Minority Health and Health Equity Archive

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    Explaining Divergent Levels of Longevity in High-Income Countries
    (National Academies Press, 2011) Crimmins, Eileen M.; Preston, Samuel H.; Cohen, Barney
    During the last 25 years, life expectancy at age 50 in the United States has been rising, but at a slower pace than in many other high-income countries, such as Japan and Australia. This difference is particularly notable given that the United States spends more on health care than any other nation. Concerned about this divergence, the National Institute on Aging asked the National Research Council to examine evidence on its possible causes. According to Explaining Divergent Levels of Longevity in High-Income Countries, the nation's history of heavy smoking is a major reason why lifespans in the United States fall short of those in many other high-income nations. Evidence suggests that current obesity levels play a substantial part as well. The book reports that lack of universal access to health care in the U.S. also has increased mortality and reduced life expectancy, though this is a less significant factor for those over age 65 because of Medicare access. For the main causes of death at older ages -- cancer and cardiovascular disease -- available indicators do not suggest that the U.S. health care system is failing to prevent deaths that would be averted elsewhere. In fact, cancer detection and survival appear to be better in the U.S. than in most other high-income nations, and survival rates following a heart attack also are favorable. Explaining Divergent Levels of Longevity in High-Income Countries identifies many gaps in research. For instance, while lung cancer deaths are a reliable marker of the damage from smoking, no clear-cut marker exists for obesity, physical inactivity, social integration, or other risks considered in this book. Moreover, evaluation of these risk factors is based on observational studies, which -- unlike randomized controlled trials -- are subject to many biases.
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    Social Epidemiology: Social Determinants of Health in the United States: Are We Losing Ground?
    (2009) Berkman, Lisa F.
    The United States ranks in the lower tiers of OECD countries in life expectancy, and recent studies indicate that socioeconomic inequalities in health have been widening in the past decades. Over this period, many rigorous longitudinal studies have identified important social, behavioral, and environmental conditions that might reduce health disparities if we could design effective interventions and make specific policy changes to modify them. Often, however, neither our policy changes nor our interventions are as effective as we hoped they would be on the basis of findings from observational studies. Reviewed here are issues related to causal inference and potential explanations for the discrepancy between observational and experimental studies. We conclude that more attention needs to be devoted to (a) identifying the correct etiologic period within a life-course perspective and (b) understanding the dynamic interplay between interventions and the social, economic, and environmental contexts in which interventions are delivered.
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    Health, United States, 2010: With Special Feature on Death and Dying
    (2011) UNSPECIFIED
    Health, United States, 2010 is the 34th report on the health status of the Nation and is submitted by the Secretary of the Department of Health and Human Services to the President and the Congress of the United States in compliance with Section 308 of the Public Health Service Act. This report was compiled by the Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics (NCHS). The National Committee on Vital and Health Statistics served in a review capacity. The Health, United States series presents national trends in health statistics. The report contains a Chartbook that assesses the Nation’s health by presenting trends and current information on selected measures of morbidity, mortality, health care utilization, health risk factors, prevention, health insurance, and personal health care expenditures. This year’s Chartbook includes a special feature on death and dying.
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    Trends in the Black-White Life Expectancy Gap in the United States, 1983-2003
    (2007) Harper, S.; Lynch, J.; Burris, S.; Davey Smith, G.
    CONTEXT: 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. OBJECTIVE: 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. DESIGN AND SETTING: US vital statistics data from the US National Vital Statistics System, maintained by the National Center for Health Statistics. Standard life table techniques were used 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. MAIN OUTCOME MEASURE: The gap in life expectancy at birth between blacks and whites. RESULTS: Among females, the black-white life expectancy gap increased 0.5 years in the period 1983-1993, primarily due to increased mortality from human immunodeficiency virus (HIV) (0.4 years) and slower declines in heart disease (0.1 years), which were somewhat offset by relative improvements in stroke (-0.1 years). The gap among males increased by 2 years in the period 1983-1993, principally because of adverse changes in HIV (1.1 years), homicide (0.5 years), and heart disease (0.3 years). Between 1993 and 2003, the female gap decreased by 1 year (from 5.59 to 4.54 years). Half of the total narrowing of the gap among females was due to relative mortality improvement among blacks in heart disease (-0.2 years), homicide (-0.2 years), and unintentional injuries (-0.1 years). The decline in the life expectancy gap was larger among males, declining by 25% (from 8.44 to 6.33 years). Nearly all of the 2.1-year decline among males was due to relative mortality improvement among blacks at ages 15 to 49 years (-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]), and lack of improvement in heart disease at older ages kept the gap from narrowing further. CONCLUSIONS: After widening during the late 1980s, the black-white life expectancy gap has declined because of relative mortality improvements in homicide, HIV, unintentional injuries, and, among females, heart disease. Further narrowing of the gap will require concerted efforts in public health and health care to address the major causes of the remaining gap from cardiovascular diseases, homicide, HIV, and infant mortality.
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    Challenges and Successes in Reducing Health Disparities: Workshop Summary
    (The National Academies Press, 2008) Cohen, Jennifer A.
    In early 2007, the Institute of Medicine of the National Academies convened the Roundtable on Health Disparities to increase the visibility of racial and ethnic health disparities as a national problem, further the development of programs and strategies to reduce disparities, foster the emergence of leadership on this issue, and track promising activities and developments in health care that could lead to dramatically reducing or eliminating disparities. The Roundtable on Health Disparities includes representatives from the health professions, state and local government, foundations, philanthropy, academia, advocacy groups, and community based organizations. Its mission is to facilitate communication across sectors and—above all—to generate action. Through national and local activities, the Roundtable strives to advance the goal of eliminating health disparities. On July 31, 2007, the first workshop of the Roundtable on Health Disparities was held at Harris-Stowe State University in St. Louis, Missouri. To help stimulate new thinking about solutions and to inform its future meetings and discussions, the Roundtable brought together a diverse group of participants from a variety of fields to discuss racial and ethnic differences in life expectancy in the United States. Measured in terms of life expectancy, tens of millions of Americans experience levels of health that are more typical of middle- and low-income developing countries. These mortality differences are caused primarily by chronic diseases and injuries with well established risk factors and are potentially amenable to intervention.
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    Black-White Inequalities in Mortality and Life Expectancy, 1933–1999: Implications for Healthy People 2010
    (2001) Levine, Robert S.; Foster, James E.; Fullilove, Robert E.; Fullilove, Mindy T.; Briggs, Nathaniel C.; Hull, Pamela C.; Husaini, Baqar A.; Hennekens, Charles H.
    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 ageadjusted, 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 blackwhite 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.