多种慢性疾病充分介导了种族对死亡率的影响；对全美代表性样本长达 25 年的随访。
Number of Chronic Medical Conditions Fully Mediates the Effects of Race on Mortality; 25-Year Follow-Up of a Nationally Representative Sample of Americans.
机构信息
Department of Psychiatry, University of Michigan, 4250 Plymouth Road, SPC 5763, Ann Arbor, MI, 48109-2700, USA.
Center for Research on Ethnicity, Culture and Health, School of Public Health, University of Michigan, Ann Arbor, USA.
出版信息
J Racial Ethn Health Disparities. 2017 Aug;4(4):623-631. doi: 10.1007/s40615-016-0266-4. Epub 2016 Jul 20.
BACKGROUND
Despite the well-established literature on the effects of race and socioeconomic status (SES) on mortality, limited information exists on mediators of these effects. Taking a life-course epidemiology approach, and using a nationally representative sample of adults in the USA, the current study has two aims: (1) to assess the effects of race and SES at baseline on all-cause mortality over a 25-year follow-up and (2) to test whether the number of chronic medical conditions (CMCs) as a time-varying covariate mediates the effects of race and SES on all-cause mortality.
METHODS
Data came from the Americans' Changing Lives (ACL) Study, a nationally representative longitudinal cohort of US adults 25 and older. The study followed 3361 Blacks or Whites for all-cause mortality for up to 25 years from 1986 to 2011. The predictors of interest were race and SES (education and family income) at baseline measured in 1986. Confounders included baseline age and gender. CMC was the potential time-varying mediator measured in 1986, 1989, 1991, 2001, and 2011. We ran Cox proportional hazard models with and without CMC as time-varying covariates.
RESULTS
In separate models, race and SES were predictors of all-cause mortality. In the model that tested the combined effect of race and SES, SES but not race was predictive of all-cause mortality. We also found evidence suggesting that CMC fully mediates the effect of race on all-cause mortality. Number of CMC only partially mediated the effect of SES on mortality.
CONCLUSION
The number of CMC fully mediates the effects of race and partially mediates the effects of SES on all-cause mortality in the USA. Mortality prevention for minority populations will benefit tremendously from elimination of CMC disparities as well as enhancement of CMC management by minority populations. Elimination of the gap due to SES may be more challenging than the elimination of the racial gap in mortality.
背景
尽管有大量关于种族和社会经济地位（SES）对死亡率影响的文献，但关于这些影响的中介因素的信息有限。本研究采用生命历程流行病学方法，使用美国全国代表性的成年人样本，有两个目的：（1）评估基线时的种族和 SES 对 25 年随访期间全因死亡率的影响；（2）检验作为时变协变量的慢性医疗状况（CMC）数量是否中介种族和 SES 对全因死亡率的影响。
方法
数据来自美国生活变化研究（ACL），这是一项具有全国代表性的美国成年人纵向队列研究，年龄在 25 岁及以上。从 1986 年到 2011 年，这项研究对 3361 名黑人和白人进行了长达 25 年的全因死亡率随访。感兴趣的预测因素是 1986 年基线时的种族和 SES（教育和家庭收入）。混杂因素包括基线年龄和性别。CMC 是 1986 年、1989 年、1991 年、2001 年和 2011 年测量的潜在时变中介因素。我们在有无 CMC 作为时变协变量的情况下运行了 Cox 比例风险模型。
结果
在单独的模型中，种族和 SES 是全因死亡率的预测因素。在测试种族和 SES 综合效应的模型中，SES 而不是种族是全因死亡率的预测因素。我们还发现证据表明，CMC 完全中介了种族对全因死亡率的影响。CMC 仅部分中介 SES 对死亡率的影响。
结论
在美国，CMC 的数量完全中介了种族和 SES 对全因死亡率的影响。消除 CMC 差异以及增强少数族裔人群对 CMC 的管理，将极大地有益于减少少数族裔人群的死亡率。消除 SES 差异的挑战可能比消除死亡率中的种族差异更具挑战性。
Zotero 插件