Black men below poverty line have lowest overall survival

By Stephen Feller

BETHESDA, Md., July 18 (UPI) -- While poverty increases the risk of death for most people, black men see the greatest increase in their risk for death, according to a long-term study of race, gender and socioeconomic condition.

Researchers at the National Institute of Aging found black men have a nearly three-fold risk of death over other people, and both black and white women also see increased risk of death if they live in poverty, according to more than a decade of statistical analysis.


Previous studies have shown being poor increases risk of death. African-Americans, especially men, have also been shown to be at higher risk for significant health conditions such as diabetes, heart disease and certain types of cancer -- in addition to environmental and socioeconomic risks that also have an effect.

"We know there are differences in race -- African-Americans have a tendency to have a worse longevity, women have a better longevity, people with higher income have better longevity -- but nobody has looked at sex and race as we have," Dr. Alan Zonderman, a researchers at the National Institute of Aging, told UPI in a phone interview. "We were surprised African-American men were so at risk."


NIA researchers have been conducting the 20-year Healthy Aging in Neighborhoods of Diversity across the Life Span study, or HANDLS, drawing data on the same group of 3,720 black and white residents of 13 Baltimore neighborhoods to find and understand relationships between environment, economic condition and race.

Although a study published in May by the same group of researchers suggested that social conditions, economic status and income inequality can have a direct effect on health, the researchers do not have data to specifically show why or how.

Living below the poverty line carries concerns about food, housing and healthcare, in addition to the stress of living in undesirable situations and no money. While the Affordable Care Act has extended healthcare access to more people, Zonderman said that may not be the only key to leveling out risk of death between those above and below the poverty line.

For the new study, published in the journal JAMA Internal Medicine, the researchers compared the poverty status of HANDLS participants -- of whom 59 percent are black, 55 percent are female and 59 percent live above poverty status.

Black men living below poverty level were found to have a 2.66 times higher risk of death than black men living above poverty status, compared to white men below poverty having about the same risk of death as those above poverty.


Both black and white women living below poverty status had an increased risk of death -- 1.77 times higher for black women and 1.85 times higher for white women -- than their counterparts living above the poverty line.

The most common causes of death among people in the study were cardiovascular disease, followed by cancer, with lung cancer as the most common form.

Zonderman said some of the health risks at play are well known, and that "those premorbidities or diseases accumulated at earlier ages, and are playing into this. Perhaps if we're treating them earlier, we could improve it but we don't have data on that at this point."

The next steps in the research, he said, are to work to connect known health risks and environment to death risk. The three-year lag for national death statistics -- those used for the new study came out in 2013 -- which NIA researchers use as a comparison to the HANDLS sample, means they cannot yet see whether Obamacare or other more recent events have affected how and when people die.

In addition to seeing the effects of greater access to healthcare, the researchers also plan to follow up on the cumulative effects of poverty on those who grew up in neighborhoods near or under the federal poverty line. They also plan to look at how interaction with neighbors and police affect the risk of death, including the health effects of discrimination, Zonderman said.


While data for those reviews does not exist yet, Zonderman said the results of the HANDLS-linked studies thus far are significant. But while he said the researchers were surprised there was such a big difference, the fact that nobody had looked at the relationship between race, gender and poverty means it should not have been that big a surprise.

"A lot of the studies that have been done compare poor African-Americans to richer white people, and they didn't dole out the whole comparison looking at black and white folks both above and below the poverty line," Zonderman said. "[Previous researchers] have only been able to adjust for the things that we have been able to compare directly."

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