The contributions of selected diseases to disparities in death rates and years of life lost for racial/ethnic minorities in the United States, 1999-2010

Abstract

Introduction: Differences in risk for death from diseases and other causes among racial/ethnic groups likely contributed to the limited improvement in the state of health in the United States in the last few decades. The objective of this study was to identify causes of death that are the largest contributors to health disparities among racial/ethnic groups.

Methods: Using data from WONDER system, we measured the relative (age-adjusted mortality ratio [AAMR]) and absolute (difference in years of life lost [dYLL]) differences in mortality risk between the non-Hispanic white population and the black, Hispanic, American Indian/Alaska Native, and Asian/Pacific Islander populations for the 25 leading causes of death.

Results: Many causes contributed to disparities between non-Hispanic whites and blacks, led by assault (AAMR, 7.56; dYLL, 4.5 million). Malignant neoplasms were the second largest absolute contributor (dYLL, 3.8 million) to black-white disparities; we also found substantial relative and absolute differences for several cardiovascular diseases. Only assault, diabetes, and diseases of the liver contributed substantially to disparities between non-Hispanic whites and Hispanics (AAMR ≥ 1.65; dYLL ≥ 325,000). Many causes of death, led by assault (AAMR, 3.25; dYLL, 98,000), contributed to disparities between non-Hispanic whites and American Indians/Alaska Natives; Asian/Pacific Islanders did not have a higher risk than non-Hispanic whites for death from any disease.

Conclusion: Assault was a substantial contributor to disparities in mortality among non-Asian racial/ethnic minority populations. Research and intervention resources need to target diseases (such as diabetes and diseases of the liver) that affect certain racial/ethnic populations.

Figure

Scatterplots of relative measure of disparities (age-adjusted mortality ratio [AAMR]) and absolute measures of disparities (difference in years of life lost [dYLL]) for each of 4 racial/ethnic minority groups compared with the non-Hispanic white population for the 25 leading causes of death in the United States, 1999–2010. Causes of death were categorized according to the International Classification of Diseases, 10^th Revision. Scatterplot A is for non-Hispanic blacks; B for Hispanic whites; C for non-Hispanic Asians/Pacific Islanders; and D for non-Hispanic American Indians/Alaska Natives. Abbreviations for categories of causes of death were used to provide clearer plots. Abbreviations: Cancer, malignant neoplasms; IHD, ischemic heart disease; Other HD, other forms of heart disease; Stroke, cerebrovascular disorders; COPD, chronic lower respiratory diseases; Diabetes, diabetes mellitus; Other Nervous, other degenerative diseases of the nervous system; Other Accidents, other external causes of accidental injury; Mental Disorder, organic, including symptomatic, mental disorders; Influenza/Pneumonia, influenza or pneumonia; Hypertensive, hypertensive diseases; Transport, transport accidents; Renal, renal failure; Liver, diseases of the liver; Bacterial, other bacterial diseases; AAC, diseases of the arteries, arterioles or capillaries; Suicide, intentional self-harm; Intestines, other diseases of the intestines; Movement, extrapyramidal or movement disorders; Lung/External, lung diseases due to external agents; Assault, assault; Ill-Defined, ill-defined or unknown causes of mortality; Other Respiratory, other respiratory diseases principally affecting the interstitium; Metabolic, metabolic disorders; Urinary, other diseases of the urinary systems.

