Ever since the German pathologist Rudoph Virchow famously noted in 1849 that “medicine is a social science,” stark societal differences in health and longevity have been documented across the globe. In the United States, more recent studies have documented how health outcomes vary with race and ethnicity. Black Americans, for example, have been shown to have higher infant mortality, maternal mortality, and age-standardized mortality than white Americans. These studies also show a lower life expectancy and a more significant burden of disease in Black Americans.
This disparity in mortality has been shown to emerge from a complex interplay of societal factors, including patterns of access to and engagement with the health care system, and the historical legacy of inequitable policies in housing, finance, and other facets of daily life. Understanding how these large discrepancies in health outcomes have changed over time will inform strategies for improving the health and welfare of all Americans.
Most studies documenting the excess mortality among Black Americans account only for recent or limited time periods. However, the US federal government has recorded the longer history and trajectory of this excess burden of illness and death for decades, especially between childhood and adult mortality. Until now, this data has remained largely unanalyzed.
In a new article in the Annals of Internal Medicine, an international team led by Dr. Angel Paternina-Caicedo, a researcher from the National University of Colombia, along with Dr. Nathaniel Hupert, associate professor of population health sciences, and colleagues from Harvard University and Yale University, analyzed seven decades of racial inequities in America, focusing on the toll of excess deaths in Black children since 1950.
The researchers used records collected by the Centers for Disease Control and Prevention and the US Census Bureau to calculate mortality rates, life expectancy, and years of potential life lost for Black and white Americans.
They found that while excess mortality among Black children has decreased over the last seven decades, this group still has double the risk of death compared to white children. This trend means that in that period, roughly 690,000 deaths among Black children, including about 523,000 infant deaths, would have been avoided if their mortality rates were equivalent to those of white children.
Life expectancy among Black Americans in the 2010s would have also been higher if Black and white populations experienced similar mortality rates during childhood. Altogether, across the 70 years of the study, five million early deaths among Black Americans could have been avoided if mortality rates were equal to those of white Americans.
“This study provides the needed historical perspective to better understand how different communities within the US and its territories sometimes experience radically different levels of health,” said Dr. Paternina-Caicedo. “The persistence of the mortality gap in children in the US over so many decades, despite its world-leading health care advances, shows the ongoing challenge of eliminating such disparities.”
The researchers recommend redoubled public health efforts to address the excess mortality risk incurred by Black Americans, as well as further attention to the structural causes of inequity underlying that risk.
Dr. Hupert adds, “These findings reinforce the importance of both strong public health reporting systems and unfettered access to vital statistics data for improving the health of the nation.”
- Highlights