Full Citation
Title: Race, Social Determinants of Health, and Risk of All-Cause and Cardiovascular Mortality in the United States
Citation Type: Journal Article
Publication Year: 2023
ISBN:
ISSN: 21968837
DOI: 10.1007/S40615-023-01567-9/TABLES/4
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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/Study Design: 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, Q5:all-cause mortality = 2.38; CVD mortality = 2.58) and NHW (aHR, Q5:all-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.
Url: https://link-springer-com.ezp2.lib.umn.edu/article/10.1007/s40615-023-01567-9
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Authors: Javed, Zulqarnain; Valero-Elizondo, Javier; Cainzos-Achirica, Miguel; Sharma, Garima; Mossialos, Elias; Parekh, Tarang; Hagan, Kobina; Hyder, Adnan A.; Kash, Bita; Nasir, Khurram
Periodical (Full): Journal of Racial and Ethnic Health Disparities
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Volume:
Pages: 1-12
Data Collections: IPUMS Health Surveys - NHIS
Topics: Fertility and Mortality, Race and Ethnicity
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