Figure

Scatterplots of relative measure of disparities (age-adjusted mortality ratio [AAMR]) and absolute measures of disparities (difference in years of life lost [dYLL]) for each of 4 racial/ethnic minority groups compared with the non-Hispanic white population for the 25 leading causes of death in the United States, 1999–2010. Causes of death were categorized according to the International Classification of Diseases, 10^th Revision. Scatterplot A is for non-Hispanic blacks; B for Hispanic whites; C for non-Hispanic Asians/Pacific Islanders; and D for non-Hispanic American Indians/Alaska Natives. Abbreviations for categories of causes of death were used to provide clearer plots. Abbreviations: Cancer, malignant neoplasms; IHD, ischemic heart disease; Other HD, other forms of heart disease; Stroke, cerebrovascular disorders; COPD, chronic lower respiratory diseases; Diabetes, diabetes mellitus; Other Nervous, other degenerative diseases of the nervous system; Other Accidents, other external causes of accidental injury; Mental Disorder, organic, including symptomatic, mental disorders; Influenza/Pneumonia, influenza or pneumonia; Hypertensive, hypertensive diseases; Transport, transport accidents; Renal, renal failure; Liver, diseases of the liver; Bacterial, other bacterial diseases; AAC, diseases of the arteries, arterioles or capillaries; Suicide, intentional self-harm; Intestines, other diseases of the intestines; Movement, extrapyramidal or movement disorders; Lung/External, lung diseases due to external agents; Assault, assault; Ill-Defined, ill-defined or unknown causes of mortality; Other Respiratory, other respiratory diseases principally affecting the interstitium; Metabolic, metabolic disorders; Urinary, other diseases of the urinary systems.

Figure

Scatterplots of relative measure of disparities (age-adjusted mortality ratio [AAMR]) and absolute measures of disparities (difference in years of life lost [dYLL]) for each of 4 racial/ethnic minority groups compared with the non-Hispanic white population for the 25 leading causes of death in the United States, 1999–2010. Causes of death were categorized according to the International Classification of Diseases, 10^th Revision. Scatterplot A is for non-Hispanic blacks; B for Hispanic whites; C for non-Hispanic Asians/Pacific Islanders; and D for non-Hispanic American Indians/Alaska Natives. Abbreviations for categories of causes of death were used to provide clearer plots. Abbreviations: Cancer, malignant neoplasms; IHD, ischemic heart disease; Other HD, other forms of heart disease; Stroke, cerebrovascular disorders; COPD, chronic lower respiratory diseases; Diabetes, diabetes mellitus; Other Nervous, other degenerative diseases of the nervous system; Other Accidents, other external causes of accidental injury; Mental Disorder, organic, including symptomatic, mental disorders; Influenza/Pneumonia, influenza or pneumonia; Hypertensive, hypertensive diseases; Transport, transport accidents; Renal, renal failure; Liver, diseases of the liver; Bacterial, other bacterial diseases; AAC, diseases of the arteries, arterioles or capillaries; Suicide, intentional self-harm; Intestines, other diseases of the intestines; Movement, extrapyramidal or movement disorders; Lung/External, lung diseases due to external agents; Assault, assault; Ill-Defined, ill-defined or unknown causes of mortality; Other Respiratory, other respiratory diseases principally affecting the interstitium; Metabolic, metabolic disorders; Urinary, other diseases of the urinary systems.

Figure

Scatterplots of relative measure of disparities (age-adjusted mortality ratio [AAMR]) and absolute measures of disparities (difference in years of life lost [dYLL]) for each of 4 racial/ethnic minority groups compared with the non-Hispanic white population for the 25 leading causes of death in the United States, 1999–2010. Causes of death were categorized according to the International Classification of Diseases, 10^th Revision. Scatterplot A is for non-Hispanic blacks; B for Hispanic whites; C for non-Hispanic Asians/Pacific Islanders; and D for non-Hispanic American Indians/Alaska Natives. Abbreviations for categories of causes of death were used to provide clearer plots. Abbreviations: Cancer, malignant neoplasms; IHD, ischemic heart disease; Other HD, other forms of heart disease; Stroke, cerebrovascular disorders; COPD, chronic lower respiratory diseases; Diabetes, diabetes mellitus; Other Nervous, other degenerative diseases of the nervous system; Other Accidents, other external causes of accidental injury; Mental Disorder, organic, including symptomatic, mental disorders; Influenza/Pneumonia, influenza or pneumonia; Hypertensive, hypertensive diseases; Transport, transport accidents; Renal, renal failure; Liver, diseases of the liver; Bacterial, other bacterial diseases; AAC, diseases of the arteries, arterioles or capillaries; Suicide, intentional self-harm; Intestines, other diseases of the intestines; Movement, extrapyramidal or movement disorders; Lung/External, lung diseases due to external agents; Assault, assault; Ill-Defined, ill-defined or unknown causes of mortality; Other Respiratory, other respiratory diseases principally affecting the interstitium; Metabolic, metabolic disorders; Urinary, other diseases of the urinary systems.

