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Race, social determinants of health, and risk of all-cause and cardiovascular mortality in the United States

Javed, Zulqarnain, Valero-Elizondo, Javier, Cainzos-Achirica, Miguel, Sharma, Garima, Mossialos, Elias ORCID: 0000-0001-8664-9297, Parekh, Tarang, Hagan, Kobina, Hyder, Adnan A., Kash, Bita and Nasir, Khurram (2023) Race, social determinants of health, and risk of all-cause and cardiovascular mortality in the United States. Journal of Racial and Ethnic Health Disparities. ISSN 2197-3792

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Identification Number: 10.1007/s40615-023-01567-9


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.

Item Type: Article
Additional Information: © 2023, W. Montague Cobb-NMA Health Institute.
Divisions: Health Policy
Subjects: H Social Sciences > HT Communities. Classes. Races
H Social Sciences
R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Date Deposited: 19 Apr 2023 08:45
Last Modified: 26 May 2024 16:03

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