Socioeconomic Data Reveals Disparities in Premature Mortality

January 24, 2020 - Researchers from Washington State University Elson S. Floyd College of Medicine examined socioeconomic data and found that premature mortality, or death occurring before age 65, is three to eight times more common among non-whites from low-income neighborhoods compared to more affluent whites in Washington.

Although racial and socioeconomic disparities are well-documented in healthcare, there isn’t much information about the connection between racial and deprivation-related inequities.

“Many studies have confirmed that white individuals living in affluent areas live longer lives and that premature death is more common in low‑income communities and communities of color, but less is known about if and how the intersection of race and socioeconomic deprivation impact health,” said Pablo Monsivais, associate professor in the Department of Nutrition and Exercise Physiology.

“What we found when we analyzed both of these factors together is that it creates an eye‑popping increase in premature mortality.”

Researchers set out to understand the factors that promote health resilience and decrease health risks associated with poverty and poor access to healthcare.

For the study, published in the journal Health & Place, the team evaluated all registered deaths in Washington from 2011 to 2015. Researchers examined the data of more than 240,000 deaths for which they could obtain the last residential address for individuals at the time of their death.

Using these addresses, they classified each deceased person’s exposure to socioeconomic deprivation, as well as race, gender, education, and other characteristics. Nearly one quarter of all deaths were premature, with cancer and heart disease being the leading causes of premature death.

The results showed that the combination of race and socioeconomic disadvantage significantly increased the incidence of premature death. Socioeconomic deprivation alone was a predictor of premature death in the largely white population of Washington decedents, with premature deaths being one and a half times more common in whites from more deprived areas than affluent areas.

However, the results also showed that area deprivation was associated with more extreme likelihood of premature death for some racial categories. Premature deaths among American Indian/Alaska Native, black and multiracial decedents from deprived areas were about three times more common than for more-affluent whites.

Deaths among Native Hawaiian/Pacific Islanders from deprived areas were nearly eight times as likely to be premature compared to deaths of more-affluent whites. Asian decedents showed only a modest association between premature death and deprivation.

The results demonstrate the strong relationship between physical health and a person’s zip code.

“Health risks associated with ‘place’, e.g., neighborhood social and environmental contexts, may be driving what appear to be race-based differences in health outcomes,” researchers said.

“Although multivariable models may attempt to provide estimates ‘adjusted for’ or ‘conditioned on’ these social and environmental exposures, their strong covariance with race may undermine attempts to ‘control for’ these factors.”

Further research will need to determine the environmental and policy-related factors that may contribute to premature death among these populations, the team noted. However, the results show that poor housing conditions, a lack of healthy living facilities, limited access to health and social services, and stress from financial insecurity likely play a major role in premature death disparities.

“There’s still a lot of work to be done to fully understand the ‘why’ and ‘how’ behind these disparities, but now that we understand just how extensively racial inequalities in mortality are amplified by social and environmental challenges in low-socioeconomic areas, our team can dig deeper into these challenges and work toward identifying solutions for our communities,” said Monsivais.