Black–White Differences in Avoidable Mortality in the USA, 1980–2005

Macinko, J., and I.T. Elo
Journal of Epidemiology and Community Health, Vol. 63 no. 9, pp. 715-721. 10.1136/jech.2008.081141

Background: Avoidable Mortality (AM) describes causes of death that should not occur in the presence of highquality and timely medical treatment and from causes that can be influenced at least in part by public policy/ behaviour. This study analyses black–white disparities in AM.

Methods: Mortality under age 65 was analysed from: (1) conditions amenable to medical care; (2) those sensitive to public policy and/or behaviour change; (3) ischaemic heart disease; (4) HIV/AIDS; and (5) the remaining causes of death. Age-standardised death rates (ASDRs) were constructed for each race and sex group using vital statistics and census data from 1980–2005. Absolute rate differences and the proportionate contribution of each cause of death group to all-cause black–white mortality disparities are calculated based on the ASDRs. Negative binomial regression was used to model relative risks of death.

Results: In 2005, medical care amenable mortality was the largest source of absolute black–white mortality disparity, contributing 30% of the black–white difference in all-cause mortality among men and 42% among women; mortality subject to policy/behaviour interventions contributed 20% of the black–white difference for men and 4% for women. Although absolute black–white differences for most conditions diminished over time, relative disparities as measured by rate ratios showed little change, except for HIV/AIDS for which relative risks increased substantially for black men and women.

Conclusions: There is considerable potential for narrowing of the black–white difference in AM, especially from causes amenable to medical care and (for men) policy/behaviour interventions.