McCord C, Freeman H P
Department of Surgery, Columbia University, New York, NY.
N Engl J Med. 1990 Jan 18;322(3):173-7. doi: 10.1056/NEJM199001183220306.
In recent decades mortality rates have declined for both white and nonwhite Americans, but national averages obscure the extremely high mortality rates in many inner-city communities. Using data from the 1980 census and from death certificates in 1979, 1980, and 1981, we examined mortality rates in New York City's Central Harlem health district, where 96 percent of the inhabitants are black and 41 percent live below the poverty line. For Harlem, the age-adjusted rate of mortality from all causes was the highest in New York City, more than double that of U.S. whites and 50 percent higher than that of U.S. blacks. Almost all the excess mortality was among those less than 65 years old. With rates for the white population as the basis for comparison, the standardized (adjusted for age) mortality ratios (SMRs) for deaths under the age of 65 in Harlem were 2.91 for male residents and 2.70 for female residents. The highest ratios were for women 25 to 34 years old (SMR, 6.13) and men 35 to 44 years old (SMR, 5.98). The chief causes of this excess mortality were cardiovascular disease (23.5 percent of the excess deaths; SMR, 2.23), cirrhosis (17.9 percent; SMR, 10.5), homicide (14.9 percent; SMR, 14.2), and neoplasms (12.6 percent; SMR, 1.77). Survival analysis showed that black men in Harlem were less likely to reach the age of 65 than men in Bangladesh. Of the 353 health areas in New York, 54 (with a total population of 650,000) had mortality rates for persons under 65 years old that were at lest twice the expected rate. All but one of these areas of high mortality were predominantly black or Hispanic. We conclude that Harlem and probably other inner-city areas with largely black populations have extremely high mortality rates that justify special consideration analogous to that given to natural-disaster areas.
近几十年来，美国白人和非白人的死亡率均有所下降，但全国平均水平掩盖了许多市中心社区极高的死亡率。利用1980年人口普查数据以及1979年、1980年和1981年的死亡证明，我们研究了纽约市中央哈莱姆健康区的死亡率，该地区96%的居民为黑人，41%的居民生活在贫困线以下。在哈莱姆区，所有原因导致的年龄调整死亡率是纽约市最高的，比美国白人高出一倍多，比美国黑人高出50%。几乎所有额外的死亡都发生在65岁以下人群中。以白人人口的死亡率为比较基础，哈莱姆区65岁以下居民的标准化（年龄调整后）死亡率，男性居民为2.91，女性居民为2.70。最高的比率出现在25至34岁的女性（标准化死亡率为6.13）和35至44岁的男性（标准化死亡率为5.98）中。这种额外死亡率的主要原因是心血管疾病（占额外死亡人数的23.5%；标准化死亡率为2.23）、肝硬化（17.9%；标准化死亡率为10.5）、凶杀（14.9%；标准化死亡率为14.2）和肿瘤（12.6%；标准化死亡率为1.77）。生存分析表明，哈莱姆区的黑人男性活到65岁的可能性低于孟加拉国的男性。在纽约的353个健康区域中，有54个（总人口65万）65岁以下人群的死亡率至少是预期死亡率的两倍。除了一个区域外，所有这些高死亡率地区主要是黑人或西班牙裔。我们得出结论，哈莱姆区以及其他可能以黑人为主的市中心地区死亡率极高，理应得到类似于对自然灾害地区的特殊关注。
