Reductions in the death rate from homicide, HIV disease, unintentional injuries – and among women, heart disease – have contributed to narrowing the life expectancy gap between blacks and whites in the United States, although substantial inequalities and challenges remain, according to a study in the March 21 issue of JAMA.

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Life expectancy at birth has generally been increasing in the United States since at least the late 19th century. For as long as data have been reported by race/ethnicity, life expectancy of blacks has been lower than that of whites, according to background information in the article. Since the early 1980s, the black-white life expectancy gap increased sharply, then subsequently declined. But the causes of these changes have not been investigated.

Sam Harper, Ph.D., of McGill University, Montreal, Quebec, and colleagues conducted a study to determine the contribution of specific age groups and causes of death to changes in the black-white life expectancy gap from 1983 to 2003. They analyzed data from the U.S. National Vital Statistics System, maintained by the National Center for Health Statistics, which collects information on all deaths occurring in the United States each year.

The authors report that after widening during the late 1980s, the black-white life expectance gap has declined because of relative mortality improvements in homicide, HIV disease, unintentional injuries – and among women, heart disease.

"For females, heart disease made by far the largest contribution to the overall life expectance gap, accounting for 1.4 years (28 percent) of the gap in 1983, 1.6 years (28 percent) in 1993, and 1.3 years (30 percent) in 2003," the authors write. "Other important causes of the 4.5-year gap in 2003 include diabetes (0.5 years), stroke (0.4 years), and perinatal death (0.4 years)."

"Among males, the largest contribution to the gap was homicide in 1983 (1.1 years) and 1993 (1.6 years), but by 2003 heart disease became the leading cause, accounting for 1.4 years (21 percent) of the overall 6.3-year gap, followed by homicide (one year), HIV (0.6 years), and perinatal death (0.4 years)," they continue.

The current difference in life expectancy at birth between blacks and whites remains substantial, 6.3 years for men and 4.5 years for women. "Homicide, HIV, and perinatal death, although demonstrating favorable trends, continue to keep the black-white gap unnecessarily large, and unfavorable mortality trends in nephritis [kidney disease] and septicemia [bloodstream infection] are currently contributing to widening the gap," the authors write.

The authors emphasize that further narrowing of the gap will require concerted efforts to address the major causes of the remaining gap.

"Reducing social and individual risk factors for major causes of death and improving access and quality of care for blacks, particularly for cardiovascular diseases, should be a pressing priority for public health and health care," they conclude.
(JAMA. 2007;297:1224-1232. Available to the media at www.jamamedia.org)

Editor's Note: This work was supported in part by the Robert Wood Johnson Foundation’s Investigator Awards in Health Policy Research Program (co-authors John Lynch, Ph.D., George Davey Smith, M.D., and Scott Burris, J.D.) and by a contract from the National Cancer Institute (Dr. Harper). Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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