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. 2016 Oct 22;16(1):1113.
doi: 10.1186/s12889-016-3744-z.

Racial disparities in adult all-cause and cause-specific mortality among us adults: mediating and moderating factors

M A Beydoun  1 , H A Beydoun  2 , N Mode  3 , G A Dore  3 , J A Canas  4 , S M Eid  2 , A B Zonderman  3
Affiliations

Racial disparities in adult all-cause and cause-specific mortality among us adults: mediating and moderating factors

M A Beydoun et al. BMC Public Health. .

Abstract

Background: Studies uncovering factors beyond socio-economic status (SES) that would explain racial and ethnic disparities in mortality are scarce.

Methods: Using 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)).

Results: Age, 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.

Conclusions: In 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.

Keywords: Adult mortality; Cancer; Cardiovascular disease; Race/ethnicity; Socio-economic status.

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Figures

Fig. 1
Fig. 1
Causes of death structure, overall and by race/ethnicity; NHANES III *
Fig. 2
Fig. 2
All-cause mortality hazard rates adjusted for age(y), sex and poverty income ratio, by race group; NHANES III
See this image and copyright information in PMC

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