Post on 07-Nov-2021
Cause of Death Contributions to Black/White differences in mortality 1985-2013ANDREW FENELONN AT I O N A L C E N T E R F O R H E A LT H S TAT I S T I C S
The findings and conclusions in this presentation are those of the author(s) and do not necessarily represent the official position of the National Center for Health Statistics, Centers for Disease Control and Prevention
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and PreventionNational Center for Health Statistics
The Heckler Report•Report of the Secretary’s Task Force on Black and Minority Health (1985)
•Secretary of Health and Human Services Margaret Heckler
•Developing effective policy requires an accurate description of the problem
•Demonstrating large differences in mortality between black and white populations in the United States
Racial/Ethnic Differences in Health•There are large and persistent differences in health and survival across racial and ethnic populations in the United States
Life Expectancy at Birth
Racial/Ethnic Differences in Health•There are large and persistent differences in health and survival across racial and ethnic populations in the United States
Racial/Ethnic Differences in Health•There are large and persistent differences in health and survival across racial and ethnic populations in the United States
•Explanations• Differences in socioeconomic position – two sided
• Segregation and neighborhood effects
• Discrimination
• Unequal access to health care
• Intersectionality
An Update is Needed•How far have we come in terms of reducing disparities in mortality between black and white populations in the United States?
•Which causes of death contribute to the black/white gap in mortality?
•Which causes of death contribute to changes in the black/white gap in mortality over time?
Data•US Vital Statistics Data 1985-2013
•Multiple Cause-of-Death public-use microdata files
•Age-standardized death rates by cause of death 1985-2013• Rankable causes of death ICD9 and ICD10
Analysis•Contribution of causes of death to black/white mortality gap
•Contribution of causes of death to change in black/white mortality gap
Trends – Men
0
100
200
300
400
500
600
0
200
400
600
800
1000
1200
1400
1600
1800
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
GapAge-AdjustedDeath Rate
Black White Gap
Source: Multiple Cause of Death Files, NCHS. Estimates may differ slightly from NCHS published results due to correction of mortality for 85+ age group.
Trends – Women
0
50
100
150
200
250
300
0
200
400
600
800
1000
1200
1400
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
GapAge-AdjustedDeath Rate
Black White Gap
Source: Multiple Cause of Death Files, NCHS. Estimates may differ slightly from NCHS published results due to correction of mortality for 85+ age group.
Cause of Death Contributions – Men
-20%
0%
20%
40%
60%
80%
100%
120%
1985 1995 2005 2013
Percent of black/whitemortality gap
Residual
Perinatal Conditions
Septicemia
Hypertension
HIV
Nephritis
Stroke
Diabetes
Homicide
Cancer
Heart Disease
Cause of Death Contributions – Women
-40%
-20%
0%
20%
40%
60%
80%
100%
120%
140%
1985 1995 2005 2013
Percentof black/whitemortality gap
Residual
Homicide
Perinatal Conditions
HIV
Septicemia
Hypertension
Stroke
Nephritis
Cancer
Diabetes
Heart Disease
Trends – Men
0
100
200
300
400
500
600
0
200
400
600
800
1000
1200
1400
1600
1800
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
GapAge-AdjustedDeath Rate
Black White Gap
Trends – Men
0
100
200
300
400
500
600
0
200
400
600
800
1000
1200
1400
1600
1800
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
GapAge-AdjustedDeath Rate
Black White Gap
Trends – Women
0
50
100
150
200
250
300
0
200
400
600
800
1000
1200
1400
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
GapAge-AdjustedDeath Rate
Black White Gap
Trends – Women
0
50
100
150
200
250
300
0
200
400
600
800
1000
1200
1400
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
GapAge-AdjustedDeath Rate
Black White Gap
Contributions to Narrowing Black/White Gap1995 - 2013
0
50
100
150
200
250
300
Change inblack/whitemortality gap
1995-2013
Residual
Chronic LiverDisease and Cirrhosis
Stroke
Homicide
UnintentionalInjuries
Heart Disease
HIV
Cancer
0
50
100
150
200
250
300
Chronic Lower Respiratory DiseaseWomenMen
Summary of Findings•The black/white gap in mortality is large and persistent, but has narrowed since 1995
•The largest contributors to this gap among men are heart disease, cancer, and homicide (60%)
•The largest contributors among women are heart disease, diabetes, and cancer (80%)
•Between 1995 and 2013, cancer, HIV, and heart disease were responsible for 57% of the reduction in the black/white gap among men
•They were responsible for 45% of the reduction in the gap among women
The legacy of the Heckler Report•Highlighting the importance of quality data in research on race/ethnic disparities in health and mortality
•We’ve come a long way, but still have work to do
•Expanding outside the black/white focus
•Identifying shifting threats in racial and ethnic health inequality
Shifting Threats
0
10
20
30
40
50
60
1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 2007 2009 2011 2013
Black White
0
5
10
15
20
25
1985 1987 1989 1991 1993 1995 1997 1999 2001 2003 2005 2007 2009 2011 2013
Black White
Diabetes Hypertension