"Outside the Skin": The Persistence of Black-White Disparities in U.S. Early-Life Mortality

Abstract

Research on Black-White disparities in mortality emphasizes the cumulative pathways through which racism gets "under the skin" to affect health. Yet this framing is less applicable in early life, when death is primarily attributable to external causes rather than cumulative, biological processes. We use mortality data from the National Vital Statistics System Multiple Cause of Death files and population counts from the Surveillance, Epidemiology, and End Result Program to analyze 705,801 deaths among Black and White males and females, ages 15-24. We estimate age-standardized death rates and single-decrement life tables to show how all-cause and cause-specific mortality changed from 1990 to 2016 by race and sex. Despite overall declines in early-life mortality, Black-White disparities remain unchanged across several causes-especially homicide, for which mortality is nearly 20 times as high among Black as among White males. Suicide and drug-related deaths are higher among White youth during this period, yet their impact on life expectancy at birth is less than half that of homicide among Black youth. Critically, early-life disparities are driven by preventable causes of death whose impact occurs "outside the skin," reflecting racial differences in social exposures and experiences that prove harmful for both Black and White adolescents and young adults.

Keywords: Adolescence/young adulthood; Homicide; Mortality; Racial disparities; Racism.

Figure 1.

United States All Cause Age-Standardized Mortality Rates (Panel A) and Ratios (Panel B), Ages 15-24, 1990-2016 Notes: Data come from National Vital Statistics System mortality files and Surveillance, Epidemiology, and End Result Program population counts. Three-year moving averages.

Figure 2.

United States External Age-Standardized Mortality Rates, Ages 15-24, 1990-2016 Notes: Data come from National Vital Statistics System mortality files and Surveillance, Epidemiology, and End Result Program population counts. Three-year moving averages.

Figure 3.

United States Drug Related Age-Standardized Death Rates, Ages 15-24, 1990-2016 Notes: Data come from National Vital Statistics System mortality files and Surveillance, Epidemiology, and End Result Program population counts. Three-year moving averages.

Figure 4.

United States Cancer Age-Standardized Death Rates, Ages 15-24, 1990-2016 Notes: Data come from National Vital Statistics System mortality files and Surveillance, Epidemiology, and End Result Program population counts. Three-year moving averages.

Figure 5.

Life Expectancy (e₀) Improvements From Cause-Specific Mortality Elimination at Ages 15-24, United States 2016 Notes: Data come from National Vital Statistics System mortality files and Surveillance, Epidemiology, and End Result Program population counts.