Black-White Differences in Avoidable Mortality in the United States, 1980-2005

Abstract

Background: This paper analyzes black-white disparities in Avoidable Mortality (AM) – causes of death that should not occur in the presence of high-quality and timely medical treatment and from causes that can be influenced at least in part by public policy/behavior.

Methods: Avoidable Mortality is defined as premature mortality under age 65 from:1) conditions amenable to medical care; 2) those sensitive to public policy and/or behavior change; 3) ischemic heart disease; 4) HIV/AIDS; and 5) the remaining causes of death. Age-standardized death rates (ASDRs) were constructed for each race and sex group using vital statistics and census data from 1980-2005. Absolute rate differences and the proportionate contribution of each cause of death group to all-cause black-white mortality disparities are calculated based on the ASDRs. Negative binomial regression was used to model relative risks of death.

Results: In 2005, medical care amenable mortality was the largest source of absolute black-white mortality disparity, contributing 30% of the black-white difference in all cause mortality among men and 42% among women; mortality subject to policy/behavior interventions contributed 20% of the black-white difference for men and 4% for women. Although absolute black-white differences for most conditions diminished over time, relative disparities as measured by rate ratios showed little change, except for HIV/AIDS for which relative risks increased substantially for black men and women.

Conclusions: There is considerable potential for narrowing of the black-white difference in avoidable mortality, especially from causes amenable to medical care and policy/behavior interventions.