Abstract
Background: Previous research has shown a significant association between psychological distress (PD) and cause-specific mortality, but contributions of sociodemographic and behavioral characteristics to mortality differences by PD are not fully explored. Methods: The Blinder-Oaxaca decomposition analysis was used to quantify the contributions of individual sociodemographic and behavioral characteristics to the observed cardiovascular disease (CVD), cancer, chronic obstructive pulmonary disease (COPD), and unintentional-injury mortality disparities between United States (US) adults with no PD and those with serious psychological distress (SPD), using the pooled 1997-2014 data from the National Health Interview Survey prospectively linked to the National Death Index (N=263,825). Results: Lower levels of education and household income, and higher proportions of current smokers, former drinkers, non-married adults, US-born, and renters contributed to higher mortality for adults with SPD. The relative percentage of mortality explained by sociodemographic and behavioral factors was highest for cancer mortality (71.25%) and lowest for unintentional-injury mortality (20.19%). Enhancing education level among adults with SPD would decrease approximately 30% of cancer or CVD mortality disparity, and around 10% of COPD and unintentional-injury mortality disparities. Half of the cancer mortality disparity (47.4%) could be attributed to a single factor, smoking. Increasing income level will decrease 7 to 13% of the disparity in cause-specific mortality. Higher proportions of renters explained higher CVD and COPD mortality among adults with SPD by 7% and 3%, respectively. Higher proportions of former drinkers explained higher CVD, cancer, and COPD mortality among adults with SPD by 6%, 7%, and 3%, respectively. Younger age, higher proportion of females, and higher BMI among adults with SPD mitigated the mortality disparities. Conclusions and Implications for Translational Research: Improved education and income levels, and reduced smoking among US adults with SPD would eliminate around 90% of the cancer mortality disparity by SPD, and half of the CVD mortality disparity. Copyright © 2021 Lee and Singh. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.
Highlights
Regarding sociodemographic characteristics and health behaviors, adults with serious psychological distress (SPD) were more likely to be female, nonHispanic Blacks (12% vs. 13%), Hispanics (14% vs. 15%), or American Indians/Alaska Natives (0.6% vs. 1.3%), United States (US)-born (83% vs. 87%), with less than high school education (13% vs. 29%), never married (22% vs. 25%), below poverty level (8% vs. 28%), renters (28% vs. 47%), less with higher body mass index (BMI) ≥40 (3% vs. 8%), current smokers (17% vs. 42%), and former drinkers (13% vs. 24%)
Higher proportions of females (-10.58%) and younger individuals (-4.17%) favored adults with SPD and decreased cardiovascular disease (CVD) mortality disparities between adults with no psychological distress (PD) and those with SPD.In Model 2,the contributions of education, poverty status, marital status, and housing tenure slightly decreased, indicating that health behaviors such as smoking and alcohol consumption partly accounted for the impact of sociodemographic factors
We found that lower levels of education and household income, and higher proportions of current smokers, former drinkers, non-married adults, US-born, and renters contributed to higher mortality for adults with SPD, while other factors such as younger age, higher proportion of females, and higher BMI mitigated this effect
Summary
In the US, the top 5 leading causes of death were heart disease, cancer, unintentional injury, chronic lower respiratory diseases,and stroke,accounting for 61% of total deaths in 2018.5 Depression, anxiety, and other psychological stressors were associated with the development and progression of these diseases and associated mortality.[6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22] Biological pathways through which psychological distress affects CVD,[6,7] cancer,[23,24] chronic obstructive pulmonary disease (COPD)[25] and unintentional injury,[26] have been well documented. Previous research has shown a significant association between psychological distress (PD) and cause-specific mortality, but contributions of sociodemographic and behavioral characteristics to mortality differences by PD are not fully explored
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