Abstract MP37: Contributions Of Social Determinants Of Health And Cardiometabolic Risk Factors To Racial/ethnic Disparities In Premature Mortality In The United States

Abstract

Introduction: Racial/ethnic disparities in premature mortality in the US arise from complex social, structural, and historical factors. We examined the extent to which differences in social determinants of health (SDoH), cardiometabolic risk factors, and health conditions explained the excess risk of premature mortality. Methods: We used nationally representative data for adults aged ≥20 years from the 1999-2010 National Health and Nutrition Examination Surveys with mortality linkage through 2015. We calculated the age-sex-adjusted hazard ratios (HRs) for premature mortality (death <75 years of age) comparing non-Hispanic (NH) Black and Hispanic adults to NH white adults. We used Cox models to determine the excess risk mediated by SDoH, cardiometabolic risk factors, and health conditions by calculating the percent reduction in the HR compared to the age-sex-adjusted model. Results: We included 11,854 NH White, 4,201 NH Black, and 5,997 Hispanic adults. The risk of premature mortality was higher among NH Black (HR: 1.7 (95% confidence interval [CI] 1.5-1.9) and Hispanic (HR: 1.5, 95% CI 1.2-1.9) adults than NH White adults. Adjusting for SDoH ( Figure ) attenuated the HRs and explained 62% and 60% of the excess risk among NH Black and Hispanic adults, respectively. Adding cardiometabolic risk factors and health conditions to the age-sex-adjusted model explained 54% of the excess risk among NH Black adults, but only 13% among Hispanic adults. Adjusting for SDoH, cardiometabolic risk factors, and health conditions together explained 73% of the excess risk among NH Black and 54% of excess risk among Hispanic adults. Discussion: Differences in SDoH explained 60% of the excess risk of premature mortality among NH Black and Hispanic adults. Differences in health status further explained some of the excess risk among NH Black, but not Hispanic, adults. Interventions to address SDoH and their downstream health consequences may reduce racial disparities in premature mortality and advance health equity.