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Progress in Reducing Disparities in Premature Mortality in the USA: a Descriptive Study

Abstract

Background

Eliminating health disparities among different segments of the US population is an overarching goal of the US Healthy People 2020 objectives.

Objective

Examine changes in educational, rural-urban, and racial disparities in premature mortality during the past 10 years.

Design and Participants

Descriptive analysis of US mortality data from 2007 to 2017.

Main Measures

Relative and absolute rural-urban, educational attainment, and Black-White disparities in premature mortality for all-cause and top 10 causes of death among persons ages 25–74 years, estimated as rate ratios and rate differences between ≤12 and ≥16 years of education, rural versus urban, and non-Hispanic Black (Black) versus non-Hispanic White (White), respectively, in 2007 and 2017.

Key Results

During 2007–2017, mortality rates in persons aged 25–74 years in the USA increased for several leading causes of death, especially in persons with <16 years of education, rural residents, and White people. As a result, disparity in mortality between 2007 and 2017 widened on both relative and absolute scales for all-cause and for 6 of the top 10 causes of death by education and for all-cause and for 9 of the top 10 causes by rural/urban residence. In contrast, Black-White disparities narrowed for all-cause and for all 7 causes that Black people had a higher rate than White people. For all-cause mortality for example, absolute disparities in the number of deaths per 100,000 person-years between 2007 and 2017 increased from 454.0 (95%CI, 446.0–462.1) to 542.7 (535.6–549.7) for educational attainment and from 85.8 (82.8–88.8) to 140.5 (137.6–143.4) for rural versus urban; in contrast, absolute Black-White disparity decreased from 315.3 (311.0–319.7) to 221.7 (218.1–225.3).

Conclusions

Educational and rural-urban disparities in premature mortality widened, whereas Black-White disparities narrowed in the USA between 2007 and 2017, though overall rates remained considerably higher in Black people.

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Acknowledgements

We acknowledge the Intramural Research Department of the American Cancer Society for supporting this study.

Funding

Supported by the Intramural Research Department of the American Cancer Society (Ma, Yabroff, Siegel, Cance, and Jemal).

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Authors and Affiliations

Authors

Contributions

Concept and design: Ma, Jemal

Acquisition, analysis, or interpretation of data: all authors

Drafting of the manuscript: Ma, Jemal

Critical revision of the manuscript for important intellectual content: all authors

Statistical analysis: Ma

Ma had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Corresponding author

Correspondence to Ahmedin Jemal D.V.M., Ph.D.

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Ma, J., Yabroff, K.R., Siegel, R.L. et al. Progress in Reducing Disparities in Premature Mortality in the USA: a Descriptive Study. J GEN INTERN MED 37, 2923–2930 (2022). https://doi.org/10.1007/s11606-021-07268-5

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KEY WORDS

  • leading causes of death
  • disparities
  • Healthy People 2020 goal
  • United States
  • premature mortality