Racial and Ethnic Variation in the Association of Social Integration with Mortality: Ten-year Prospective Population-based US Study

Substantial data link social relationships with mortality but few studies have examined whether these associations are consistent across racial and ethnic groups. The purpose of the present study was to evaluate the presence and form of the social relationship/ mortality association in a representative sample of US Black (n = 4,201), non-Hispanic White (n = 20,217) and Hispanic (n = 5,097) groups. In models adjusted for age, sex, chronic disease, socioeconomic status and smoking social integration was inversely related to ten-year survival in all groups. However, among Whites the association was linear and graded whereas among Blacks the association was linear but was statistically significant only for the highest level of social integration (hazard ratio [ HR] = 0.66, 95% confidence interval = 0.47-0.94). A threshold pattern was observed among Hispanics, in that lower mortality risk was found for all social integration categories above the lowest level (HRs from 0.58 to 0.52, P's < 0.01) and each of the higher social integration categories were in turn equivalent. Received social support was unrelated to mortality across all groups. Higher social integration is associated with a survival advantage for Blacks and Whites. For Hispanics, moderate and high levels of social integration were equally protective.