Abstract
BackgroundStudies uncovering factors beyond socio-economic status (SES) that would explain racial and ethnic disparities in mortality are scarce.MethodsUsing prospective cohort data from the Third National Health and Nutrition Examination Survey (NHANES III), we examined all-cause and cause-specific mortality disparities by race, mediation through key factors and moderation by age (20–49 vs. 50+), sex and poverty status. Cox proportional hazards, discrete-time hazards and competing risk regression models were conducted (N = 16,573 participants, n = 4207 deaths, Median time = 170 months (1–217 months)).ResultsAge, sex and poverty income ratio-adjusted hazard rates were higher among Non-Hispanic Blacks (NHBs) vs. Non-Hispanic Whites (NHW). Within the above-poverty young men stratum where this association was the strongest, the socio-demographic-adjusted HR = 2.59, p < 0.001 was only partially attenuated by SES and other factors (full model HR = 2.08, p = 0.003). Income, education, diet quality, allostatic load and self-rated health, were among key mediators explaining NHB vs. NHW disparity in mortality. The Hispanic paradox was observed consistently among women above poverty (young and old). NHBs had higher CVD-related mortality risk compared to NHW which was explained by factors beyond SES. Those factors did not explain excess risk among NHB for neoplasm-related death (fully adjusted HR = 1.41, 95 % CI: 1.02–2.75, p = 0.044). Moreover, those factors explained the lower risk of neoplasm-related death among MA compared to NHW, while CVD-related mortality risk became lower among MA compared to NHW upon multivariate adjustment.ConclusionsIn sum, racial/ethnic disparities in all-cause and cause-specific mortality (particularly cardiovascular and neoplasms) were partly explained by socio-demographic, SES, health-related and dietary factors, and differentially by age, sex and poverty strata.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3744-z) contains supplementary material, which is available to authorized users.
Highlights
Studies uncovering factors beyond socio-economic status (SES) that would explain racial and ethnic disparities in mortality are scarce
The past several decades have witnessed an overall reduction in mortality rates coupled with a sustained Black-White mortality rate disparity with higher rates observed in Blacks (e.g. 1950: 5310 per 100,000 resident Non-Hispanic Black (NHB) population over 65y vs. 4865 per 100,000 resident Non-Hispanic White (NHW) population over 65y; 2006: Rates were 3669 per 100,000 vs
Physical examination and laboratory data from National health and nutrition examination surveys (NHANES) III, we retained adults age ≥ 20y (n = 18,825), who self-reported their race/ ethnicity as Non-Hispanic Whites (NHW), NHB or MA, excluding other ethnicities. This yielded a final sample of 18,110 participants, of whom N = 16,573 were retained upon multiple imputations for descriptive statistics and N = 15,889 for survival analyses, with a total of 4,207 deaths (2359 among NHW, 1090 among NHB and 758 among MA)
Summary
Studies uncovering factors beyond socio-economic status (SES) that would explain racial and ethnic disparities in mortality are scarce. Though narrowing down in recent years, [3] this disparity in mortality remains wide and was explained partly by a long-standing socioeconomic racial stratification [4]. This comes in stark contrast to the Mexican-American (MA) and Hispanic ethnic group disparities with NHWs in mortality rates. While socio-economic status (SES) was shown to moderate as well as mediate racial disparities in adult mortality, [11] only one study to date has systematically uncovered the contribution of behavioral and health-related potential mediators that go beyond SES [12]
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