A study by Tulane University reveals that Black adults in the U.S. have a 59% higher risk of premature death compared to White adults due to disparities in eight social determinants of health: employment, income, food security, education level, healthcare access, health insurance quality, home ownership, and marital status. The research demonstrated that when these unfavorable factors were accounted for, the racial mortality disparity vanished, underscoring the notion that race-based health disparities are social constructs rather than biological.
The research reveals that the disparity in mortality rates based on race in America is not a result of biological differences, but rather a social construct. Furthermore, it suggests that this gap can be narrowed by focusing on eight key factors.
Adults of Black ethnicity residing in the United States have a risk of premature death that is 59% higher compared to their White counterparts.
New research, carried out by Tulane University and published in the journal Lancet Public Health, indicates that the difference in premature mortality rates is fully accounted for by inequities in eight key areas of life crucial to health and overall well-being. These areas are employment, income, access to nutritious food, educational attainment, healthcare accessibility, quality of health insurance, home ownership, and marital status.
These eight factors are called social determinants of health. Using data from the National Health and Nutrition Examination Survey, a CDC survey used to determine disease prevalence and risks across the country, Tulane researchers modeled the impact of each factor on a person’s life expectancy. When all unfavorable social determinants were accounted for, the 59% mortality disparity was reduced to zero.
“It totally disappeared,” said Josh Bundy, lead author and 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.”
While the mortality gap has been largely pinned on socioeconomic factors such as education level, income, and employment status in recent years, researchers have acknowledged that these factors only explained most of the gap, Bundy said.
“This is the first time that anyone completely explained the differences,” Bundy said. “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 were still found to play a major role, accounting for approximately 50% of the Black-White difference in mortality in the study. However, the other nearly 50% of the difference was explained by marital status, food security, and whether someone has public or private health insurance, softer indicators that can speak to a person’s social support network, stability, or job quality.
Unfavorable social determinants of health were more common among Black adults and were found to carry enormous risks.
Having just one unfavorable social determinant of health was found to double a person’s chances of an early death. With six or more, a person has eight times higher risk of premature mortality.
Jiang He, the corresponding author and Joseph S. Copes Chair of Epidemiology the School of Public Health and Tropical Medicine, said these results “demonstrated that race-based health disparities are social, not biological, constructs.”
Bundy agreed, adding that the findings explain how “structural racism and discrimination lead to worse social risk factors, which may lead to premature death.”
“So how do we eliminate the structural differences between races?” Bundy said. “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?”
As a concept, social determinants of health are a relatively new framework being emphasized by the CDC’s Healthy People 2030 initiative.
Going forward, Bundy 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.”
Reference: “Social determinants of health and premature death among adults in the USA from 1999 to 2018: a national cohort study” by Joshua D Bundy, Katherine T Mills, Hua He, Thomas A LaVeist, Keith C Ferdinand, Jing Chen and Jiang He, 25 May 2023, The Lancet Public Health.
DOI: 10.1016/S2468-2667(23)00081-6