Interplay of gender, marital status, education, race linked to an American life expectancy of 18 years

The interplay of a quartet of gender, marital status, education, and race is linked to an 18-year lifespan gap for U.S. citizens, and while no one factor is more influential than the other, the more of these influential factors a person has, the their risk of an earlier death increases, according to research published in the open access journal BMJ opened.

But a simple scoring system based on these characteristics could help overcome this complexity to identify those most at risk, the researchers say.

Individual risks and genetic factors explain some of the disparities in health and death, but evidence increasingly points to the role of social determinants – the conditions in which people are born, grow, live, work and age – in shaping the health, the researchers explain. .

But when it comes to identifying groups at high risk of premature death, using just one of these factors often masks large inequalities in longevity within these groups, and different factors affect health in different ways, making it difficult to identify someone at risk. add.

To better understand how these inequalities work in combination, and to more accurately identify people at high risk of premature death from all and specific causes, the researchers looked at differences in lifespan associated with four key social determinants. drawing up a scoring system.

They extracted information on registered deaths and population numbers from national statistics and census data for the period 2015-2019, to analyze the potential influence of all combinations of gender, race, marital status and education level on the risk of premature death. groups in total.

They include 12 specific causes of death, representing the 11 leading causes of death in the US, including homicide and lung, breast, prostate and other cancers.

The final analysis is based on partial life expectancy: the years between 30 and 80 years. This revealed very large differences between the 54 groups, with a difference of 18 years between those with the shortest and longest partial life expectancies.

For example, white men with a high school diploma or less who have never married have the shortest partial life expectancy at 37 years. At the other end of the scale, white, married women with a college degree can expect a partial life expectancy of 55 years.

But no single factor provided a clear benefit to all people equally, the researchers found.

For example, white, married, college-educated men have a partial life expectancy of 52 years, which is higher than that of 81% of all female groups (22 out of 27). Similarly, some groups with low levels of education outlive groups with high levels of education.

And married Hispanic women with a high school education or less have a partial life expectancy of 51 years, which is higher than 44% of groups characterized by a college degree (eight out of 18).

And a trait that curtails partial life expectancy can be offset by a trait that extends it, and vice versa, the researchers say.

For example, having an education to the high school level or less reduces partial life expectancy by almost four years, but being married and female increases it by almost five years, raising the life expectancy of married women with this level of education above the national level.

And while a college degree extends partial life expectancy by almost four years, never being married and having a male gender shortens life expectancy by almost five years, putting it below the national level.

Based on these findings, the researchers developed a scoring system, ranging from −10 to a maximum of 8, for identifying groups at high risk of premature death based on the four social determinants of health.

Being female (score of 4), married (0), white (1), and educated to high school level or less (-5) yields a total score of 0. About half of the 54 groups score 0 or higher and almost one in five (19%) −5 or lower.

While not everyone in low-scoring groups will die prematurely, people in these groups may be at increased risk and may need more medical or public health interventions, the researchers explain.

Marriage and higher education are two characteristics that always confer lower risk, but the gradient is not as clear by race. Some specific causes of death, such as suicide, unintentional injuries, chronic lung disease, and lung cancer, negatively impact more whites, while others, such as liver disease, negatively impact more Hispanics.

Most causes of death tend to negatively impact blacks across the board. And women generally have a survival advantage over men for all causes of death except other cancers and Alzheimer’s disease.

But different social determinants of health affect each cause of death differently, causing the causes of death that contribute to the mortality disadvantage to vary among the 54 groups, even if the overall score is the same, the researchers found.

For example, white, previously married women with a high school diploma or less are at high risk of dying from lung cancer, other cancers, chronic lung disease, Alzheimer’s disease, kidney disease, influenza and pneumonia.

And black never-married men with college degrees are at greater risk of dying from heart disease, prostate cancer, brain disease, diabetes, kidney disease and homicide. Both groups have an overall risk score of −3.

The researchers acknowledge that the scoring system could oversimplify the underlying factors at play. Marital status is also subject to change. And including more characteristics, such as income, area of ​​residence, environmental factors, access to health care or lifestyle, could increase the accuracy of the scoring system, they suggest.

But they nevertheless conclude: ‘There is a complex interaction between social and individual health determinants, with no single determinant being able to explain the entire observed variation in lifespan.

“Having one characteristic associated with higher mortality is often not a sufficient criterion to be considered a high mortality risk, but the risk does increase with the number of such characteristics. Furthermore, not all social determinants of health analyzed have the same degree of influence on lifespan and mortality.”