Pre-pandemic trends and Black:White inequities in life expectancy across the 30 most populous U.S. cities: a population-based study
Ontology highlight
ABSTRACT:
SUBMITTER: Silva A
PROVIDER: S-EPMC10664538 | biostudies-literature | 2023 Jan
REPOSITORIES: biostudies-literature
Similar Datasets
Project description:ObjectivesTo examine city-level kidney disease mortality rates and Black:White racial inequities for the USA and its largest cities, and to determine if these measures changed over the past decade.MethodsWe used National Vital Statistics System mortality data and American Community Survey population estimates to calculate age-standardized kidney disease mortality rates for the non-Hispanic Black (Black), non-Hispanic White (White), and total populations for the USA and the 30 most populous US cities. We examined two time points, 2008-2013 (T1) and 2014-2018 (T2), and assessed changes in rates and inequities over time. Racial inequities were measured with Black:White mortality rate ratios and rate differences.ResultsKidney disease mortality rates varied from 2.5 (per 100,000) in San Diego to 24.6 in Houston at T2. The Black kidney disease mortality rate was higher than the White rate in the USA and all cities studied at both time points. In T2, the Black mortality rate ranged from 7.9 in New York to 45.4 in Charlotte, while the White mortality rate ranged from 2.0 in San Diego to 18.6 in Indianapolis. At T2, the Black:White rate ratio ranged from 1.79 (95% CI 1.62-1.99) in Philadelphia to 5.25 (95% CI 3.40-8.10) in Washington, DC, compared to the US rate ratio of 2.28 (95% CI 2.25-2.30). Between T1 and T2, only one city (Nashville) saw a significant decrease in the Black:White mortality gap.ConclusionsThe largest US cities experience widely varying kidney disease mortality rates and widespread racial inequities. These local data on racial inequities in kidney disease mortality can be used by city leaders and health stakeholders to increase awareness, guide the allocation of limited resources, monitor trends over time, and support targeted population health strategies.
| S-EPMC9086025 | biostudies-literature
Project description:ImportanceTo address elevated mortality rates and historically entrenched racial inequities in mortality rates, the United States needs targeted efforts at all levels of government. However, few or no all-cause mortality data are available at the local level to motivate and guide city-level actions for health equity within the country's biggest cities.ObjectivesTo provide city-level data on all-cause mortality rates and racial inequities within cities and to determine whether these measures changed during the past decade.Design, setting, and participantsThis cross-sectional study used mortality data from the National Vital Statistics System and American Community Survey population estimates to calculate city-level mortality rates for the non-Hispanic Black (Black) population, non-Hispanic White (White) population, and total population from January 2016 to December 2018. Changes from January 2009 to December 2018 were examined with joinpoint regression. Data were analyzed for the United States and the 30 most populous US cities. Data analysis was conducted from February to November 2020.ExposureCity of residence.Main outcomes and measuresTotal population and race-specific age-standardized mortality rates using 3-year averages, mortality rate ratios between Black and White populations, excess Black deaths, and annual average percentage change in mortality rates and rate ratios.ResultsThe study included 26 295 827 death records. In 2016 to 2018, all-cause mortality rates ranged from 537 per 100 000 population in San Francisco to 1342 per 100 000 in Las Vegas compared with the overall US rate of 759 per 100 000. The all-cause mortality rate among Black populations was 24% higher than among White populations nationally (rate ratio, 1.236; 95% CI, 1.233 to 1.238), resulting in 74 402 excess Black deaths annually. At the city level, this ranged from 6 excess Black deaths in El Paso to 3804 excess Black deaths every year in Chicago. The US rate remained constant during the study period (average annual percentage change, -0.10%; 95% CI, -0.34% to 0.14%; P = .42). The racial inequities in rates for the US decreased between 2008 and 2019 (annual average percentage change, -0.51%; 95% CI, -0.92% to -0.09%; P =0.02). Only 14 of 30 cities (46.7%) experienced improvements in overall mortality rates during the past decade. Racial inequities increased in more cities (6 [20.0%]) than in which it decreased (2 [6.7%]).Conclusions and relevanceIn this study, mortality rates and inequities between Black and White populations varied substantially among the largest US cities. City leaders and other health advocates can use these types of local data on the burden of death and health inequities in their jurisdictions to increase awareness and advocacy related to racial health inequities, to guide the allocation of local resources, to monitor trends over time, and to highlight effective population health strategies.
