Contribution of chronic conditions to mortality: Differences by race and ethnicity

Racial and ethnic health disparities are persistent in the United States. The accumulation of chronic conditions and mortality are important contributors to these observed inequities.

We assessed the contribution of coexisting conditions to mortality among Hispanic, non-Hispanic White, and non-Hispanic Black older adults born in the United States. We used nationally-representative data from the Health and Retirement Study (HRS) from 1998-2020 (n = 10,430). Estimates for the absolute additive contributions of nine chronic conditions using a longitudinal extension of the average attributable fraction (LE-AAF) were derived from survey-weighted multivariable discrete survival models adjusted for sociodemographic and health characteristics.

Death occurred in 42.2 % (95 % confidence interval [CI]=37.4, 47.0) of Hispanic, 42.7 % (95 % CI=41.7, 44.2) of White, and 46.4 % (95 % CI=42.7, 50.1) of Black respondents. The eight conditions increasing the risk of death contributed 73.9 % (95 % CI=50.7, 100.0) of mortality events among Hispanic respondents, 66.2 % (95 % CI=48.9, 81.5) among Black respondents, and 57.7 % (95 % CI=52.1, 62.5) among White respondents. Dementia had the strongest association with mortality with an adjusted odds ratio of 3.23 for Hispanic (95 % CI=1.90, 5.49), 3.14 for White (95 % CI=2.61, 3.78), and 2.11 for Black (95 % CI=1.63, 2.73) respondents. The development and progression of cancer malignancies contributed most to mortality for White adults. In contrast, hypertension, contributed most to mortality for Hispanic and Black adults.

Hispanic, Black, and White Americans differed in the prevalence and incidence of chronic conditions, as well as their association with mortality. Together, these conditions resulted in contributions to mortality that varied substantially.