Social determinants of health associated with higher CVD mortality rates in Black persons
Unemployment, lower family income, food insecurity, not owning a home, and not being married or living with a partner were significantly associated with cardiovascular disease (CVD) mortality independently of established behavioral and metabolic risk factors.
Social determinants of health are major contributors to higher mortality rates from cardiovascular disease (CVD) in Black versus White persons, a study found.
Researchers conducted an observational study of 50,808 persons ages 20 years and older to examine the degree to which social, behavioral, and metabolic risk factors are associated with CVD mortality and the extent to which racial differences in CVD mortality persist after these factors are accounted for. Data from the National Health and Nutrition Examination Survey from 1999 to 2018 were linked to the National Death Index with follow-up through 2019. Results were published Aug. 15 by Annals of Internal Medicine.
A total of 2,589 CVD deaths were confirmed over an average of 9.4 years of follow-up, 537 in Black participants, 415 in Hispanic participants, 1,563 in White participants, and 74 in other participants. The age- and sex-standardized rates of CVD mortality per 100,000 person-years were 484.7 deaths in Black participants, 384.5 deaths in White participants, 292.4 deaths in Hispanic participants, and 255.1 deaths in other participants. When data were adjusted for all measured risk factors simultaneously, several social (unemployment, low family income, food insecurity, lack of home ownership, and unpartnered status), behavioral (current smoking, lack of leisure-time physical activity, and sleeping fewer than six or more than eight hours per day), and metabolic (obesity, hypertension, and diabetes) risk factors were associated with a significantly higher risk for CVD death.
The difference in Black and White CVD mortality diminished after adjustment for behavioral and metabolic risk factors and was no longer present after adjustment for social determinants of health in the U.S. population. After adjustment for metabolic, behavioral, and social risk factors separately, hazard ratios of CVD mortality for Black compared with White participants were 1.34 (95% CI, 1.16 to 1.55), 1.31 (95% CI, 1.15 to 1.50), and 1.04 (95% CI, 0.90 to 1.21), respectively, versus 1.54 (95% CI, 1.34 to 1.77) before adjustment.
According to the authors, because data on the complex relationship of social, behavioral, and metabolic risk factors with racial differences in CVD mortality are scarce, future research is warranted to understand the underlying mechanisms and develop novel interventions for reducing CVD mortality in populations, especially in Black persons.
“Such information may be critical to guide the development of national public health policies for targeted interventions aimed at eliminating health disparities in CVD mortality,” they wrote.