About 80 percent of older adults have one chronic disease, according to the National Council on Aging. Additionally, 95 percent of health care costs for those older adults in the United States can be attributed to chronic diseases.
In his recent study at the University of Michigan, Shervin Assari, a psychiatric research investigator, found that, among individuals with a chronic disease, African Americans die earlier on average than white people. For him, the question remained: what role does chronic health conditions play in these earlier death rates?
While it was clear to Assari racial and socioeconomic factors influence premature death in the United States, he wanted to look into whether these factors have an effect on mortality altogether, or if one factor explains the effect of the other.
The study, published in the Journal of Racial and Ethnic Health Disparities, used data from the Americans’ Changing Lives Study — a nationally representative longitudinal study following 3,361 white and Black adults 25 years of age and older in the United States. With this dataset, Assari assessed multiple measures, including demographics, socioeconomic status, race, number of chronic medical conditions and mortality to establish why Black people die earlier than white people.
Behaviors that contribute to contracting these chronic health diseases include a lack of physical activity, smoking cigarettes, excessive drinking and poor dietary habits, according to the Centers for Disease Control and Prevention.
Assari discovered that, while the number of chronic medical conditions mediate the effect of race on mortality, the same may not be for the effects of social class.
“The mechanism by which race influences mortality may have some differences from the mechanism that education does the same thing,” Assari said.
Assari found that, if chronic medical conditions — such as obesity, diabetes, heart disease and cancer — are the reason that Black people die earlier than white people, the best solution would be to improve medical care so as to reduce Black deaths by chronic disease.
“If you can help Blacks avoid chronic conditions, you have succeeded in undoing the effects of race on mortality,” Assari said. “The only thing you need to do to undo the effects of race on mortality is to help them prevent chronic disease or improve care of chronic disease and management of chronic disease so that that doesn’t kill them more than whites.”
This is not, however, the case for social class.
According to Assari, poor socioeconomic status has been linked to many chronic conditions, along with racial status. Yet chronic diseases alone do not explain how social class determines these earlier instances of death. The number of chronic medical conditions only partially mediates the effects of social class, implying other factors must be involved.
Assari said beside a number of chronic medical conditions, education or socioeconomic status, the type of chronic medical condition or mental health status could play a role in the risk of premature death.
“(Prevention or management of chronic disease) is not the only solution,” Assari said. “If you undo the effects of education on number of chronic conditions or the progress of (CMC), education would still have some effect on mortality. The way education and the way race influence mortality may have similarities and differences.”
Julia Carter, an epidemiology student at the University of Pittsburg, has been working with Assari for her summer internship through the Michigan Institute for Clinical and Health Research in the Immersion in Health Disparities Research Program.
Carter said she and Assari see racial disparities like these in every aspect of health. However, aside from the factors that could play a role in the risk of mortality mentioned in Assari’s study, Carter said she thinks culture is another element that needs to be considered.
“Culture plays a big part in health disparities, especially along race lines,” Carter said. “For minority populations, culture isn’t often times taken into account. For example, obesity — if you go and see a primary care physician and they don’t take into account the contextual factors as to why you might be obese or why a minority individual might be obese, the interventions proposed are not going to be effective.”
Carter agreed with Assari’s findings that race and socioeconomic status work both together and separately.
“Race and (socioeconomic status) are so interlinked,” Carter said. “It’s so hard to separate those two because they go so hand in hand. At what point do you know if this is a race thing or a (socioeconomic status) thing, given that race and (socioeconomic status) are linked?”
Additionally, Carter said showing different stratified levels of socioeconomic status — rather than limiting research to simply poor versus wealthy — is crucial in showing a negative progression in health and chronic conditions.