Race, Social Determinants of Health, and Risk of All-Cause and Cardiovascular Mortality in the United States.
J Racial Ethn Health Disparities
; 11(2): 853-864, 2024 Apr.
Article
in En
| MEDLINE
| ID: mdl-37017921
ABSTRACT
OBJECTIVE:
To examine the independent and interdependent effects of race and social determinants of health (SDoH) and risk of all-cause and cardiovascular disease (CVD) mortality in the US. DATA SOURCE/STUDYDESIGN:
Secondary analysis of pooled data for 252,218 participants of the 2006-2018 National Health Interview Survey, linked to the National Death Index.METHODS:
Age-adjusted mortality rates (AAMR) were reported for non-Hispanic White (NHW) and non-Hispanic Black (NHB) individuals overall, and by quintiles of SDoH burden, with higher quintiles representing higher cumulative social disadvantage (SDoH-Qx). Survival analysis was used to examine the association between race, SDoH-Qx, and all-cause and CVD mortality.FINDINGS:
AAMRs for all-cause and CVD mortality were higher for NHB and considerably higher at higher levels of SDoH-Qx, however, with similar mortality rates at any given level of SDoH-Qx. In multivariable models, NHB experienced 20-25% higher mortality risk relative to NHW (aHR = 1.20-1.26); however, no association was observed after adjusting for SDoH. In contrast, higher SDoH burden was associated with up to nearly threefold increased risk of all-cause (aHR, Q5 vs Q1 = 2.81) and CVD mortality (aHR, Q5 vs Q1 = 2.90); the SDoH effect was observed similarly for NHB (aHR, Q5all-cause mortality = 2.38; CVD mortality = 2.58) and NHW (aHR, Q5all-cause mortality = 2.87; CVD mortality = 2.93) subgroups. SDoH burden mediated 40-60% of the association between NHB race and mortality.CONCLUSIONS:
These findings highlight the critical role of SDoH as upstream drivers of racial inequities in all-cause and CVD mortality. Population level interventions focused on addressing adverse SDoH experienced by NHB individuals may help mitigate persistent disparities in mortality in the US.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Black or African American
/
Cardiovascular Diseases
Type of study:
Etiology_studies
/
Prognostic_studies
/
Risk_factors_studies
Aspects:
Determinantes_sociais_saude
Limits:
Humans
Country/Region as subject:
America do norte
Language:
En
Journal:
J Racial Ethn Health Disparities
Year:
2024
Document type:
Article
Affiliation country:
Estados Unidos
Publication country:
CH
/
SUIZA
/
SUÍÇA
/
SWITZERLAND