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Racial and ethnic disparities in mortality persist, largely driven by social determinants of health. Addressing systemic factors is crucial for improving health equity across diverse populations.

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Area of Science:

  • Public Health
  • Epidemiology
  • Social Determinants of Health

Background:

  • Persistent racial and ethnic disparities in longevity and cardiovascular disease (CVD) mortality exist despite population health improvements.
  • The Multi-Ethnic Study of Atherosclerosis (MESA) investigated these disparities.

Purpose of the Study:

  • To describe all-cause and CVD mortality risks by race and ethnicity.
  • To examine the influence of socioeconomic status (SES) and other factors on these disparities.

Main Methods:

  • Utilized Cox proportional hazards modeling with time-updated covariates in 6814 US adults (aged 45-84) from the MESA study.
  • Progressively adjusted for age, sex, SES, lifestyle, psychosocial, clinical risk factors, and immigration history.
  • Evaluated associations between self-reported race/ethnicity and all-cause/CVD mortality over a median of 15.8 years.

Main Results:

  • Initially, Black participants had higher mortality (HR 1.34), Chinese lower (HR 0.79), and Hispanic no difference vs. White participants.
  • After SES adjustment, Black mortality HR decreased (HR 1.16) but remained significant; Chinese and Hispanic mortality hazards also decreased.
  • Further adjustments for other factors eliminated significant mortality differences for Black and Chinese participants compared to White, and showed lower risk for Hispanic participants (HR 0.77).

Conclusions:

  • Racial and ethnic differences in mortality are largely attributable to social determinants of health.
  • Findings underscore the need to identify and address systemic factors contributing to health disparities.
  • Interventions should focus on social and systemic factors to promote health equity.