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Social Determinants of Health Explain Half of Racial Health Disparities

The racial health disparity in risk of all-cause mortality for Black folks shrank from 34 to 16 percent after adjusting for social determinants of health.

The social determinants of health explain about half of the racial health disparities in life expectancy in the United States, emphasizing the nation’s need to address social risk factors, according to researchers from Johns Hopkins Medicine.

The analysis of 7,000 ages 45 to 84 years old showed that Black people have a 34 percent greater risk of death from any cause compared to White adults. But when controlling for social determinants of health, that risk shrank to 16 percent, the researchers wrote in Circulation.

“We have experienced tremendous improvements in public health in recent decades; however, these study results demonstrate continued mortality inequities among racial and ethnic minorities in our country,” Wendy Post, MD, MS, the study’s corresponding author, said in a statement.

“We demonstrate that social determinants of health explain many of these differences,” continued Post, who is also director of cardiovascular research at the Johns Hopkins University School of Medicine.

These findings come as healthcare leaders work to better understand the driving forces behind racial health disparities. Black and Hispanic patients have worse outcomes across nearly all disease states, including all-cause mortality, compared to White adults. Social determinants of health might be at play in addition to implicit bias and institutional racism.

This most recent study particularly zeroed in on the role that social determinants of health play in racial health disparities.

The researchers found notable racial health disparities in life expectancy before adjusting for social determinants of health. Disparities primarily affected Black people, with Black folks having a 34 percent greater risk of death from any cause compared to White adults. Asian people had a 21 percent lower risk of death, while there was scant difference between White and Hispanic people.

But when considering social determinants of health, those disparities changed.

For example, controlling for household income, neighborhood wealth, education, and health insurance reduced the risk of death from any cause to 16 percent among Black people. Said otherwise, social determinants of health explained away about half of the racial health disparity in life expectancy between Black and White people.

The researchers did not investigate the forces driving the remaining 16 percent disparity, but other healthcare experts have indicated that social factors like implicit bias and institutional racism could be at play. Differences in the patient-provider relationship, neighborhood characteristics and redlining, and other racist policies could alter how Black people interact with healthcare, ultimately impacting their health.

When looking at Asian and Hispanic people, immigration played a role, the Johns Hopkins study found. When looking at cardiovascular disease (CVD) death particularly, Asian and Hispanic people who had immigrated to the US more recently had a lower risk of mortality. The data did not make clear whether newer immigrants were healthier or whether they had less time to adopt what the press release called “some of the unhealthy factors associated with an American lifestyle.”

“We need to continue to identify and then act on these deeply rooted factors in our society that lead to persistent differences in mortality outcomes, to improve population health and longstanding disparities for minority populations,” Post said.

These findings mirror previous assessments looking at specific disease states. In February 2022, the Centers for Disease Control and Prevention (CDC) found that Black folks living in areas with a higher Social Vulnerability Index score were more likely to get an HIV diagnosis, underscoring the role social determinants play in HIV racial health disparities.

Something similar came to light with CVD. Research published in Mayo Clinic Proceedings found that social deprivation and SDOH account for about 40 percent of cardiovascular mortality disparities across the country.

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