Trends in the Life Expectancy Gap between Blacks and Whites in the United States, 1983-2003
JAMA, Vol. 297, p. 1224, 2007
26 Pages Posted: 27 Oct 2008
Abstract
Since the early 1980s the black-white gap in life expectancy at birth increased sharply and subsequently declined, but the causes of these changes have not been investigated. The objective of this study was to determine the contribution of specific age groups and causes of death contributing to the changes in the black-white life expectancy gap from 1983-2003. The main outcome measure was the gap in life expectancy at birth between blacks and whites.
The data were drawn from United States vital statistics. We used standard life table techniques to decompose the change in the black-white life expectancy gap by combining absolute changes in age-specific mortality with relative changes in the distribution of causes of death.
Among females the black-white life expectancy gap increased 0.5 years from 1983-1993, primarily due to increased mortality from HIV (0.4 years) and slower declines in heart diseases (0.1 years), which were somewhat offset by relative improvements in stroke (-0.1 years). The gap among males increased by 2 years from 1983-1993, principally because of adverse changes in HIV (1.1 years), homicide (0.5 years) and heart diseases (0.3 years). From 1993 to 2003 the female gap decreased by 1 year, from 5.59 to 4.54. Half of the total narrowing of the gap among females was due to relative mortality improvement among blacks in heart diseases (-0.2 years), homicide (-0.2 years), and unintentional injuries (-0.1 year). The decline in the life expectancy gap was larger among males, declining by 25% from 8.44 to 6.33 years. Nearly all the 2.1-year decline among males was due to relative mortality improvement among blacks at ages 15-49 (-2.0 years). Three causes of death accounted for 71% of the narrowing of the gap among males: homicide (-0.6 years), HIV (-0.6 years), and unintentional injuries (-0.3 years), while lack of improvement in heart diseases at older ages kept the gap from narrowing further.
After widening during the late 1980s, the black-white life expectancy gap has declined because of mortality improvements in homicide, HIV, unintentional injuries, and, among females, heart diseases. Further narrowing of the gap will require concerted efforts in public health and health care to address the major causes of the remaining gap: cardiovascular diseases, homicide, HIV, and infant mortality.
Keywords: epidemiology, health disparities, homicide, accidents, race
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