Over the last four decades, the wealth, health, and mortality disparity between affluent and impoverished Americans has grown consistently. Recently, a pioneering study by the Vanderbilt University Medical Center focused on a highly impoverished, predominantly Black demographic. The findings were stark: individuals earning below $15,000 annually died on average over a decade sooner than those with yearly incomes above $50,000.
This groundbreaking research highlights the urgent need to address the disparities in mortality linked to both race and income. As noted in Elsevier’s recent publication in the American Journal of Preventive Medicine, addressing these issues requires a holistic approach. The study underscores the importance of striving for income equality to diminish low-income Americans’ health and mortality disparities.
Dr Wei Zheng, MD, PhD, MPH, the director of the Vanderbilt Epidemiology Center and the study’s corresponding author, pointed out a significant finding. Although tobacco smoking is traditionally seen as the leading cause of death in the US, the study revealed that the risk of death due to poverty in this low-income group surpasses that due to smoking.
The research included 79,385 participants aged between 40 and 79 from the ongoing Southern Community Cohort Study. Most of these participants were enlisted at community health centres across 12 southeastern states from 2002 to 2009. About two-thirds of the cohort members are Black, and over half reported a household income below $15,000 annually. This setup provided a unique lens to examine the severe impact of extreme poverty on mortality in a racially diverse, low-income population.
The study participants provided detailed information through questionnaires about their health and lifestyle behaviours that influence disease risk and mortality, including smoking, alcohol consumption, physical activity, and diet quality.
During the roughly 18-year follow-up period, there were 19,749 deaths among the participants. Analysis showed that low-income individuals with the poorest lifestyle scores experienced a mortality rate more than six times higher than those in the highest income bracket with the best lifestyle scores. Interestingly, low-income participants with the best lifestyle scores still had a lower cumulative mortality rate than high-income individuals with the poorest lifestyle scores. This finding reinforces the significant impact of lifestyle and behavioural factors on health and lifespan.
However, the study also noted that low-income communities often lack access to healthy food options, adequate healthcare, and safe environments conducive to physical exercise. These limitations mean that promoting healthy behaviours alone is insufficient to counteract the detrimental effects of poverty on mortality.
Among high-income participants, White individuals had a lower cumulative mortality risk compared to Black individuals. However, this trend reversed in the low-income bracket, where White participants exhibited higher mortality rates than their Black counterparts. In the high-income group, the average age at death was 82.7 years for Whites and 81.2 years for Blacks, while in the low-income group, it was 67.8 years for Whites and 70.9 years for Blacks.
Even with some participants adhering to healthier lifestyles, the life expectancy disparity between the two income groups varied from around ten years for Blacks to nearly 15 years for Whites. The findings from this study are a clarion call for the evaluation of policies and public health strategies aimed at reducing mortality and health disparities among low-income Americans. Without targeted interventions to separate the link between low income and poor health, we may continue to see the socioeconomic gaps in health not only widen but also become more entrenched.
More information: Lili Liu et al, Impacts of Poverty and Lifestyles on Mortality: A Cohort Study in Predominantly Low-Income Americans, American Journal of Preventive Medicine. DOI: 10.1016/j.amepre.2024.02.015
Journal information: American Journal of Preventive Medicine Provided by Elsevier
