Describing well-being in the US by race/ethnicity, education level, and urbanicity: A cross-sectional study using the Gallup National Health and Well Being Index

For a more comprehensive understanding of health disparities, consideration must be given not only to morbidity and mortality outcomes but also to more holistic health-related constructs, such as well-being. We assessed differences in well-being across sociodemographic subgroups in the United States (US). We used data from the Gallup National Health and Well-being Index (2014–2016, n = 530,920) to assess independent cross-sectional associations of self-reported race, ethnicity, educational attainment, and rural residence with measures of well-being for non-institutionalized residents from 50 US states and the District of Columbia. Our outcome measures are thriving, calculated from self-reported current and future life evaluation, and the composite Well-Being Index (WBI), calculated from 38 self-reported metrics spanning 5 domains of well-being (Career, Community, Physical, Financial, Social). We summarized these measures for race-education-urban subgroups and tested for interactions among these three factors, before and after adjustment for year of survey completion, age, sex, marital status, household size, and income. Among our sample, 55% were thriving. After adjustment, higher levels of education were associated with increased odds of thriving: compared with those with no high school degree, we found higher odds of thriving for respondents reporting completion of high school/technical school/some college (OR=1.61(1.57,1.66)), college (OR=2.77(2.69,2.85)), and postgraduate (OR=3.38 (3.29,3.49)) education. Compared with White respondents, Black (OR (95% CI)=1.15 (1.12,1.17)) and Hispanic (OR=1.26 (1.23,1.29)) respondents had higher odds of thriving; results were similar for WBI, except Asian respondents had also higher WBI after adjustment for all covariates (OR=2.54 (2.28,2.80)). Across race-education-urban subgroups, non-White respondents with a college degree living in urban and rural areas had the highest odds of thriving; White respondents with no college degree living in urban areas had the lowest odds of thriving (p < 0.001 for each), after adjustment. These findings raise questions about how well-being is mediated given the known worse clinical health measures among minoritized groups.