Public Health Life Expectancy Gaps Among Black and White Persons and Contributing Causes of Death in 3 Large US Cities, 2018-2019

Authors: Pamela T. Roesch, MPH; Nazia S. Saiyed, MPH; Emily Laflamme, MPH; Fernando G. De Maio, PhD; Maureen R. Benjamins, PhD

Importance:
- US cities exhibit significant but variable levels of racial mortality inequities, primarily due to structural racism.
- As partnerships aim to eliminate health inequities, it is essential to have local data to streamline efforts.
Objective:
- Analyze contributions of 26 cause-of-death categories to Black to White life expectancy differentials across three major US cities.
Design, Setting, and Participants:
- A cross-sectional study analyzing 2018-2019 data from the National Vital Statistics System Multiple Cause of Death data files.
- Analyzed data based on factors such as race, ethnicity, sex, age, residential area, and causes of death in Baltimore, Houston, and Los Angeles.
- Life expectancy was calculated using abridged life tables with 5-year age intervals for non-Hispanic Black and White populations.
- Data analysis timeframe was February to May 2022.

Utilized the Arriaga method to calculate the Black to White life expectancy gap proportion attributable to 26 specified cause-of-death categories according to the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes.

Study Population:
- 66,321 death records analyzed for 2018-2019.
- Population Breakdown:
- Black: 29,057 (44%)
- Male: 34,745 (52%)
- Aged 65+: 46,128 (70%)
Life Expectancy Gaps:
- Baltimore: 7.60 years
- Houston: 8.06 years
- Los Angeles: 9.57 years
Top Contributors to Gaps:
- Circulatory Diseases
- Cancer
- Injuries
- Diabetes and Endocrine Disorders
City Specific Findings:
- Circulatory diseases:
- Los Angeles: 3.76 years (39.3%)
- Baltimore: 2.12 years (28.0%)
- Different magnitude of contribution noted across cities: 11.3 percentage points higher in Los Angeles vs Baltimore.
- Injuries contributed significantly to the gap in Baltimore (2.22 years [29.3%]), compared to Houston (1.11 years [13.8%]) and Los Angeles (1.36 years [14.2%]).

The study elucidates the composition of life expectancy disparities between Black and White populations across three large US cities, demonstrating unique contributing causes.
Insight gained can inform local resource allocation efforts aimed at diminishing racial inequities.

Structural racism contributes significantly to racial mortality inequities in major US cities.
The extent of these inequities and progress toward addressing them vary by city.
Local analyses of causes of death are critical for tailoring interventions aimed at health equity.
Previous studies provided limited city-level causal insights, necessitating a focused approach on urban data.
Examples of previous analyses include studies in Chicago that highlighted heart disease and homicide’s role in exacerbating life expectancy gaps.

Overall life expectancy data provides a broad idea of structural racism’s impact.
Distinct causes of death must be identified to effectively guide local initiatives.
Previous national and state-level studies highlight chronic diseases and injuries as common contributors, yet city-level uniqueness should be acknowledged.
80% of the US population resides in urban areas, amplifying the relevance of localized research.

Analyze racial life expectancy inequities in Baltimore, Houston, and Los Angeles using decomposition methods.
Selection Criteria:
- Significant Black to White life expectancy gap, recent changes in these gaps, and geographic diversity.
- Excluded regions with recent similar analyses (e.g., Chicago, Washington DC).

Death data sourced from 2018-2019 Multiple Cause of Death data files from the National Vital Statistics System.
Data collected with respect to underlying and contributing causes of death, race, sex, and demographics.
Applied 2019 American Community Survey estimates for population and socioeconomic characteristics.

Life expectancy calculated using methods by Chiang and categorized according to the ICD-10 framework.
Ages grouped into five-year intervals, while excluding non-relevant records.

All three cities are geographically diverse and exhibit differences in mortality and socioeconomics.
Comparison of populations and relevant socioeconomic indicators reveals issues like poverty, income inequality, and educational attainment.

Total death records extracted: 95,776
- 48,911 from Los Angeles, 34,088 from Houston, 12,777 from Baltimore.
Final analysis included 66,321 records (Los Angeles: 29,134; Houston: 24,663; Baltimore: 12,524).

Reported life expectancies for 2018-2019:
- Los Angeles: Black - 71.98, White - 81.55
- Houston: Black - 68.75, White - 76.82
- Baltimore: Black - 70.14, White - 77.73
- Overall Black-White gap showed Los Angeles leading (9.57 years), followed by Houston (8.06 years) and Baltimore (7.60 years).

Circulatory diseases maintained a substantial contribution across cities:
- Los Angeles: 3.76 years (39.3%)
- Houston: 2.53 years (31.4%)
- Baltimore: 2.12 years (28.0%)
Baltimore shows an increased gap from injuries (2.22 years [29.3%] vs lesser contributions in others).

Male individuals showed a higher vulnerability to injuries primarily due to homicides.
Overall, circulatory diseases, cancer, and diabetes are significant contributors.
Female individuals experience greater contributions from chronic conditions, less so from injury-related deaths.

Differences across cities reinforce the need for localized responses to address racial health inequities.
Understanding the top contributors elevates the potential for targeted funding and initiatives.
- Chronic diseases and injuries most critically affect racial disparities.
Call for multi-faceted approaches targeting structural racism alongside commercial, financial, and social determinants of health.

Focus on Black to White comparisons may overlook mortality experiences of other marginalized groups.
Analysis does not account for changes post-COVID-19, potentially inflating existing gaps.
Data context must expand beyond 2010 Census, and the method has limitations in attributing cause contributions rigidly.

This study offers valuable insights into racial life expectancy gaps, underlining a distinct need for localized health equity initiatives.
Effective allocation of resources hinges on rigorous understanding and action toward specified causal pathways affecting urban mortality inequities.
Collaboration across sectors will enhance health equity efforts and support holistic interventions.

List of references cited throughout the study (briefly noted as these may require direct citation from the document).