Death of family members as an overlooked source of racial disadvantage in the United States

Abstract

Long-standing racial differences in US life expectancy suggest that black Americans would be exposed to significantly more family member deaths than white Americans from childhood through adulthood, which, given the health risks posed by grief and bereavement, would add to the disadvantages that they face. We analyze nationally representative US data from the National Longitudinal Study of Youth (n = 7,617) and the Health and Retirement Study (n = 34,757) to estimate racial differences in exposure to the death of family members at different ages, beginning in childhood. Results indicate that blacks are significantly more likely than whites to have experienced the death of a mother, a father, and a sibling from childhood through midlife. From young adulthood through later life, blacks are also more likely than whites to have experienced the death of a child and of a spouse. These results reveal an underappreciated layer of racial inequality in the United States, one that could contribute to the intergenerational transmission of health disadvantage. By calling attention to this heightened vulnerability of black Americans, our findings underscore the need to address the potential impact of more frequent and earlier exposure to family member deaths in the process of cumulative disadvantage.

Keywords: bereavement; disparities; family; life expectancy; race.

Fig. S1.

Ratio of black/white cumulative risk for specific family member deaths. (A) National Longitudinal Study of Adolescent to Adult Health (Add Health). (B) National Longitudinal Survey of Youth 1979 (NLSY-79). Ratio for black-to-white cumulative risk of specific family member deaths; values above 1 reflect greater risk for blacks; age refers to the age by which the death occurred. Information on child death in Add Health is not shown, given that only five whites experienced the loss of a child before age 20 in that dataset; by age 30, however, the ratio of black-to-white cumulative risk was 2.9; lines cover the ages when respondents reported on each death.

Fig. S2.

Adjusted odds ratios of no family member death vs. cumulative family member deaths for blacks relative to whites. (A) National Longitudinal Study of Adolescent to Adult Health (Add Health). (B) National Longitudinal Survey of Youth 1979 (NLSY-79). Odds ratios for no family member deaths and multiple family member deaths for blacks compared with whites; n = 6,691 for Add Health and n = 5,354 for NLSY-79. ***P < 0.001.

Fig. S3.

Age-specific hazard of family member deaths to age 30: National Longitudinal Study of Adolescent to Adult Health (Add Health). Age-specific hazard of death exposures for blacks and whites; hazard ratios are shown with 95% confidence intervals. (A) Maternal death; (B) paternal death; (C) child death; (D) sibling death.

Fig. S4.

Age-specific hazard of family member deaths to age 50: National Longitudinal Survey of Youth 1979 (NLSY-79). Age-specific hazard of death exposures for blacks and whites; hazard ratios are shown with 95% confidence intervals. (A) Maternal death; (B) paternal death; (C) child death; (D) spousal death.

Fig. 1.

Ratio for black/white cumulative risk of specific family member deaths. (A) National Longitudinal Survey of Youth 1997; (B) Health and Retirement Study. Values above 1 reflect greater risk for blacks; age refers to the age by which the death occurred; lines cover the ages when respondents reported on each death.

Fig. 2.

Odds ratios for no family member deaths and multiple family member deaths for blacks compared with whites. (A) National Longitudinal Survey of Youth 1997; (B) Health and Retirement Study. n = 34,757 for HRS and n = 7,055 for NLSY-97. ***P < 0.001.

Fig. 3.

Age-specific hazard of death exposures for blacks and whites; hazard ratios shown with 95% confidence intervals. (A) Maternal death; (B) paternal death; (C) sibling death; (D) child death.

Fig. 4.

Age-specific hazard of death exposures for blacks and whites; hazard ratios shown with 95% confidence intervals. (A) Maternal death; (B) paternal death; (C) spousal death; (D) sibling death; (E) child death.