| S-EPMC9386890 | biostudies-literature
Project description:The United States has poor birth outcomes, including high rates of infant mortality and substantial racial inequities, compared to other developed nations. However, both overall mortality rates and racial inequities in rates vary across locations, emphasizing the structural forces that shape population health. We used mortality and natality data from the National Vital Statistics System to assess racial inequities in infant mortality rates within the most populous US cities for 2018-2021. Specifically, we: (1) calculate overall and race-specific infant mortality rates for 69 cities and racial inequities in infant mortality for 48 cities; and, (2) analyze associations between these inequities and city-level measures of structural racism. City-level infant mortality rates ranged from 1.96 deaths per 1,000 births in Irvine, CA to 13.92 in Detroit, MI. The non-Hispanic Black infant mortality rate was 2.5 times higher than the non-Hispanic white rate in the US and the Black:white rate ratio was statistically significant in all study cities, ranging from 1.8 (Omaha, NE) to 5.0 (Cincinnati, OH). The Black:white rate ratio was greater than 4.0 in 10 cities. Overall and race-specific infant mortality rates were associated with measures of education, economic status, incarceration, segregation, and diversity. Racial inequities in infant mortality were associated with measures of economic status. Understanding infant mortality inequities at the city level is critical to support the efforts of urban health advocates. Moreover, examining the persistent associations of structural racism with infant mortality will help guide necessary programmatic or policy decisions to reduce infant mortality in US cities.
| S-EPMC11897040 | biostudies-literature
Project description:BackgroundLife expectancy (LE) differences within and between states by race/ethnicity have not been examined.ObjectiveTo estimate LE for selected race/ethnicity groups in states from 1990 to 2019.DesignCross-sectional time-series analysis.SettingUnited States.ParticipantsDeidentified death records and Census data were used to construct regression models with smoothed time series of mortality from 1990 to 2019.MeasurementsLE at birth, by sex and year, for subgroups of people reporting Hispanic, non-Hispanic Black, or non-Hispanic White race/ethnicity.ResultsDisparities in LE across states were 8.0 years for females and 12.2 years for males in 1990 and 7.9 years for females and 7.8 years for males in 2019. When race/ethnicity groups were accounted for, disparities across states were 20.7 years for females and 24.5 years for males in 1990, decreasing to 18.5 years for females and 23.7 years for males in 2019. Disparities across states increased within each race/ethnicity group between 1990 and 2019, with the largest increase for non-Hispanic White males and the smallest for Hispanic females. The disparity between race/ethnicity groups within states decreased for most of the 23 states with estimates for all 3 groups but increased for females in 7 states and males in 5 states.LimitationBecause of small sample size, LE was not estimated for 37 of 153 state-race/ethnicity groups.ConclusionDisparity in LE across states was greater when race/ethnicity groups were considered. Disparities across all state-race/ethnicity groups in general have decreased over the past 3 decades. Within each race/ethnicity group, disparities across states have increased. Although racial/ethnic disparities decreased in most of the 23 states for which LE was estimated for all 3 groups, they increased for females in 7 states and males in 5 states.Primary funding sourceNational Heart, Lung, and Blood Institute.
