Daily discrimination and financial problems have a large impact on early mortality risk
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A history of bad relationships, discrimination and financial insecurity increase someone’s risk of dying early. What’s more, each of these factors has a bigger impact on your mortality risk than a lack of exercise, according to a study of thousands of people in the US. The findings also suggest that racism has a huge impact on when a person will die, says Eli Puterman at the University of British Columbia in Canada, who led the work.
Biological factors play an important role in our health, says Puterman, but non-biological factors – our behaviours and life experiences – have an effect too. To find out how influential these factors might be, Puterman and his colleagues turned to data from 13,611 US adults, aged between 52 and 104, who had filled out detailed questionnaires about their lives and then had their health tracked for six years.
The team examined how each volunteer had responded to questions about 57 social and behavioural factors that might have affected their health. The group then looked at each factor individually to assess whether any had increased the likelihood of dying within the six-year period.
“Unsurprisingly, health behaviours seemed to take the lead,” says Puterman. Being a smoker almost doubled a person’s risk of dying within the six-year period, for example. And those who said they had an alcohol use disorder increased this risk by 36 per cent.
Other social factors appear to play a significant role, too. Individuals who had been through a divorce were 45 per cent more likely to die within the six-year period, for example. “It was surprising to see (divorce) so high up there,” says Puterman. “But at the end of the day, our negative relationships really do have a very high impact on our daily well-being and our health, and divorce has probably emerged from years of negative experiences with a spouse.”
Experiencing financial hardship was another important factor. The risk of dying was increased by 32 per cent in those who had experienced recent financial difficulties, as well as those with a history of unemployment. People who had used food stamps in the past were 28 per cent more likely to die within the six-year period.
These factors appear to have more influence on mortality risk than a lack of exercise, which, according to the analysis, increased the risk of death during the study period by 15 per cent.
The findings fit with previous research, says Jane Falkingham at the University of Southampton, UK. People who live in poor quality housing can experience damp or other issues that might influence health, and those on lower incomes can struggle to afford healthy foods, she says. “Biology doesn’t determine everything,” she says. “Genetics can predispose you to an outcome, but actually your social and environmental experiences influence your health outcomes as much as, if not more than, biology.”
The top 20 most influential factors on mortality included the experience of major or daily discrimination. And when, in a separate analysis, Puterman and his colleagues specifically looked at the impact of ethnicity, they found that African Americans were 22 per cent more likely than Caucasians to die within the six-year period.
“African Americans in the US have greater financial difficulties and have more daily discrimination,” says Puterman. The chronic stress brought on by these factors can affect the healthy functioning of the immune system, heart and digestive system, as well as affecting mental health.
The impact of ethnicity could be higher, Puterman adds. Individuals that have been especially affected by the factors that increase mortality may have already died before they reached the age of the study participants, he says.
Improving health outcomes
In the UK, some ethnic minorities also have worse health outcomes, partly because such groups are more likely to be poorer, says Falkingham. But “even after you control for all these other factors, there are still differences”, she says. “Which then does just point toward racism.”
Plenty of reports have suggested ways to improve health outcomes for such groups, such as the recent Public Health England review into the disproportionate impact of covid-19 on black, Asian and minority ethnic (BAME) groups. The review recognised that the pandemic “exposed and exacerbated longstanding inequalities affecting BAME groups in the UK”, and that racism, discrimination and stigma may play a role. It included a list of recommendations.
“One of the problems is we keep having these reviews, and having lots and lots of recommendations, but we don’t quite follow through on them,” says Falkingham.
Journal reference: PNAS, DOI: 10.1073/pnas.1918455117
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