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Cited by 262Health disparities and outcomesInsurance, Mortality, Demography, Risk ManagementGlobal Cancer Incidence and Screening

Black-White Inequalities in Mortality and Life Expectancy, 1933–1999: Implications for Healthy People 2010

Levine, Robert S., Foster, James E., Fullilove, Robert E., Fullilove, Mindy T., Briggs, Nathaniel C., Hull, Pamela C., Husaini, Baqar A., Hennekens, Charles H.·2001·Public Health Reports®
DOI 10.1093/phr/116.5.474
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Abstract

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 age-adjusted, 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 black-white 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.

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  • Lower life expectancy among many racial/ethnic minority groups compared to white groups may be partly due to the disproportionate burden of chronic health conditions.

    “This may be an important reason why life expectancy is lower among many racial/ethnic minority groups compared to white groups (Levine et al., 2001).”

    From Addressing sleep disturbances: an opportunity to prevent cardiometabolic disease? (2014) · cites this paper as Levine et al., 2001

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Authors
Levine, R. S., Foster, J. E., Fullilove, R. E., Fullilove, M. T., Briggs, N. C., Hull, P. C., Husaini, B. A., & Hennekens, C. H.
Affiliations
  • Meharry Medical College (US)
  • Vanderbilt University (US)
  • Columbia University (US)
  • New York State Psychiatric Institute (US)
  • Tennessee State University (US)
  • University of Miami (US)
Corresponding author
Levine, Robert S.
ORCID
Venue
Public Health Reports®
Publisher
SAGE Publications
Published
2001-09
Volume
116
Issue
5
Pages
474-483
ISSN
  • 0033-3549 (ISSN-L)
  • 1468-2877
DOI
10.1093/phr/116.5.474
OpenAlex
W2038502007
Cited by
262
References
34
Citations by year
2026: 4 · 2025: 3 · 2024: 2 · 2023: 5 · 2022: 24 · 2021: 10 · 2020: 15 · 2019: 14 · 2018: 8 · 2017: 12 · 2016: 5 · 2015: 8 · 2014: 9 · 2013: 15 · 2012: 10
FWCI
5.50
Type
journal article
Language
en
Open access
closed
Licence
journals.sagepub.com/page/policies/text-and-data-mining-license (tdm)
Locations
  • Public Health Reports (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Robert Wood Johnson Foundation
  • Agency for Healthcare Research and Quality (1 U18HS11131)
Topics
  • Social Sciences › Health › Health disparities and outcomes
  • Social Sciences › Demography › Insurance, Mortality, Demography, Risk Management
  • Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
Keywords
racial disparities in health, life expectancy, Healthy People 2010, excess mortality, premature mortality, African Americans, mortality trends, mortality forecasting, health care access
MeSH terms
Adolescent, Adult, Aged, Black or African American, Cause of Death, Child, Child, Preschool, Female, Forecasting, Health Priorities, Humans, Infant, Infant, Newborn, Life Expectancy, Male, Middle Aged, Mortality, National Center for Health Statistics, U.S., Public Health Administration, Socioeconomic Factors, United States, Models, Statistical, White People

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