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First published September-October 2001

Black-White Inequalities in Mortality and Life Expectancy, 1933–1999: Implications for Healthy People 2010

Robert S. Levine, MD [email protected], James E. Foster, PhD, Robert E. Fullilove, EdD, Mindy T. Fullilove, MD, Nathaniel C. Briggs, MD, MSc, Pamela C. Hull, MA, Baqar A. Husaini, PhD, and Charles H. Hennekens, MD, DrPHView all authors and affiliations
Volume 116, Issue 5
https://doi.org/10.1093/phr/116.5.474

Abstract

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.

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Information

Published In

Volume 116, Issue 5
Pages: 474 - 483
Article first published: September-October 2001
Issue published: September-October 2001

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© 2001 US Surgeon General's Office.
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PubMed: 12042611

Authors

Affiliations

Robert S. Levine, MD
Department of Family and Community Medicine, Meharry Medical College, Nashville, TN
[email protected]
View all articles by this author
James E. Foster, PhD
School of Graduate Studies, Vanderbilt University, and Vanderbilt Institute for Public Policy Studies, Nashville, TN
View all articles by this author
Robert E. Fullilove, EdD
Division of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY
View all articles by this author
Mindy T. Fullilove, MD
Division of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY
New York State Psychiatric Institute, New York, NY
View all articles by this author
Nathaniel C. Briggs, MD, MSc
Department of Family and Community Medicine, Meharry Medical College, Nashville, TN
View all articles by this author
Pamela C. Hull, MA
Center for Health Research, Tennessee State University, Nashville, TN
Department of Sociology, Vanderbilt University, Nashville, TN
View all articles by this author
Baqar A. Husaini, PhD
Center for Health Research, Tennessee State University, Nashville, TN
View all articles by this author
Charles H. Hennekens, MD, DrPH
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
View all articles by this author

Notes

Address correspondence to Robert S. Levine, MD, Dept. of Family and Community Medicine, Meharry Medical College, 1005 D.B. Todd Jr. Blvd., Nashville, TN 37208; tel. 615-327-6782; fax 615-327-6131; e-mail <[email protected]>

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