Study finds white men living above poverty level have same risk as those below, while both black and white women face higher risk below

African American men who live in poverty have the greatest mortality risk, according to a study from the National Institute on Aging which examined race, gender and socioeconomic status.

The study, published on Monday in the Journal of the American Medical Association Internal Medicine, found that African American men living below 125% of the US federal poverty guidelines had a 2.66-times higher risk of mortality compared with African American men living above it. White men who lived below poverty level had approximately the same risk as white men above.

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Among women below the poverty level, there was a higher mortality risk for both African American and white women below compared with those above. The risk was similar for both races.

The researchers pointed to fear and marginalization of African American men in American society as a potential source of their increased vulnerability. They discussed other possible sources, such as “educational attainment”, income or “labor market participation”, but said these factors still leave a gap between white and African American men.

“This lifelong ostracism facilitates cascading negative outcomes in education, employment, and in interaction with the criminal justice system,” the researchers wrote. “The resultant poverty is a virulent health risk factor for [African American] men.”

Alan B Zonderman, one of the study’s authors, said that marginalization seemed to extend to the healthcare system, leading to distrust in medical institutions. While Zonderman cautioned that this was an interpretation without direct evidence, he said that subjects were asked how they were treated by medical institutions at the time of recruitment.

“We asked people: ‘How do you feel about going to the doctor? How do you feel about the way you’re treated?’” Zonderman said in a phone interview on Friday. “A number of participants reported to us both on the questionnaires we gave them and in sort of informal discussions that they were not treated very well.”

Zonderman said that there’s “plenty of evidence African American men are feared in our society”, citing comments made by Barack Obama on his own upbringing.

Last week, in an ABC town hall, Obama spoke of racism experienced during his youth, including getting pulled over by police. The South Carolina Republican Tim Scott discussed his own experiences with racism in a speech on the Senate floor last week. Scott, one of two black senators currently in office, spoke of being unjustly pulled over by police, accused of driving a stolen vehicle and having his status as a senator questioned because he is African American.

The study pulls its subjects from the Healthy Aging in Neighborhoods of Diversity Across the Life Span research, a continuing project in Baltimore, Maryland, for which Zonderman is also a researcher. The 3,720 participants from the HANDLS study were recruited in their communities from 2004 to 2009 based on race, gender, age group and poverty status. For this analysis, their data was then matched with the National Death Index.

That the subjects all come from the Baltimore brings to mind the death of Freddie Gray in the city last year. However, Zonderman said the researchers “don’t have the right kind of data to say whether this is a cause of the criminal justice system”.

The analysis looked at “all cause mortality”, not one specific cause of death. However, the researchers found the most prevalent causes were cardiovascular disease and cancer.

Though the study focuses on residents of Baltimore, comparisons showed the city was demographically similar to areas across the country, such as Oakland, California; Cleveland, Ohio; and Milwaukee, Wisconsin. “There’s no guarantee, of course, that what we found is going to generalize to other places, but presumably if the demographics are similar and the conditions are similar to those cities, I suspect that we would find very similar kinds of things,” said Zonderman.

In their paper, the researchers suggested revisions to the poverty thresholds that influence eligibility for federal programs should take this high mortality risk for poor African American men into account.

“It’s perhaps time to begin thinking about some kind of intervention,” Zonderman said. He warned that something needed to be done before the risk of earlier deaths for poor African American men “takes hold”.