The impact of socioeconomic status as a fundamental cause of disease and mortality has been well documented across western countries. This multidimensional construct—variously measured as educational attainment, occupational status, income or poverty level, wealth, and/or otherwise—operates across the life course via multiple mechanisms to condition health and mortality outcomes. In the U.S., socioeconomic status is highly correlated with race/ethnicity and a contributor to persistent black-white differences in disease patters and mortality rates. However, relatively few studies have examined the differential health effects of socioeconomic status within the U.S. African-American community. Relatively small sample sizes of this subgroup have presented challenges to a closer examination of socioeconomic status in the black population. They have also limited the study of multiple risk factors in addition to socioeconomic status, including the net effects of psychosocial, behavioral, and biological variables in an economically diverse group of African Americans. This study contributes to this area of limited research by using a sample of 1,773 economically diverse African American adult men and women in Pitt County, North Carolina to estimate the relative effects of socioeconomic status and psychosocial, behavioral, and biological covariates on (1988-all-cause and cardiovascular mortality over a 16-year period between 1988 and 2004.
Sex-specific analyses were performed using four measures of socioeconomic status. The economic measures included educational attainment, occupational status, home ownership, and financial strain. Psychosocial covariates included in the analysis were social support, stress, and marriage. Health behavioral covariates included physical activity, smoking, and drinking alcohol. Biological covariates including body mass index, waist-hip ratio and hypertension were utilized. Current health status was also used.
Gender, elements of socioeconomic status, health behaviors and biological factors in adulthood influenced all-cause and cardiovascular mortality. In the full sample of women and men, gender (i.e. being male) persists as the primary predictor of mortality followed in importance by health behaviors and biological factors. However, important interactions by gender reveal some heterogeneity in the effects of alternative specific indicators of these multiple factors. African American men with less than or equal to 8 years of education were at a greater risk of death over the 16 year follow up period than men with a high school diploma or more education. This relationship was strong and statistically significant controlling for all covariates. Having an unskilled/blue collar job versus a semi-skilled or skilled/white collar job did not significantly increase the hazard of death. Alcohol use, waist-hip ratio, hypertension, and current health status were also associated with increased hazard of death as well.
Education played less of a role in women's mortality than in men's. Education had a weak and non-significant association with death in women in this analysis. However, women who were not married, did not own a home, or experienced financial strain were at an increased risk of death, although these associations were reduced in the full model when health behaviors were added. Body mass index, hypertension, and current health status were significantly associated with death in women. Unexpectedly, low emotional support and not working were associated with 1survival among the women in this cohort.
The overall pattern of results suggests that different aspects of socioeconomic status influence mortality differently for men and women in this sample. Education and occupational status matter more for men: the former has persistent direct effects and the latter operates primarily through biological factors and health behaviors like frequent alcohol use. Homeownership, marital status and financial strain, matter more than education or occupation for women and operate through biological factors and different health behaviors such as obesity. These gendered variations illustrate the complexity of the operation of socioeconomic status as a fundamental cause of disease and mortality in African Americans.