Not long ago, public health research that identified disparate outcomes between racial or ethnic groups would conclude that the difference likely had to do with the lower socioeconomic status, on average, of non-whites – with a frequent caveat that maybe there was some genetic risk factor.
As we have learned more about genetics, there is less room to suppose that genes could account for elevated rates of cancer, heart disease and other major health problems among Black, Latino and Asian Americans. Researchers have therefore tried to untangle race and ethnicity from socioeconomic status in an effort to isolate the specific risk factors that drive the United States’ alarming racial disparities.
In a paper published this week in JAMA Network Open, researchers led by Meera Sangaramoorthy, MPH, looked at all-cause mortality in a large, very diverse cohort of people followed for up to 20 years. The paper, senior authored by Iona Cheng, PhD, broke the groups out by race/ethnicity – including European American, African American, Latino, Japanese American and Native Hawaiian. It then sorted each group by state – all participants lived in California or Hawai’i – and into four tiers of socioeconomic status based on where they lived on their individual level of education.
The analysis confirmed that lower socioeconomic status correlated with higher risk of death in each race and ethnicity considered, even after accounting for age and health behaviors such as diet, exercise, and smoking. The researchers also looked at some common causes of death, such as cardiovascular disease and cancer, and the patterns remained the same.
“Socioeconomic status is a huge health determinant,” Sangaramoorthy said. “We’d like to keep getting the word out that social and economic factors are really important for health. When you have a study that is this large, with over 180,000 participants, the statistical findings and the science behind it are really strong. The study didn’t view participants just at one point in time, but followed them for years, and that also reduces a lot of uncertainty about whether the relationship between socioeconomic status and poor health outcomes can be explained by some other factor.”
In California, European and African Americans had nearly the same relative mortality risk, with their lowest and highest socioeconomic tiers statistically aligned. California Latinos were less likely to die than members of either group. Overall, Hawai’i-dwelling Japanese American participants with high socioeconomic status had the lowest mortality rates, while low-socioeconomic status Native Hawaiians in the state had the highest – they were nearly 2.5 times more likely to die during the study than their Japanese American counterparts.
By diving deeper into the differences within racial and ethnic groups, Dr. Cheng and her colleagues continue to identify complexities that might otherwise hide within statistics that consider racial and ethnic groups more monolithically. The group has made a name for itself parsing the racial, ethnic, socioeconomic and cultural differences that affect the health of those who fall under the broad umbrella of “Asian and Pacific Islander.”