Supplemental Figure

Scatterplots of relative disparities (age-adjusted mortality ratio) and absolute disparities (years of life lost) for each of 4 racial/ethnic minority groups compared with the non-Hispanic white population for the 26th- to 50^th-ranked leading causes of death in the United States, 1999–2010. Causes of death were categorized according to the International Classification of Diseases, 10^th Revision. Scatterplot A is for non-Hispanic blacks; B is for Hispanic whites; C is for non-Hispanic Asians/Pacific Islanders; and D is for non-Hispanic American Indians/Alaska Natives. Abbreviations for categories of causes of death were used to provide clearer plots. Abbreviations: PHD, pulmonary heart disease and diseases of pulmonary circulation; General, general symptoms and signs; Unk Neoplasms, neoplasms of uncertain or unknown behavior; HIV, human immunodeficiency virus disease; Substance Use, mental or behavioral disorders due to psychoactive substance use; Gal BilTract Pan, disorders of gallbladder, biliary tract, or pancreas; Other Digest, other diseases of the digestive system; Other Respiratory, other diseases of the respiratory system; Other Nervous, other disorders of the nervous system; Sys Atrophies, systemic atrophies primarily affecting the central nervous system; Esophagus stomach duod, diseases of esophagus, stomach, or duodenum; Hepatitis, viral hepatitis; Intestinal Infect, intestinal infectious diseases; Undetermined Intent, event of undetermined intent; Fetal Growth, disorders related to length of gestation or fetal growth; Connective Tissue, systemic connective tissue disorders; Obesity, obesity or other hyperalimentation; Arthropathies, arthropathies; Veins Lymphatic, diseases of veins, lymphatic vessels, or lymph nodes, not elsewhere classified; Circulatory Malform, congenital malformations of the circulatory system.

Supplemental Figure

Scatterplots of relative disparities (age-adjusted mortality ratio) and absolute disparities (years of life lost) for each of 4 racial/ethnic minority groups compared with the non-Hispanic white population for the 26th- to 50^th-ranked leading causes of death in the United States, 1999–2010. Causes of death were categorized according to the International Classification of Diseases, 10^th Revision. Scatterplot A is for non-Hispanic blacks; B is for Hispanic whites; C is for non-Hispanic Asians/Pacific Islanders; and D is for non-Hispanic American Indians/Alaska Natives. Abbreviations for categories of causes of death were used to provide clearer plots. Abbreviations: PHD, pulmonary heart disease and diseases of pulmonary circulation; General, general symptoms and signs; Unk Neoplasms, neoplasms of uncertain or unknown behavior; HIV, human immunodeficiency virus disease; Substance Use, mental or behavioral disorders due to psychoactive substance use; Gal BilTract Pan, disorders of gallbladder, biliary tract, or pancreas; Other Digest, other diseases of the digestive system; Other Respiratory, other diseases of the respiratory system; Other Nervous, other disorders of the nervous system; Sys Atrophies, systemic atrophies primarily affecting the central nervous system; Esophagus stomach duod, diseases of esophagus, stomach, or duodenum; Hepatitis, viral hepatitis; Intestinal Infect, intestinal infectious diseases; Undetermined Intent, event of undetermined intent; Fetal Growth, disorders related to length of gestation or fetal growth; Connective Tissue, systemic connective tissue disorders; Obesity, obesity or other hyperalimentation; Arthropathies, arthropathies; Veins Lymphatic, diseases of veins, lymphatic vessels, or lymph nodes, not elsewhere classified; Circulatory Malform, congenital malformations of the circulatory system.

