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The Contribution of Health Care and Other Interventions to Black–White Disparities in Life Expectancy, 1980–2007

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Abstract

Black–white mortality disparities remain sizable in the United States. In this study, we use the concept of avoidable/amenable mortality to estimate cause-of-death contributions to the difference in life expectancy between whites and blacks by gender in the United States in 1980, 1993, and 2007. We begin with a review of the concept of “avoidable mortality” and results of prior studies using this cause-of-death classification. We then present the results of our empirical analyses. We classified causes of death as amenable to medical care, sensitive to public health policies and health behaviors, ischemic heart disease, suicide, HIV/AIDS, and all other causes combined. We used vital statistics data on deaths and Census Bureau population estimates and standard demographic decomposition techniques. In 2007, causes of death amenable to medical care continued to account for close to 2 years of the racial difference in life expectancy among men (2.08) and women (1.85). Causes amenable to public health interventions made a larger contribution to the racial difference in life expectancy among men (1.17 years) than women (0.08 years). The contribution of HIV/AIDS substantially widened the racial difference among both men (1.08 years) and women (0.42 years) in 1993, but its contribution declined over time. Despite progress observed over the time period studied, a substantial portion of black–white disparities in mortality could be reduced given more equitable access to medical care and health interventions.

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Notes

  1. Tuberculosis, cervical cancer, rheumatic heart disease, hypertension, stroke, and appendicitis.

  2. Maternal and perinatal mortality, Hodgkin’s disease, cervical and breast cancer, tuberculosis, asthma, appendicitis, cholelithiasis, cholecystitis and abdominal hernia, ischemic heart disease, hypertension and cerebrovascular disease, and peptic ulcers.

  3. Tuberculosis, cervical cancer, Hodgkin’s disease, rheumatic heart disease, hypertensive disease, acute respiratory disease, pneumonia and bronchitis, influenza, asthma, appendicitis, hernias, and cholecystitis.

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Acknowledgments

We thank anonymous reviewers for their comments and Ye Wang for programming assistance. Irma T. Elo and James Macinko were supported by a grant (R21 HD060175-01A1) from Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institute of Health. Hiram Beltran-Sanchez acknowledges financial support from the National Institute on Aging (T32AG000037), the Harvard Center for Population and Development Studies and the Center for Demography, Health and Aging at the University of Wisconsin-Madison.

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Authors and Affiliations

  1. Population Studies Center, University of Pennsylvania, 3718 Locust Walk, Philadelphia, PA, 19104, USA

    Irma T. Elo

  2. Center for Demography and Ecology, University of Wisconsin, 4329 Sewell Social Science, Madison, WI, USA

    Hiram Beltrán-Sánchez

  3. New York University, 411 Lafayette Street 5th Floor, New York, NY, 10003, USA

    James Macinko

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  1. Irma T. Elo
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Correspondence to Irma T. Elo.

Appendix

Appendix

See Tables 4 and 5.

Table 4 Life expectancy by race and sex, US 1980, 1993, and 2007
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Table 5 Definitions of cause-of-death categories
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Elo, I.T., Beltrán-Sánchez, H. & Macinko, J. The Contribution of Health Care and Other Interventions to Black–White Disparities in Life Expectancy, 1980–2007. Popul Res Policy Rev 33, 97–126 (2014). https://doi.org/10.1007/s11113-013-9309-2

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  • DOI: https://doi.org/10.1007/s11113-013-9309-2

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