Introduction
African Americans and low-income whites have higher mortality than the U.S. general
population. This study prospectively investigated the combined influence of major
lifestyle factors and poverty on mortality in this vulnerable population.
Methods
Data were collected in 2002–2009 from 79,101 Southern Community Cohort Study participants,
of which 67% were African American and 55% had household incomes <$15,000. Mortality
outcomes were identified from the National Death Index though December 31, 2011 (data
analyzed in 2014–2015). Healthy behavior scores were created based on tobacco smoking,
alcohol intake, diet, physical activity, and sedentary time. The primary analysis
was performed based on the score created by counting each participant as having met/not
met public health guidelines for each behavior.
Results
Healthy behavior scores were associated with reduced cancer, cardiovascular disease,
and all-cause mortality. Associations were stronger for whites than African Americans:
hazard ratios for all-cause mortality comparing participants meeting four or five
guidelines versus participants meeting zero were 0.41 (95% CI=0.30, 0.55) for African
American men; 0.36 (95% CI=0.24, 0.55) for white men; 0.46 (95% CI=0.36, 0.59) for
African American women; and 0.27 (95% CI=0.18, 0.43) for white women. The association
between healthy lifestyle and all-cause mortality was weaker among those with incomes
<$15,000 than those with higher income, particularly in men (p<0.05 for interaction).
Conclusions
This study demonstrates the importance of health behaviors on mortality among all
groups, but highlights the need for additional research to identify factors contributing
to high risk of mortality among low-income and African American populations.
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Article info
Publication history
Published online: May 11, 2016
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© 2016 Published by Elsevier Inc. All rights reserved.
