Two overarching goals of Healthy People 2010 are to increase years and quality of healthy life and to eliminate health disparities. Because obesity disproportionately affects African and Hispanic Americans, understanding the influence of race on obesity's impact on different health outcomes is especially vital to achieving these goals. Interestingly, although African Americans (AAs) continue to have substantially lower life-expectancy than whites, observational studies suggest that obesity may have a lower impact on mortality in AAs than in whites even though healthcare expenditures in obese AAs are lower than in obese white Americans. Racial differences in obesity-related mortality and cost may be a reflection of differences on several fronts: higher rates of competing health risks such as smoking, HIV, and trauma in AAs; a reduced association between obesity and cardiovascular risk factors in AAs; and delays in diagnosis and treatment of risk factors in normal-weight AAs. Using data from 3 national databases -the Medicare Current Beneficiary Survey (MCBS), National Health and Nutrition Examination Survey (NHANES), and Medical Expenditures Panel Survey (MEPS)- this study will examine the interplay of race and body mass index (BMI) as they relate to 4 important outcomes: 1) mortality; 2) cardiovascular risk factors; 3) delays in diagnosis and treatment of cardiovascular risk factors; and 4) healthcare expenditures. Previous studies examining obesity-related mortality have not been able to adequately address the issue of competing health risks and residual confounding from smoking and preclinical illness, which can obscure an association between obesity and higher mortality. Because MCBS data are linked to Medicare claims longitudinally, this study will be able to limit uncontrolled confounding from smoking and pre-clinical disease and competing health risks. Furthermore, the studies proposed in this application will address several important questions: Is the association between obesity and novel cardiovascular risk factors reduced compared to whites? Are leaner minority adults, who may be at higher risk for some cardiovascular risk factors than predicted by their body mass index, more susceptible to having delays in diagnosis and treatment of these risk factors? What are the different types of care and medical conditions that drive racial differences in obesity-related healthcare expenditures? In clarifying these relationships, our findings could shed light on mechanisms underlying racial differences in obesity-related risk and cost. Our findings could also guide the setting of public health priorities and the targeting of specific initiatives to reduce racial disparities in healthcare and mortality. ? ?
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