Poverty Doubles Mortality Risk for Middle-Aged Black Men

Janis C. Kelly

July 21, 2016

Living below 125% of the US federal poverty level was associated with significantly increased risk for death for black men, black women, and white women, but not for white men, according to data from a study of healthy aging published online July 18 in JAMA Internal Medicine.

Alan B. Zonderman, PhD, and colleagues from the Laboratory of Epidemiology and Population Sciences, Intramural Research Program, National Institute on Aging, Baltimore, Maryland, used data from the Healthy Aging in Neighborhoods of Diversity Across the Life Span (HANDLS) study and the National Death Index. They examined sex, race, and socioeconomic factors in overall mortality in 3720 community-dwelling black and white adults aged 30 to 64 years recruited from 13 neighborhoods in Baltimore City. The fixed cohort included 998 African American (AA) men, 1200 AA women, 687 white men, and 835 white women.

Socioeconomic data showed that 46% of the black men, 49% of the black women, 29% of the white men, and 35% of the white women were in poverty status, defined as less than 125% of the US federal poverty guidelines. For 2016, these were income levels of $11,880 for individuals, $16,020 for a family of two, $20,160 for a family of three, $24,300 for a family of four, $28,440 for a family of five, $32,580 for a family of six, $36,730 for a family of seven, and $40,890 for a family of eight, not including most government benefits.

The authors write, "We found a significant 3-way interaction among sex, race, and poverty status such that AA men below poverty status had the lowest overall survival."

Specifically, risk for mortality was 2.66 (95% confidence interval [CI], 1.8 - 3.89) times higher for AA men below poverty status than for AA men living above poverty status, but about the same (hazard ratio [HR], 0.97; 95% CI, 0.53 - 1.75) for white men below or above poverty status. For women living below poverty status, mortality risk was nearly double that for living above poverty status (HR, 1.77 for AA women [95% CI, 1.15 - 2.73] and HR, 1.85 [95% CI, 1.11 - 3.10] for white women), but was not significantly linked to race.

The top causes of death in all groups were cardiovascular disease (30%) and cancer (23%; most commonly, lung cancer, which caused 32 of the 76 cancer deaths).

The authors conclude, "Our findings at 125% of the poverty line suggest that revision of poverty thresholds triggering eligibility for federal programs that influence quality of life, health, and equal opportunity should take into account premature mortality driven by poverty as a first step to address the vulnerability of poor AA men."

The study was supported by the Intramural Research Program of the National Institute on Aging and the National Institute on Minority Health and Health Disparities. The authors have disclosed no relevant financial relationships.

JAMA Intern Med. Published online July 18, 2016. Abstract

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