It's about time: Racial/ethnic health disparities conditional on socioeconomic status among US women, 1978–2018

This study explores temporal patterns in racial/ethnic and socioeconomic disparities in health among US women. While prior research has shown that socioeconomic gains often yield smaller health benefits for racially marginalized populations, less is known about how these patterns vary across historical periods, age groups, and birth cohorts. Using data from the National Health Interview Survey 1978–2018 (N = 1,416,652), we examine how education, income, and employment status are linked to self-rated health across intersecting time dimensions. We find that health returns of socioeconomic resources tend to peak in midlife and are particularly limited for women racialized as Black and American Indian/Alaska Native. For example, among middle-aged women, self-rated health is higher for those living above the poverty threshold than those living below it, with larger differences for women racialized as White (3.77 vs. 3.15) than for women racialized as Black (3.43 vs. 3.05) or American Indian/Alaska Native (3.42 vs. 3.00). Over time, sociopolitical shifts appear to benefit women racialized as White more than women racialized as Black, with larger health advantages associated with socioeconomic resources under both Democratic (e.g., Carter: 3.70 vs. 3.33; Obama: 3.80 vs. 3.54) and Republican (e.g., Reagan: 3.81 vs. 3.44; Trump: 3.79 vs. 3.55) administrations. Across successive birth cohorts, health differences associated with socioeconomic resources have narrowed, with smaller gaps between advantaged and disadvantaged groups in income, education, and employment among Millennials than among Baby Boomers. These findings highlight the importance of historical and social context in shaping health disparities.