| S-EPMC10519623 | biostudies-literature
Project description:Testing for SARS-CoV-2 infection has been a key strategy to mitigate and control the COVID-19 pandemic. Wide spatial and racial/ethnic disparities in COVID-19 outcomes have emerged in US cities. Previous research has highlighted the role of unequal access to testing as a potential driver of these disparities. We described inequities in spatial accessibility to COVID-19 testing locations in 30 large US cities. We used location data from Castlight Health Inc corresponding to October 2021. We created an accessibility metric at the level of the census block group (CBG) based on the number of sites per population in a 15-minute walkshed around the centroid of each CBG. We also calculated spatial accessibility using only testing sites without restrictions, i.e., no requirement for an appointment or a physician order prior to testing. We measured the association between the social vulnerability index (SVI) and spatial accessibility using a multilevel negative binomial model with random city intercepts and random SVI slopes. Among the 27,195 CBG analyzed, 53% had at least one testing site within a 15-minute walkshed, and 36% had at least one site without restrictions. On average, a 1-decile increase in the SVI was associated with a 3% (95% Confidence Interval: 2% - 4%) lower accessibility. Spatial inequities were similar across various components of the SVI and for sites with no restrictions. Despite this general pattern, several cities had inverted inequity, i.e., better accessibility in more vulnerable areas, which indicates that some cities may be on the right track when it comes to promoting equity in COVID-19 testing. Testing is a key component of the strategy to mitigate transmission of SARS-CoV-2 and efforts should be made to improve accessibility to testing, particularly as new and more contagious variants become dominant.
| S-EPMC9420026 | biostudies-literature
Project description:BackgroundAlthough the black-white gap in life expectancy has narrowed in the U.S., there is considerable variability across states. In Wisconsin, the black-white gap exceeds 6 years, well above the national average. Reducing this disparity is an urgent public health priority, but there is limited understanding of what contributes to Wisconsin's racial gap in longevity. Our investigation identifies causes of death that contribute most to Wisconsin's black-white gap in life expectancy among males and females, and highlights specific ages where each cause of death contributes most to the gap.MethodsOur study employs 1999-2016 restricted-use mortality data provided by the National Center for Health Statistics. After generating race- and sex-specific life tables for each 3-year period of observation (e.g., 1999-2001), we trace recent trends in the black-white life expectancy gap in Wisconsin. We subsequently conduct a series of analyses to decompose the black-white gap in three time periods into 13 separate causes and 19 different age groups.ResultsIn 2014-16, Wisconsin's black-white gap in life expectancy was 7.34 years for males (67% larger than the national gap), and 5.61 years for females (115% larger than the national gap). Among males, homicide was the single largest contributor, accounting for 1.56 years of the total gap. Heart disease and cancer followed, contributing 1.43 and 1.42 years, respectively. Among females, heart disease and cancer were the two leading contributors to the gap, accounting for 1.12 and 1.00 years, respectively. Whereas homicide contributed most to the racial gap in male longevity during late adolescence and early adulthood, heart disease and cancer exerted most of their influence between ages 50-70 for both males and females. Other notable contributors were unintentional injuries (males), diabetes and cerebrovascular disease (females), and perinatal conditions (males and females).ConclusionsOur study identifies targets for future policy interventions that could substantially reduce Wisconsin's racial gap in life expectancy. Concerted efforts to eliminate racial disparities in perinatal mortality and homicide early in the life course, and chronic conditions such as cancer and heart disease in later life, promise to help Wisconsin achieve the public health objective of racial parity in longevity.
| S-EPMC6612087 | biostudies-literature
Project description:Child protective services (CPS) contact occurs at substantially higher rates among Black than White families. The present study considers systemic racism as a central driver of this disparity and emphasizes racialized poverty as a possible mechanism. We used data from the Fragile Families and Child Wellbeing Study and logistic regression analyses to assess the associations between income poverty, a racialized experience, and CPS contact, separately among Black and White families. Results indicated that income poverty was a significant predictor of CPS contact among White families, who were protected by higher income. In contrast, income per se was not a significant predictor of CPS contact among Black families, who were instead impacted by racialized family regulation and consequences of poverty, such as poor health and depression. Refundable state Earned Income Tax Credit (EITC) policies were protective for Black families, and more expansive Temporary Assistance for Needy Families (TANF) programs decreased CPS contact for Black and White families. Implications include centering systemic racism and specifically racialized poverty as causes of racial inequities in CPS contact and rethinking the role of CPS in protecting children.
