The association between ethnic density and poor self-rated health among US Black and Hispanic people

Objective. US studies have found that members of ethnic minority groups may have better mental health when they live in areas with a higher concentration of people of the same ethnicity. We investigate if the same effect is found for self-rated health in a population based sample of US Black and Hispanic people. Design. We used multilevel logistic regression to test whether or not same-ethnic density, measured at the level of the Metropolitan Statistical Area (MSA), using the US census 2000, was associated with self-rated health amongst 3117 Black men, 4288 Black women, 6253 Hispanic men and 6534 Hispanic women from the US Current Population Survey, Annual Demographic File, 2000, after adjustment. Results. When ethnic density was modelled as a categorical variable, but not as a linear variable, there was a significant association between ethnic density and poor self-rated health for Black men and women. Relative to those living at same-ethnic densities of 0-4.9%, living at densities of greater than 5% was associated with increased risk of poor self-rated health, with the greatest incremental difference being for relatively small increases in ethnic density from 0-4.9% to 5-9.9% (odds ratio [OR] 1.85, 95% confidence interval [CI] 1.16-2.94), with subsequent increases in ethnic density having limited impact. The OR for densities of 10-14.9% was 2.03, 95% CI 1.23-3.34; for densities of 15-24.9% the OR was 2.19, 95% CI 1.33-3.62 and for densities of 25-50% the OR was 2.21, 95% CI 1.28-3.81. For Hispanics there was a significant interaction between gender and same-ethnic density. For women, higher levels of same-ethnic density were associated with a reduced risk of poor self-rated health. Conversely, for men greater ethnic density was linked to an increased risk. Conclusions. Associations between ethnic density and self-rated health are inconsistent and differ by ethnicity and gender.