HQ Team
May 27, 2023: Adult people of colour in the US have 59% higher risk of premature deaths than their white counterparts, according to a study.
Researchers at the private Tulane University Louisiana took samples of individuals aged 20-74 years from the US National Health and Nutrition Examination Survey between 1999 and 2018.
They pinpointed eight social determinants of health where disparities between the two races existed — employment, income, food security, education level, access to healthcare, quality health insurance, home ownership, and marital status.
Tulane researchers modeled the impact of each factor on a person’s life expectancy. When all unfavorable social determinants were accounted for, the 59% mortality disparity was reduced to zero.
“It totally disappeared,” said Josh Bundy, lead author and epidemiologist at Tulane’s School of Public Health and Tropical Medicine. “There’s no difference between Black and White premature mortality rates after accounting for these social determinants.”
Study parameters
The study included 48,170 national health survey and consisted of 10,543 participants of color, 13, 211 hispanic, 19, 629 white participants, and 4,787 people of other racial and ethnic groups.
“This is the first time that anyone completely explained the differences,” Bundy said. “We didn’t expect that, and we were excited about that finding because it suggests social determinants should be the primary targets for eliminating health disparities.”
“So how do we eliminate the structural differences between races?” Bundy said. “And regardless of race, if you have six or more of these factors, you’re at a really high risk. How do we address these issues for everyone?”
Socioeconomic factors were still found to play a major role, accounting for approximately 50% of the Black-White difference in mortality in the study.
The other nearly 50% of the difference was explained by marital status, food security, and whether someone has public or private health insurance, softer indicators that can speak to a person’s social support network, stability, or job quality.
Social determinants
Unfavorable social determinants of health were more common among colored adults and were found to carry enormous risks.
Having just one unfavorable social determinant of health was found to double a person’s chances of an early death. With six or more, a person has eight times higher risk of premature mortality.
Jiang He, the corresponding author and Joseph S. Copes Chair of Epidemiology the School of Public Health and Tropical Medicine, said these results “demonstrated that race-based health disparities are social, not biological, constructs.”
As a concept, social determinants of health is a relatively new framework being emphasized by the CDC’s Healthy People 2030 initiative.
“These social determinants of health are the foundation of health problems,” Bundy said. “They need to be a top priority going forward and it’s going to take policy, research and a multi-disciplinary approach to tackle these issues.”
Mortality gap
Bundy hoped the concept gains more traction and that policymakers use these findings to address the race-based mortality gap.
“Structural racism and discrimination lead to worse social risk factors, which may lead to premature death,” he said.
The importance of social determinants of health in addressing health inequities is getting increasingly recognized, according to the study.
The framework reflects a comprehensive assessment of the health effects of the “conditions in the environments where people are born, live, learn, work, play, worship, and age” and shapes public health initiatives such as the US Healthy People 2030 initiative.
The initiative seeks to achieve health equity and improve the health and well-being of all people.
