. 2023 Aug 22;23(1):1591.

doi: 10.1186/s12889-023-16178-6.

Can lifestyle factors explain racial and ethnic inequalities in all-cause mortality among US adults?

Klajdi Puka^#^{1

2

3}, Carolin Kilian^#¹, Yachen Zhu⁴, Nina Mulia⁴, Charlotte Buckley⁵, Aurélie M Lasserre^{1

6}, Jürgen Rehm^{1

2

7

8

9

10

11

12}, Charlotte Probst^{13

14

15

16}

Affiliations

¹ Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada.
² Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada.
³ Department of Epidemiology and Biostatistics, Western University, London, ON, Canada.
⁴ Alcohol Research Group, Public Health Institute, Emeryville, CA, USA.
⁵ Department of Automatic Control and Systems Engineering, University of Sheffield, Sheffield, UK.
⁶ Addiction Medicine, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland.
⁷ Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.
⁸ Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
⁹ Program on Substance Abuse & WHO CC, Public Health Agency of Catalonia, Barcelona, Spain.
¹⁰ Dalla Lana School of Public Health, Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
¹¹ I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation.
¹² Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
¹³ Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada. charlotte.probst@camh.ca.
¹⁴ Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada. charlotte.probst@camh.ca.
¹⁵ Department of Psychiatry, University of Toronto, Toronto, ON, Canada. charlotte.probst@camh.ca.
¹⁶ Heidelberg Institute of Global Health (HIGH), Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany. charlotte.probst@camh.ca.

^# Contributed equally.

PMID: 37605166
PMCID: PMC10464312
DOI: 10.1186/s12889-023-16178-6

Can lifestyle factors explain racial and ethnic inequalities in all-cause mortality among US adults?

Klajdi Puka et al. BMC Public Health. 2023.

. 2023 Aug 22;23(1):1591.

doi: 10.1186/s12889-023-16178-6.

Authors

Affiliations

¹ Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada.
² Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada.
³ Department of Epidemiology and Biostatistics, Western University, London, ON, Canada.
⁴ Alcohol Research Group, Public Health Institute, Emeryville, CA, USA.
⁵ Department of Automatic Control and Systems Engineering, University of Sheffield, Sheffield, UK.
⁶ Addiction Medicine, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland.
⁷ Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.
⁸ Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
⁹ Program on Substance Abuse & WHO CC, Public Health Agency of Catalonia, Barcelona, Spain.
¹⁰ Dalla Lana School of Public Health, Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
¹¹ I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation.
¹² Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
¹³ Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada. charlotte.probst@camh.ca.
¹⁴ Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada. charlotte.probst@camh.ca.
¹⁵ Department of Psychiatry, University of Toronto, Toronto, ON, Canada. charlotte.probst@camh.ca.
¹⁶ Heidelberg Institute of Global Health (HIGH), Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany. charlotte.probst@camh.ca.

^# Contributed equally.

PMID: 37605166
PMCID: PMC10464312
DOI: 10.1186/s12889-023-16178-6

Abstract

Background: Racial and ethnic inequalities in all-cause mortality exist, and individual-level lifestyle factors have been proposed to contribute to these inequalities. In this study, we evaluate the extent to which the association between race and ethnicity and all-cause mortality can be explained by differences in the exposure and vulnerability to harmful effects of different lifestyle factors.

Methods: The 1997-2014 cross-sectional, annual US National Health Interview Survey (NHIS) linked to the 2015 National Death Index was used. NHIS reported on race and ethnicity (non-Hispanic White, non-Hispanic Black, and Hispanic/Latinx), lifestyle factors (alcohol use, smoking, body mass index, physical activity), and covariates (sex, age, education, marital status, survey year). Causal mediation using an additive hazard and marginal structural approach was used.

Results: 465,073 adults (18-85 years) were followed 8.9 years (SD: 5.3); 49,804 deaths were observed. Relative to White adults, Black adults experienced 21.7 (men; 95%CI: 19.9, 23.5) and 11.5 (women; 95%CI: 10.1, 12.9) additional deaths per 10,000 person-years whereas Hispanic/Latinx women experienced 9.3 (95%CI: 8.1, 10.5) fewer deaths per 10,000 person-years; no statistically significant differences were identified between White and Hispanic/Latinx men. Notably, these differences in mortality were partially explained by both differential exposure and differential vulnerability to the lifestyle factors among Black women, while different effects of individual lifestyle factors canceled each other out among Black men and Hispanic/Latinx women.

Conclusions: Lifestyle factors provide some explanation for racial and ethnic inequalities in all-cause mortality. Greater attention to structural, life course, healthcare, and other factors is needed to understand determinants of inequalities in mortality and to advance health equity.

Keywords: Alcohol; BMI; Ethnicity; Health behaviors; Obesity; Physical activity; Race; Smoking.

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Conflict of interest statement

The authors declare no competing interests.

Figures

**Fig. 1**
Diagram of the modelled direct and indirect relations between race and ethnicity, lifestyle factors, covariates, and all-cause mortality

**Fig. 2**
Visual representation of the prevalence (%, unweighted) of lifestyle factors posing higher health risks at baseline by sex and race and ethnicity

**Fig. 3**
Survival probabilies stratified by sex and race and ethnicity

See this image and copyright information in PMC

Update of

Can lifestyle factors explain racial and ethnic inequalities in all-cause mortality among US adults?
Puka K, Kilian C, Zhu Y, Mulia N, Buckley C, Lasserre AM, Rehm J, Probst C. Puka K, et al. Res Sq [Preprint]. 2023 Apr 14:rs.3.rs-2701139. doi: 10.21203/rs.3.rs-2701139/v1. Res Sq. 2023. Update in: BMC Public Health. 2023 Aug 22;23(1):1591. doi: 10.1186/s12889-023-16178-6. PMID: 37090619 Free PMC article. Updated. Preprint.

References

1. Williams DR, Collins C. US socioeconomic and racial differences in Health: patterns and explanations. Ann Rev Sociol. 1995;21:349–86. doi: 10.1146/annurev.so.21.080195.002025. - DOI
1. Sudano JJ, Baker DW. Explaining US racial/ethnic disparities in health declines and mortality in late middle age: the roles of socioeconomic status, health behaviors, and health insurance. Soc Sci Med. 2006 Feb;62(4):909–22. - PubMed
1. Beydoun MA, Beydoun HA, Mode N, Dore GA, Canas JA, Eid SM, Zonderman AB. Racial disparities in adult all-cause and cause-specific mortality among us adults: mediating and moderating factors. BMC Public Health. 2016 Dec;16(1):1113. - PMC - PubMed
1. Ruiz JM, Steffen P, Smith TB. Hispanic Mortality Paradox: a systematic review and Meta-analysis of the longitudinal literature. Am J Public Health. 2013 Mar;103(3):e52–60. - PMC - PubMed
1. Williams DR, Collins C. Racial residential segregation: a fundamental cause of racial disparities in health. Public Health Rep. 2001 Sep;116(5):404–16. - PMC - PubMed

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Can lifestyle factors explain racial and ethnic inequalities in all-cause mortality among US adults?

Affiliations

Can lifestyle factors explain racial and ethnic inequalities in all-cause mortality among US adults?

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

Update of

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources