Ethnic disparities in mortality and group-specific risk factors in the UK Biobank

Kara Keun Lee; Emily T Norris; Lavanya Rishishwar; Andrew B Conley; Leonardo Mariño-Ramírez; John F McDonald; I King Jordan

doi:10.1371/journal.pgph.0001560

Ethnic disparities in mortality and group-specific risk factors in the UK Biobank

PLOS Glob Public Health. 2023 Feb 23;3(2):e0001560. doi: 10.1371/journal.pgph.0001560. eCollection 2023.

Authors

Kara Keun Lee^{1

2}, Emily T Norris³, Lavanya Rishishwar³, Andrew B Conley³, Leonardo Mariño-Ramírez⁴, John F McDonald^{1

2}, I King Jordan^{1

2

3}

Affiliations

¹ School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, United States of America.
² Integrated Cancer Research Center, School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, United States of America.
³ IHRC-Georgia Tech Applied Bioinformatics Laboratory, Atlanta, GA, United States of America.
⁴ National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, United States of America.

Abstract

Despite a substantial overall decrease in mortality, disparities among ethnic minorities in developed countries persist. This study investigated mortality disparities and their associated risk factors for the three largest ethnic groups in the United Kingdom: Asian, Black, and White. Study participants were sampled from the UK Biobank (UKB), a prospective cohort enrolled between 2006 and 2010. Genetics, biological samples, and health information and outcomes data of UKB participants were downloaded and data-fields were prioritized based on participants with death registry records. Kaplan-Meier method was used to evaluate survival differences among ethnic groups; survival random forest feature selection followed by Cox proportional-hazard modeling was used to identify and estimate the effects of shared and ethnic group-specific mortality risk factors. The White ethnic group showed significantly worse survival probability than the Asian and Black groups. In all three ethnic groups, endoscopy and colonoscopy procedures showed significant protective effects on overall mortality. Asian and Black women show lower relative risk of mortality than men, whereas no significant effect of sex was seen for the White group. The strongest ethnic group-specific mortality associations were ischemic heart disease for Asians, COVID-19 for Blacks, and cancers of respiratory/intrathoracic organs for Whites. Mental health-related diagnoses, including substance abuse, anxiety, and depression, were a major risk factor for overall mortality in the Asian group. The effect of mental health on Asian mortality, particularly for digestive cancers, was exacerbated by an observed hesitance to answer mental health questions, possibly related to cultural stigma. C-reactive protein (CRP) serum levels were associated with both overall and cause-specific mortality due to COVID-19 and digestive cancers in the Black group, where elevated CRP has previously been linked to psychosocial stress due to discrimination. Our results point to mortality risk factors that are group-specific and modifiable, supporting targeted interventions towards greater health equity.

Copyright: This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.

Grants and funding

The work was supported by the National Institutes of Health (NIH) Distinguished Scholars Program (DSP) (1ZIAMD000016 and 1ZIAMD000018 to LMR and the Division of Intramural Research (DIR) of the National Institute on Minority Health and Health Disparities (NIMHD) at NIH), the IHRC-Georgia Tech Applied Bioinformatics Laboratory (RF383 to KKL, ETN, LR, ABC, and IKJ), and the Ovarian Cancer Institute (Atlanta), Deborah Nash Endowment, and Northside Hospital Research Foundation to JFM. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.