Supplemental Figure

Scatterplots of relative disparities (age-adjusted mortality ratio) and absolute disparities (years of life lost) for each of 4 racial/ethnic minority groups compared with the non-Hispanic white population for the 26th- to 50^th-ranked leading causes of death in the United States, 1999–2010. Causes of death were categorized according to the International Classification of Diseases, 10^th Revision. Scatterplot A is for non-Hispanic blacks; B is for Hispanic whites; C is for non-Hispanic Asians/Pacific Islanders; and D is for non-Hispanic American Indians/Alaska Natives. Abbreviations for categories of causes of death were used to provide clearer plots. Abbreviations: PHD, pulmonary heart disease and diseases of pulmonary circulation; General, general symptoms and signs; Unk Neoplasms, neoplasms of uncertain or unknown behavior; HIV, human immunodeficiency virus disease; Substance Use, mental or behavioral disorders due to psychoactive substance use; Gal BilTract Pan, disorders of gallbladder, biliary tract, or pancreas; Other Digest, other diseases of the digestive system; Other Respiratory, other diseases of the respiratory system; Other Nervous, other disorders of the nervous system; Sys Atrophies, systemic atrophies primarily affecting the central nervous system; Esophagus stomach duod, diseases of esophagus, stomach, or duodenum; Hepatitis, viral hepatitis; Intestinal Infect, intestinal infectious diseases; Undetermined Intent, event of undetermined intent; Fetal Growth, disorders related to length of gestation or fetal growth; Connective Tissue, systemic connective tissue disorders; Obesity, obesity or other hyperalimentation; Arthropathies, arthropathies; Veins Lymphatic, diseases of veins, lymphatic vessels, or lymph nodes, not elsewhere classified; Circulatory Malform, congenital malformations of the circulatory system.

Supplemental Figure

Scatterplots of relative disparities (age-adjusted mortality ratio) and absolute disparities (years of life lost) for each of 4 racial/ethnic minority groups compared with the non-Hispanic white population for the 26th- to 50^th-ranked leading causes of death in the United States, 1999–2010. Causes of death were categorized according to the International Classification of Diseases, 10^th Revision. Scatterplot A is for non-Hispanic blacks; B is for Hispanic whites; C is for non-Hispanic Asians/Pacific Islanders; and D is for non-Hispanic American Indians/Alaska Natives. Abbreviations for categories of causes of death were used to provide clearer plots. Abbreviations: PHD, pulmonary heart disease and diseases of pulmonary circulation; General, general symptoms and signs; Unk Neoplasms, neoplasms of uncertain or unknown behavior; HIV, human immunodeficiency virus disease; Substance Use, mental or behavioral disorders due to psychoactive substance use; Gal BilTract Pan, disorders of gallbladder, biliary tract, or pancreas; Other Digest, other diseases of the digestive system; Other Respiratory, other diseases of the respiratory system; Other Nervous, other disorders of the nervous system; Sys Atrophies, systemic atrophies primarily affecting the central nervous system; Esophagus stomach duod, diseases of esophagus, stomach, or duodenum; Hepatitis, viral hepatitis; Intestinal Infect, intestinal infectious diseases; Undetermined Intent, event of undetermined intent; Fetal Growth, disorders related to length of gestation or fetal growth; Connective Tissue, systemic connective tissue disorders; Obesity, obesity or other hyperalimentation; Arthropathies, arthropathies; Veins Lymphatic, diseases of veins, lymphatic vessels, or lymph nodes, not elsewhere classified; Circulatory Malform, congenital malformations of the circulatory system.