Black Americans face a greater risk of early death than white people do, and now a new study points to the reasons why.
Known as the social determinants of health, these eight factors are critical for health and well-being.
The reason that Black adults in the United States have a 59% higher risk of premature death than white adults can be linked to disparities in employment, income, food security, education level, access to health care, quality health insurance, home ownership and marital status, according to the new report.
For the study, the researchers from Tulane University in New Orleans used the U.S. National Health and Nutrition Examination Survey to determine disease prevalence and risks across the country. They then modeled the impact of each of these eight factors on a person’s life expectancy. The disparity in deaths was at zero when accounting for all social determinants.
“It totally disappeared,” said lead study author Joshua Bundy, an epidemiologist at Tulane’s School of Public Health and Tropical Medicine. “There’s no difference between Black and white premature mortality rates after accounting for these social determinants.”
Education, income and employment status explained most, but not all, of the mortality gap.
“This is the first time that anyone completely explained the differences,” Bundy said in a university news release. “We didn’t expect that, and we were excited about that finding because it suggests social determinants should be the primary targets for eliminating health disparities.”
Socioeconomic factors accounted for about 50% of the difference in deaths between Black and white people in the study.
The other approximately 50% was explained by marital status, food security and whether someone has public or private health insurance. These can indicate a person’s social support network, stability or job quality, the study authors noted.
Having unfavorable social determinants of health was more common among Black adults. They were also found to carry enormous risk. Even just having one unfavorable social determinant of health was found to double a person’s chances of an early death. With six or more of these social determinant disparities, a person had an eight times higher risk of premature death.
The findings were published May 25 in The Lancet Public Health.
These study results “demonstrated that race-based health disparities are social, not biological, constructs,” said corresponding author Dr. Jiang He, the chair of epidemiology at Tulane's School of Public Health and Tropical Medicine.
These findings, Bundy said, explain how “structural racism and discrimination lead to worse social risk factors, which may lead to premature death.”
So, Bundy added, "How do we eliminate the structural differences between races? And regardless of race, if you have six or more of these factors, you’re at a really high risk. How do we address these issues for everyone?”
The Healthy People 2030 initiative launched by the U.S. Centers for Disease Control and Prevention is now emphasizing social determinants of health.
Bundy said he hopes the concept gains more traction and that policymakers use these findings to address the race-based mortality gap.
“These social determinants of health are the foundation of health problems,” Bundy said. “They need to be a top priority going forward, and it’s going to take policy, research and a multi-disciplinary approach to tackle these issues.”
The U.S. Department of Health and Human Services has more on the social determinants of health.
SOURCE: Tulane University, news release, May 25, 2023