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Black Americans Dying Too Young

High rates of heart disease, cancer and infant mortality largely behind 1.6 million ‘excess deaths’ over 22-year stretch


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For many Black Americans, death comes too soon, according to researchers who reviewed more than two decades of U.S. death certificate data collected by the Centers for Disease Control and Prevention (CDC).

Black Americans experienced 1.63 million excess deaths during that period. This refers to the difference in the number of deaths that occurred during a particular period and the number of deaths expected during that time.

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The higher mortality rate meant a cumulative loss of more than 80 million years of life compared with white Americans from 1999 to 2020. The excess death rates are largely due to increased rates of heart disease, cancer and infant mortality, according to a newly published report in JAMA.

“It is important to remember this is not an abstract concept. There is a real human toll to these entrenched inequities,” coauthor Marcella Nunez-Smith, M.D., an associate dean for health equity research at Yale School of Medicine, said in a statement. “The impact on families and communities should be unacceptable to all of us.”

The study found encouraging gains were made in the early 2000s, but those evaporated in 2020 amid the COVID-19 pandemic. The report notes that even when disparities were at their lowest mark, there were more than 50,000 annual excess deaths and 3 million annual excess years of potential life lost among the Black population compared with the white population.

Clyde Yancy, M.D., a coauthor of the study and chief of cardiology at Northwestern University’s Feinberg School of Medicine, said in a statement that the numbers provide a “reasonable quantitative assessment” of racial disparities in death. The sheer size of the problem suggests an “overwhelming need” for a public health response to solve it, he said.

“If we are indeed a civil and just people, our charge must be the adaptation of new public health initiatives targeting health equity,” Yancy said. “As we go forward, and with the aging of our population, the health of our citizenry directly impacts the health of our economy — the pandemic made that incontrovertibly clear. We are reminded once again that the absence of health in anyone of us affects the health of all of us.”

What they did

For the study, researchers reviewed U.S. death certificate data from the CDC, comparing the age-adjusted mortality rates between the Black population and the white population from 1999 to 2020.

They estimated the excess years of potential life lost among the Black population by comparing the age of premature death against typical life expectancy. In 2021, non-Hispanic white Americans had a life expectancy at birth of 76.4; for non-Hispanic Black Americans, it was 70.8, according to the CDC.

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What’s behind the numbers?

Over the 22-year period, disproportionately higher mortality rates in Black men and women resulted in 997,623 and 628,464 excess deaths, respectively. Excess deaths and years of potential life lost were evident throughout most major causes of death, although heart disease was the most prominent for Black men and women, followed by cancer for Black men.

The researchers suggest that “disparities in rates of hypertension control and other factors associated with heart disease are in part responsible for this excess loss of life.” Research presented at a 2020 virtual meeting of the American Heart Association (AHA) found Black Americans are less likely to survive acute heart blockage and cardiac arrest than white Americans.

For that study, researchers reviewed medical records of 182,000 hospital patients admitted with cardiac arrest complications in the United States from 2012 to 2017, AARP reported.

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The JAMA study noted that differences in loss of life were most prominent among infants, “with Black-White mortality and years of potential life lost rate ratios greater than 2.3 among those younger than 1 year old.”

“The sobering disparity noted in this study among infants and during childhood accounted for a markedly elevated number of excess deaths and an even more pronounced disparity in years of potential life lost. This excess mortality occurred in a period of life of highest vulnerability and warrants new dedicated public health initiatives targeting early childhood health,” the researchers wrote.

The pandemic effect

The researchers found that the COVID-19 pandemic exacerbated the disparities highlighted in their study.

“Despite initial progress during the early 2000s, we found persistent excess mortality rates among non-Hispanic Black adults,” study lead author César Caraballo, M.D., a postdoctoral associate at Yale, said in a statement. “The abrupt worsening of these disparities in the first year of the pandemic indicates that current efforts to eliminate mortality disparities have been minimally effective and that progress has been fragile.”

The researchers said contributing factors included disproportionately higher infection exposure, financial instability, food insecurity and psychological distress, as well as persistently higher barriers to health care, higher prevalence of multi-morbidity and worse average health status.

“We need targeted strategies aimed at early childhood health and preventing heart disease and cancer, some of the main drivers of these disparities, to build a more equitable future,” Caraballo said.

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