Complex patterns are also evident when race, SES and gender are considered. One study found a pattern consistent with a “diminishing returns hypothesis” in which as SES levels increase, blacks do not have the same improvements in health as their white counterparts, with the racial disparity being largest at the highest levels of SES.53 Other research has found a distinctive pattern of association between SES and health for black men in which poor health and/or risk factors are positively related to SES. In the CARDIA study, for example, education was associated with an increasing risk of a poor lipid profile (high triglycerides, LDL cholesterol, total cholesterol and lower HDL cholesterol) for black men while the opposite pattern existed for black women and whites.54 Other studies have found SES to be positively associated with suicide, hypertension and stress among Black men.55 Cigarette smoking provides another example of these complex interactions. Black men and women have levels of cigarette smoking that are comparable to those of whites, but when race and SES are simultaneously considered, at every level of income and education, cigarette smoking is lower for blacks than for whites, with the differences being especially marked at low SES levels.56
