Can lifestyle factors explain racial and ethnic inequalities in all-cause mortality among US adults?

BMC Public Health

Research

Nina Mulia¹  Yachen Zhu¹  Charlotte Buckley²  Carolin Kilian³  Aurélie M. Lasserre⁴  Klajdi Puka⁵  Charlotte Probst⁶  Jürgen Rehm⁷ 

[1] Alcohol Research Group, Public Health Institute, Emeryville, CA, USA;Department of Automatic Control and Systems Engineering, University of Sheffield, Sheffield, UK;Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada;Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada;Addiction Medicine, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland;Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada;Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada;Department of Epidemiology and Biostatistics, Western University, London, ON, Canada;Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada;Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada;Department of Psychiatry, University of Toronto, Toronto, ON, Canada;Heidelberg Institute of Global Health (HIGH), Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany;Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada;Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada;Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany;Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany;Program on Substance Abuse & WHO CC, Public Health Agency of Catalonia, Barcelona, Spain;Dalla Lana School of Public Health, Department of Psychiatry, University of Toronto, Toronto, ON, Canada;I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation;Department of Psychiatry, University of Toronto, Toronto, ON, Canada;

关键词: Race;    Ethnicity;    Health behaviors;    Smoking;    Alcohol;    Physical activity;    Obesity;    BMI;   

DOI  :  10.1186/s12889-023-16178-6

 received in 2023-03-16, accepted in 2023-06-22,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundRacial and ethnic inequalities in all-cause mortality exist, and individual-level lifestyle factors have been proposed to contribute to these inequalities. In this study, we evaluate the extent to which the association between race and ethnicity and all-cause mortality can be explained by differences in the exposure and vulnerability to harmful effects of different lifestyle factors.MethodsThe 1997–2014 cross-sectional, annual US National Health Interview Survey (NHIS) linked to the 2015 National Death Index was used. NHIS reported on race and ethnicity (non-Hispanic White, non-Hispanic Black, and Hispanic/Latinx), lifestyle factors (alcohol use, smoking, body mass index, physical activity), and covariates (sex, age, education, marital status, survey year). Causal mediation using an additive hazard and marginal structural approach was used.Results465,073 adults (18–85 years) were followed 8.9 years (SD: 5.3); 49,804 deaths were observed. Relative to White adults, Black adults experienced 21.7 (men; 95%CI: 19.9, 23.5) and 11.5 (women; 95%CI: 10.1, 12.9) additional deaths per 10,000 person-years whereas Hispanic/Latinx women experienced 9.3 (95%CI: 8.1, 10.5) fewer deaths per 10,000 person-years; no statistically significant differences were identified between White and Hispanic/Latinx men. Notably, these differences in mortality were partially explained by both differential exposure and differential vulnerability to the lifestyle factors among Black women, while different effects of individual lifestyle factors canceled each other out among Black men and Hispanic/Latinx women.ConclusionsLifestyle factors provide some explanation for racial and ethnic inequalities in all-cause mortality. Greater attention to structural, life course, healthcare, and other factors is needed to understand determinants of inequalities in mortality and to advance health equity.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

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