Black-white differences in avoidable mortality in the USA, 1980-2005

Abstract

Background: Avoidable Mortality (AM) describes causes of death that should not occur in the presence of high-quality 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.