Black-White Inequalities in Mortality and Life Expectancy, 1933–1999

Implications for Healthy People 2010

Bibliographic Data

ID23344447
AuthorsRobert S Levine (0000-0001-6476-0701, Meharry Medical College, corresponding author), James E Foster (Vanderbilt University), Robert E Fullilove (Columbia University), Mindy Thomson Fullilove (0000-0002-0790-6951, New York Psychoanalytic Society and Institute), Nathaniel C Briggs (Meharry Medical College), Pamela C Hull (0000-0003-4412-9087, Tennessee State University), Baqar A Husaini (0000-0001-5386-3916, Tennessee State University), Charles H Hennekens (0000-0003-1214-1663, Department of Medicine and Department of Epidemiology and Public Health, University of Miami School of Medicine, and Miami Heart Institute, Mount Sinai Medical Center, Miami, FL)
Year2001
Volume116
Issue5
Pages474-483
Publication date2001-09-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenuePublic Health Reports (JOURNAL)
Journal identifiersISSN: 0033-3549 • E-ISSN: 1468-2877
PublisherSAGE Publications (PUBLISHER • US)
DOI10.1093/phr/116.5.474
PMID12042611
OpenAlexW2038502007
LanguageEN
Citations received80
References cited21

OBJECTIVES: Optimistic predictions for the Healthy People 2010 goals of eliminating racial/ethnic disparities in health have been made based on absolute improvements in life expectancy and mortality. This study sought to determine whether there is evidence of relative improvement (a more valid measure of inequality) in life expectancy and mortality, and whether such improvement, if demonstrated, predicts future success in eliminating disparities. METHODS: Historical data from the National Center for Health Statistics and the Census Bureau were used to predict future trends in relative mortality and life expectancy, employing an Autoregressive Integrated Moving Average (ARIMA) model. Excess mortality and time lags in mortality and life expectancy for blacks relative to whites were also estimated. RESULTS: Based on data for 1945 to 1999, forecasts for relative black:white age-adjusted, all-cause mortality and white:black life expectancy at birth showed trends toward increasing disparities. From 1979, when the Healthy People initiative began, to 1998, the black:white ratio of age-adjusted, gender-specific mortality increased for all but one of nine causes of death that accounted for 83.4% of all US mortality in 1998. From 1980 to 1998, average numbers of excess deaths per day among American blacks relative to whites increased by 20%. American blacks experienced 4.3 to 4.5 million premature deaths relative to whites in 1940-1999. CONCLUSIONS: The rationale that underlies the optimistic Healthy People 2010 forecasts, that future success can be built on a foundation of past success, is not supported when relative measures of inequality are used. There has been no sustained decrease in black-white inequalities in age-adjusted mortality or life expectancy at birth at the national level since 1945. Without fundamental changes, most probably related to the ways medical and public health practitioners are trained, evaluated, and compensated for prevention-related activities, as well as further research on translating the findings of prevention studies into clinical practice, it is likely that simply reducing disparities in access to care and/or medical treatment will be insufficient. Millions of premature deaths will continue to occur among African Americans.

Biology · Environmental health · Inequality · Life expectancy · Population · Sociology · White (mutation) · Cultural Competency in Health Care · Demography · Health disparities and outcomes · Mathematics · Medicine · Racial and Ethnic Identity Research · Gerontology