Study Reveals Social Determinants of Health Influence Premature Mortality Disparities

by François Dupont
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premature mortality disparity

According to a recent study conducted by Tulane University, Black adults in the United States face a significantly higher risk of premature death compared to their White counterparts. However, the research highlights that this mortality disparity is not rooted in biological differences, but rather in eight key social determinants of health. These determinants include employment, income, food security, education level, healthcare access, health insurance quality, home ownership, and marital status.

The study, published in the Lancet Public Health journal, emphasizes that the gap in premature mortality rates can be fully explained by inequities in these crucial areas that directly impact health and overall well-being. By analyzing data from the National Health and Nutrition Examination Survey, a comprehensive CDC survey, researchers were able to model the influence of each determinant on life expectancy. Remarkably, when all unfavorable social determinants were taken into account, the 59% mortality disparity between Black and White adults vanished entirely.

Lead author and Tulane epidemiologist Josh Bundy expressed excitement over this finding, stating that it is the first time researchers have fully explained the differences in premature mortality rates. The results indicate that social determinants should be the primary focus when striving to eliminate health disparities. While socioeconomic factors such as education level, income, and employment status account for approximately 50% of the Black-White mortality difference, factors like marital status, food security, and type of health insurance explain the remaining 50%, shedding light on softer indicators that reflect social support networks, stability, and job quality.

The study underscores the substantial risks associated with unfavorable social determinants of health, which were more prevalent among Black adults. Merely having one such determinant was found to double the likelihood of early death, while six or more increased the risk eightfold. Corresponding author Jiang He, the Joseph S. Copes Chair of Epidemiology at Tulane’s School of Public Health and Tropical Medicine, emphasizes that these findings demonstrate the social, rather than biological, nature of race-based health disparities. Bundy echoes this sentiment, linking structural racism and discrimination to the presence of detrimental social risk factors that can ultimately lead to premature death.

The concept of social determinants of health, which highlights the impact of non-medical factors on well-being, is gaining recognition and is a key focus of the CDC’s Healthy People 2030 initiative. Moving forward, the researchers hope that policymakers prioritize addressing these determinants to bridge the race-based mortality gap. Bundy emphasizes that social determinants of health serve as the foundation of health problems and require a multidisciplinary approach encompassing policy, research, and intervention to effectively 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

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