Race, Social Determinants of Health, and Risk of All-Cause and Cardiovascular Mortality in the United States

Authors

Zulqarnain Javed, Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA. zjaved@houstonmethodist.org.
Javier Valero-Elizondo, Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA.
Miguel Cainzos-Achirica, Department of Cardiology, Hospital del Mar / Parc de Salut Mar, Barcelona, Spain.
Garima Sharma, Division of Cardiology, Ciccarone Center for Prevention of Cardiovascular Disease, The Johns Hopkins, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Elias Mossialos, Department of Health Policy, London School of Economics, London, UK.
Tarang Parekh, Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA.
Kobina Hagan, Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA.
Adnan A. Hyder, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA.
Bita Kash, Center for Health and Nature, Houston Methodist, Houston, TX, USA.
Khurram Nasir, Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA.

Document Type

Journal Article

Publication Date

4-1-2024

Journal

Journal of racial and ethnic health disparities

Volume

11

Issue

2

DOI

10.1007/s40615-023-01567-9

Keywords

All-cause mortality; Cardiovascular mortality; Mortality; Race; Racial disparities; Social determinants of health

Abstract

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.

APA Citation

Javed, Zulqarnain; Valero-Elizondo, Javier; Cainzos-Achirica, Miguel; Sharma, Garima; Mossialos, Elias; Parekh, Tarang; Hagan, Kobina; Hyder, Adnan A.; Kash, Bita; and Nasir, Khurram, "Race, Social Determinants of Health, and Risk of All-Cause and Cardiovascular Mortality in the United States" (2024). GW Authored Works. Paper 4854.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/4854

Department

Global Health