Explaining racial/ethnic differences in all-cause mortality in the Multi-Ethnic Study of Atherosclerosis (MESA): Substantive complexity and hazardous working conditions as mediating factors

Kaori Fujishiro, Anjum Hajat, Paul A. Landsbergis, John D. Meyer, Pamela J. Schreiner, Joel D. Kaufman

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

Research on racial/ethnic health disparities and socioeconomic position has not fully considered occupation. However, because occupations are racially patterned, certain occupational characteristics may explain racial/ethnic difference in health. This study examines the role of occupational characteristics in racial/ethnic disparities in all-cause mortality. Data are from a U.S. community-based cohort study (n=6342, median follow-up: 12.2 years), in which 893 deaths (14.1%) occurred. We estimated mortality hazard ratios (HRs) for African Americans, Hispanics, and Chinese Americans compared with whites. We also estimated the proportion of the HR mediated by each of two occupational characteristics, substantive complexity of work (e.g., problem solving, inductive/deductive reasoning on the job) and hazardous conditions (e.g., noise, extreme temperature, chemicals), derived from the Occupational Information Network database (O*NET). Analyses were adjusted for age, sex, nativity, working status at baseline, and study sites. African Americans had a higher rate of all-cause death (HR 1.41; 95% confidence interval [CI]: 1.19–1.66) than whites. Chinese-American ethnicity was protective (HR 0.59, CI: 0.40–0.85); Hispanic ethnicity was not significantly different from whites (HR 0.88; CI: 0.67–1.17). Substantive complexity of work mediated 30% of the higher rate of death for African Americans compared with whites. For other groups, mediation was not significant. Hazardous conditions did not significantly mediate mortality in any racial/ethnic group. Lower levels of substantive complexity of work mediate a substantial part of the health disadvantage in African Americans. This job characteristic may be an important factor in explaining racial health disparities.

Original languageEnglish (US)
Pages (from-to)497-505
Number of pages9
JournalSSM - Population Health
Volume3
DOIs
StatePublished - Dec 2017

Bibliographical note

Funding Information:
This research was supported by contracts HHSN268201500003I, N01-HC-95159, N01-HC-95160, N01-HC-95161, N01-HC-95162, N01-HC-95163, N01-HC-95164, N01-HC-95165, N01-HC-95166, N01-HC-95167, N01-HC-95168 and N01-HC-95169 from the National Heart, Lung, and Blood Institute (NHLBI) and by Grants UL1-TR-000040 and UL1-TR-001079 from the National Center for Research Resources (NCRR). The authors thank the other investigators, the staff, and the participants of the MESA study for their valuable contributions. A full list of participating MESA investigators and institutions can be found at http://www.mesa-nhlbi.org. The information contained herein was derived in part from data provided by the Bureau of Vital Statistics, New York City Department of Health and Mental Hygiene. Occupational coding was funded by the National Institute for Occupational Safety and Health Intramural Funds (NORA FY08 CRN SLB8). This publication was developed under a STAR research assistance agreement, No. RD831697 (MESA Air), awarded by the U.S Environmental Protection Agency. AH was also supported by K99ES023498 from the National Institute of Environmental Health Sciences.

Publisher Copyright:
© 2017

Copyright:
Copyright 2017 Elsevier B.V., All rights reserved.

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