Vital Signs: Racial Disparities in Age-Specific Mortality Among Blacks or African Americans — United States, 1999–2015

Results

In 1999, age-adjusted death rates for any cause of death were 1,135.7 per 100,000 blacks and 854.6 per 100,000 whites ( Table 1). By 2015, the racial gap had narrowed with age-adjusted death rates of 851.9 per 100,000 blacks and 735.0 per 100,000 whites. The age-adjusted death rate in 2015 relative to that in 1999 had declined 25% for blacks and 14% for whites; there were 284 fewer age-adjusted deaths per 100,000 blacks during 2015 compared with 1999, whereas there were 120 fewer age-adjusted deaths per 100,000 whites. The disparity gap in all-cause mortality rates decreased from 33% in 1999 to 16% in 2015. Among adults aged ≥65 years, the death rate in 2015 relative to that in 1999 declined 27% for blacks and 17% for whites, resulting in a crossover in death rates beginning in 2010, when blacks had lower death rates than whites ( Figure 1).

Age-specific deaths for selected leading causes of death among blacks declined between 1999 and 2015 ( Figure 2). Notable declines, for example, included heart disease (15%), cancer (24%), and human immunodeficiency virus (HIV) disease (80%) at ages 18–34 years; heart disease (22%), cancer (38%), and HIV disease (79%) at ages 35–49 years; and heart disease (32% and 43%), cancer (27% and 29%) and cerebrovascular disease (34% and 41%) for the 50–64 and ≥65 age groups (Table 1).

During 2014, sociodemographic characteristics differed by race ( Table 2). Blacks in each age group were more likely than whites to have <12 years of education, to be unemployed, live below the poverty level, and less likely to live in a household where the head of household owned the home. Blacks were more likely to have no health insurance than whites for the 18–34, 35–49, and 50–64 age groups, but few persons in either population reported having no health insurance at age ≥65 years.

During 2015, health behaviors differed between the two populations ( Table 3). Blacks were more likely to be obese, to have no leisure time physical activity, and less likely to have a normal body weight in all age groups compared with whites. In contrast, blacks were less likely to report binge drinking than whites. Although blacks had higher prevalences of current cigarette smoking than whites at ages 50–64 years and ≥65 years, they had a lower prevalence at ages 18–34 years.

In all age groups, blacks were more likely than whites to report not being able to see a doctor in the past year because of cost. Blacks aged 18–34 years were less likely to have a personal doctor or health care provider than whites (Table 3). Blacks with high blood pressure were more likely than whites in each age group to report taking medication to control it.

Blacks in all age groups were more likely to report fair to poor health status than whites (Table 3). Blacks were more likely than whites to report frequent mental distress and frequent physical distress at age ≥50 years. The prevalence of having diagnoses of some chronic conditions was higher among blacks than whites across age groups, including for asthma, high blood pressure, diabetes, and stroke. In contrast, blacks across all age groups were less likely than whites to report a cancer diagnosis.

In 2015, blacks had 40% higher death rates than whites for all-cause mortality in all age groups <65 years ( Table 4). At ages 18–34 years, blacks had higher death rates than whites for eight of the 10 leading causes of death among blacks in that age group (heart disease; cancer; cerebrovascular disease; diabetes mellitus; homicide; HIV disease; and conditions resulting from pregnancy, childbirth, and the puerperium). At ages 35–49 years, blacks had higher death rates than whites for heart disease; cancer; cerebrovascular disease; diabetes mellitus; homicide; nephritis, nephrotic syndrome, and nephrosis; septicemia; and HIV disease. At ages 50–64 years, blacks had higher death rates than whites for leading chronic diseases (heart disease, cancer; cerebrovascular disease; diabetes mellitus; and nephritis, nephrotic syndrome, and nephrosis) as well as for unintentional injury, septicemia, and HIV disease. Death rates from heart disease, cancer, cerebrovascular disease, diabetes mellitus, and homicide began increasing at earlier ages among blacks than among whites. There were significant declines in deaths from HIV disease in the past 17 years for both racial populations. Among persons aged 35–49 years, there were 45 fewer HIV disease deaths per 100,000 among blacks during 2015 compared with 1999, while among whites there were six fewer HIV disease deaths (Table 1). However, during 2015, blacks in age groups 18–34, 35–49, and 50–64 were seven to nine times more likely than whites to die from HIV disease. Some age groups of blacks had lower death rates than whites for four leading causes of death: ages 18–49 years for unintentional injuries, ages 50–64 years for chronic liver disease and cirrhosis, ages ≤49 years for suicide, and ages ≥65 years for Alzheimer’s disease.