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Comparative Study
. 2023 May 16;329(19):1662-1670.
doi: 10.1001/jama.2023.7022.

Excess Mortality and Years of Potential Life Lost Among the Black Population in the US, 1999-2020

César Caraballo  1   2 , Daisy S Massey  3 , Chima D Ndumele  4 , Trent Haywood  5 , Shayaan Kaleem  6 , Terris King  7 , Yuntian Liu  1 , Yuan Lu  1   2 , Marcella Nunez-Smith  8 , Herman A Taylor  9 , Karol E Watson  10 , Jeph Herrin  2 , Clyde W Yancy  11   12 , Jeremy Samuel Faust  13 , Harlan M Krumholz  1   2   4
Affiliations
Comparative Study

Excess Mortality and Years of Potential Life Lost Among the Black Population in the US, 1999-2020

César Caraballo et al. JAMA. .

Erratum in

  • Figure Label Correction.
    [No authors listed] [No authors listed] JAMA. 2023 Sep 19;330(11):1101. doi: 10.1001/jama.2023.17516. JAMA. 2023. PMID: 37639252 Free PMC article. No abstract available.

Abstract

Importance: Amid efforts in the US to promote health equity, there is a need to assess recent progress in reducing excess deaths and years of potential life lost among the Black population compared with the White population.

Objective: To evaluate trends in excess mortality and years of potential life lost among the Black population compared with the White population.

Design, setting, and participants: Serial cross-sectional study using US national data from the Centers for Disease Control and Prevention from 1999 through 2020. We included data from non-Hispanic White and non-Hispanic Black populations across all age groups.

Exposures: Race as documented in the death certificates.

Main outcomes and measures: Excess age-adjusted all-cause mortality, cause-specific mortality, age-specific mortality, and years of potential life lost rates (per 100 000 individuals) among the Black population compared with the White population.

Results: From 1999 to 2011, the age-adjusted excess mortality rate declined from 404 to 211 excess deaths per 100 000 individuals among Black males (P for trend <.001). However, the rate plateaued from 2011 through 2019 (P for trend = .98) and increased in 2020 to 395-rates not seen since 2000. Among Black females, the rate declined from 224 excess deaths per 100 000 individuals in 1999 to 87 in 2015 (P for trend <.001). There was no significant change between 2016 and 2019 (P for trend = .71) and in 2020 rates increased to 192-levels not seen since 2005. The trends in rates of excess years of potential life lost followed a similar pattern. From 1999 to 2020, the disproportionately higher mortality rates in Black males and females resulted in 997 623 and 628 464 excess deaths, respectively, representing a loss of more than 80 million years of life. Heart disease had the highest excess mortality rates, and the excess years of potential life lost rates were largest among infants and middle-aged adults.

Conclusions and relevance: Over a recent 22-year period, the Black population in the US experienced more than 1.63 million excess deaths and more than 80 million excess years of life lost when compared with the White population. After a period of progress in reducing disparities, improvements stalled, and differences between the Black population and the White population worsened in 2020.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Haywood reported that he is the chief medical officer of Zing Health and had served as deputy chief medical officer for the Centers for Medicare & Medicaid Services, Blue Cross Blue Shield Association, and Vizient. Dr Taylor reported serving as an advisor and consultant for UnitedHealth Group, Pfizer, and Novartis. Dr Yancy reported spousal (former) employment at Abbott Labs, Inc. Dr Krumholz reported receiving personal fees from UnitedHealth, Element Science, Eyedentifeye, and F-Prime; being a cofounder of Refactor Health and HugoHealth; and being associated with contracts, through Yale New Haven Hospital, from the Centers for Medicare & Medicaid Services and through Yale University from the US Food and Drug Administration, Johnson & Johnson, Pfizer, and Google. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. US Black Population Excess Age-Adjusted Mortality and Years of Potential Life Lost Rates, 1999-2020
To assess trends over time, the relationship between each metric and study year was graphically assessed, and time was modeled as a linear spline with knots that reflected the observed inflection points from 1999 to 2019. For excess mortality rates, these inflection points were from 2007 to 2011 for males and 2015 for females. For excess rates of years of potential life lost, the knots were 2007 and 2011 for males and 2012 for females. Rates that fall above the dotted line indicate rates higher than the White population and those that fall below, rates lower than the White population. Autoregressive integrated moving average models using a 1-year correlation were implemented to account for the serial correlation of annual rates. The 2019-2020 change was estimated using a z test.
Figure 2.
Figure 2.. US Black Population Excess Age-Adjusted Mortality and Years of Potential Life Lost Rates by Leading Causes of Death, 1999-2020
Excess mortality or the years of potential life lost rates were defined as the difference in each year’s mortality rate or years of potential life lost rate between the Black population and the White population. All rates are estimated per 100 000 individuals. Presented herein are the 22-year leading causes of death among both populations (details are in the Methods section). For visualization purposes, causes of death are presented in descending order based on the mean 22-year excess mortality rate among Black males. An excess mortality rate or years of potential life lost rate of 0 is shown in white and represents the absence of a difference. In shades of red are the annual metrics for which the Black population estimates were higher than those of the White population. In shades of blue are the annual metrics for which the White population estimates were higher than those of the Black population.
Figure 3.
Figure 3.. US Black Population Excess Mortality Rate and Years of Potential Life Lost by Age Group
Excess mortality rates among the US Black population by age group were calculated by subtracting the mortality rate of the White population from that of the Black population. Excess years of potential life lost rates among the US Black population were defined as the difference in years of potential life lost within each age group between the Black population and the White population. An excess mortality or years of potential life lost rate of 0 represents the absence of a difference. Rates were estimated per 100 000 individuals. Rates that fall above the blue dotted line indicate rates higher than the White population and those that fall below, rates lower than the White population.
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