| S-EPMC9325927 | biostudies-literature
Project description:Although the black-white gap in life expectancy has been shrinking in the U.S., national improvement conceals ongoing disparities. Nowhere is this more evident than Washington D.C., where the black-white gap has persistently exceeded 10 years. Using 1999-2017 mortality data from the National Center for Health Statistics, we employed demographic techniques to pursue three aims: first, we created period life tables to examine longevity trends in Washington D.C.; second, we decomposed black-white life expectancy differences into 23 causes of death in three time periods (2000, 2008, 2016); third, we assessed age-specific contributions for each cause of death. Findings revealed that heart disease (4.14 years), homicide (2.43 years), and cancer (2.30 years) contributed most to the 17.23-year gap among males in 2016. Heart disease and cancer contributed most at ages 55-69; homicide contributed most at ages 20-29. Among females in 2016, heart disease (3.24 years), cancer (2.36 years), and unintentional injuries (0.85 years) contributed most to the 12.06-year gap. Heart disease and cancer contributed most at ages 55-69, and unintentional injuries at ages 50-59. Our investigation provides detailed evidence about contributors to the black-white longevity gap in Washington D.C., which can aid in the development of targeted public health interventions.
| S-EPMC7453009 | biostudies-literature
Project description:Objectives of studyTo test recent claims that cancer inequities are bound to increase as population health improves.MethodsWe analyzed 1960-2006 age-standardized US county cancer mortality data, total and site-specific (lung, prostate, colorectal, breast, cervix, stomach), stratified by county income quintile for the US total, black, and white populations.ResultsBetween 1960 and 2006, US socioeconomic inequities in cancer mortality variously shrunk, widened, reversed, and stagnated, depending on time period and cancer site. For all cancers combined and most, but not all, sites, absolute, but not relative, socioeconomic gaps were greater for the black compared to white population. Compared to the yearly age-specific mortality rates among whites in the most affluent counties, the percent of excess cancer deaths among whites in the lower four county income quintiles first rose above 0 in 1990 and in 2006 equaled 5.4% (95% CI 4.8, 6.0); among blacks, it rose from 6.0% (95% CI 4.5, 7.4) in 1960 to 24.7% (95% CI 23.9, 25.5) in 1990 and remained at this level through 2006.ConclusionsThe hypothesis that cancer mortality inequities are bound to increase is refuted by long-term data on total and site-specific cancer mortality stratified by socioeconomic position and race/ethnicity.
| S-EPMC3262111 | biostudies-literature
Project description:BackgroundI examined age patterns and the role of shifting educational distributions in driving trends in educational gradients in life expectancy among non-Hispanic Whites between 1991 and 2005.MethodsData were from the 1986-2004 National Health Interview Survey with mortality follow-up through 2006. Life expectancies were computed by sex, period and education. Age decompositions of life expectancy gradients and composition-adjusted life expectancies were computed to account for age patterns and shifting educational distributions.ResultsLife expectancy at age 25 among White men increased for all education groups, decreased among the least-educated White women and increased among White women with college degrees. Much of the decline in measured life expectancy for White women with less than a high school education comes from the 85+ age group. Educational gradients in life expectancy widened for White men and women. One-third of the gradient is due to ages below 50. Approximately 26% (0.7 years) and 87% (0.8 years) of the widening of the gradient in life expectancy between ages 25 and 85 for White women and men is attributable to shifting education distributions. Over half of the decline in temporary life expectancy among the least-educated White women is due to compositional change.ConclusionsLife expectancy has increased among White men for all education groups and has decreased among White women with less than a high school education, though not to the extent reported in previous studies. The fact that a large proportion of the change in education-specific life expectancy among women is due to the 85+ age group suggests changes in institutionalization may be affecting estimates. Much of the change in education-specific life expectancy and the growth in the educational gradient in life expectancy is due to the shifting distribution of individuals across education categories.
| S-EPMC4607744 | biostudies-literature