability on geographic variations in the health of Black and White older adults. 2. Measure the relative influence of individual and community characteristics on the racial health disparity among older adults, specifically on ADL and IADL disability. 3. Determine whether vulnerability to community influences varies by race or socioeconomic status.
