Abstract
BACKGROUND: Racial and ethnic health disparities are persistent in the United States. The accumulation of chronic conditions and mortality are important contributors to these observed inequities. METHODS: We assessed the contribution of coexisting conditions to mortality among Hispanic, non-Hispanic White, and non-Hispanic Black older adults born in the United States. We used nationally-representative data from the Health and Retirement Study (HRS) from 1998-2020 (n = 10,430). Estimates for the absolute additive contributions of nine chronic conditions using a longitudinal extension of the average attributable fraction (LE-AAF) were derived from survey-weighted multivariable discrete survival models adjusted for sociodemographic and health characteristics. RESULTS: Death occurred in 42.2 % (95 % confidence interval [CI]=37.4, 47.0) of Hispanic, 42.7 % (95 % CI=41.7, 44.2) of White, and 46.4 % (95 % CI=42.7, 50.1) of Black respondents. The eight conditions increasing the risk of death contributed 73.9 % (95 % CI=50.7, 100.0) of mortality events among Hispanic respondents, 66.2 % (95 % CI=48.9, 81.5) among Black respondents, and 57.7 % (95 % CI=52.1, 62.5) among White respondents. Dementia had the strongest association with mortality with an adjusted odds ratio of 3.23 for Hispanic (95 % CI=1.90, 5.49), 3.14 for White (95 % CI=2.61, 3.78), and 2.11 for Black (95 % CI=1.63, 2.73) respondents. The development and progression of cancer malignancies contributed most to mortality for White adults. In contrast, hypertension, contributed most to mortality for Hispanic and Black adults. CONCLUSIONS: Hispanic, Black, and White Americans differed in the prevalence and incidence of chronic conditions, as well as their association with mortality. Together, these conditions resulted in contributions to mortality that varied substantially.