SES and Multimorbidity Among Black Women and Men: A Case of Diminishing Returns?

TL;DR

Higher socioeconomic status does not consistently lead to better health for Black Americans, especially Black women, suggesting health benefits of wealth and education may diminish for this group.

Contribution

This study examines how socioeconomic status affects multimorbidity in Black women and men, revealing gender-specific patterns and supporting the diminishing returns hypothesis.

Findings

Higher education and income were linked to lower multimorbidity in Black men but not in women.

Occupational prestige was inversely associated with multimorbidity among Black men.

Black women showed no significant associations between socioeconomic status and multimorbidity.

Abstract

Higher socioeconomic status (SES) is typically associated with better health, but research suggests that Black Americans do not experience the same health benefits from SES as other groups. While multimorbidity (MM) is a growing public health concern, few studies have examined how SES influences MM among Black Americans. Using data from the Nashville Stress and Health Study, we investigated the relationship between several SES indicators—education, household income, occupational prestige, and a combined SES index—and MM among Black women (n = 325) and men (n = 296). Full sample and gender-stratified negative binomial regression models indicate limited associations between SES and MM, with effects primarily observed among men. Among women, no significant associations between SES and MM were found. Among men, having some college education was linked to higher MM (IRR=1.50, 95% CI: 1.06-2.12, p = 0.024), while a bachelor’s degree or higher was protective (IRR=0.58, 95% CI: 0.38-0.89, p = 0.013). Middle-income men had lower MM (IRR=0.66, 95% CI: 0.46-0.96, p = 0.031), and occupational prestige was inversely associated with MM (IRR=0.99, 95% CI: 0.99-1.00, p = 0.022). These findings support the diminishing returns hypothesis, demonstrating that SES does not uniformly translate to better health for Black Americans, particularly Black women. The absence of significant associations for women highlights the need for further research on gendered SES-health relationships to address MM inequities in this population.