Comparison of All-Cause Mortality Rates and Inequities Between Black and White Populations Across the 30 Most Populous US Cities
Level 4 - case-series / case-control
Cross-sectional vital statistics analysis and ecological trend study.
OpenAlex W3125407753 · doi:10.1001/jamanetworkopen.2020.32086
What was done
The authors conducted a cross-sectional and trend analysis of 26,295,827 death records from the National Vital Statistics System combined with American Community Survey population estimates. They calculated age-standardized all-cause mortality rates for non-Hispanic Black, non-Hispanic White, and total populations from 2016 to 2018 across the United States and its 30 most populous cities. Temporal changes from 2009 to 2018 in mortality rates and Black-to-White mortality rate ratios were assessed using joinpoint regression to calculate average annual percentage change.
What was found
- Overall mortality (2016–2018) ranged from 537 per 100,000 in San Francisco to 1,342 per 100,000 in Las Vegas, compared to a national rate of 759 per 100,000. - Nationally, all-cause mortality among Black populations was 24% higher than among White populations (rate ratio, 1.236; 95% CI, 1.233 to 1.238), resulting in 74,402 excess Black deaths annually. - Excess annual Black deaths at the city level ranged from 6 in El Paso to 3,804 in Chicago. - Over 10 years, national mortality rates were flat (average annual percentage change [AAPC], -0.10%; 95% CI, -0.34% to 0.14%; P = .42), while national Black-White inequity slightly decreased (AAPC, -0.51%; 95% CI, -0.92% to -0.09%; P = .02). - Only 14 of 30 cities (46.7%) saw overall mortality rate improvements; racial inequities widened in 6 cities (20.0%) and narrowed in only 2 cities (6.7%).
Why it matters
National trends obscure substantial municipal-level variations in mortality and racial health disparities. Providing city-specific data equips local governments and health departments to allocate targeted resources where Black-White mortality gaps persist or are widening.
Limits
The study is restricted to the 30 most populous US cities, excluding smaller cities, suburban, and rural populations. Analysis is limited to aggregate non-Hispanic Black and non-Hispanic White comparisons, omitting other racial/ethnic groups, cause-specific mortality breakdowns, and individual-level socioeconomic confounders.
Cited by
- context Louisville, Kentucky is among the top 10 or top 20 largest cities by population in the United States.