Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada.
Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, CA, USA.
Public Health Rep. 2019 Nov/Dec;134(6):634-642. doi: 10.1177/0033354919878158. Epub 2019 Oct 10.
Racial differences in mortality in the United States have narrowed and vary by time and place. The objectives of our study were to (1) examine the gap in life expectancy between white and black persons (hereinafter, racial gap in life expectancy) in 4 states (California, Georgia, Illinois, and New York) and (2) estimate trends in the contribution of major causes of death (CODs) to the racial gap in life expectancy by age group.
We extracted data on the number of deaths and population sizes for 1969-2013 by state, sex, race, age group, and 6 major CODs. We used a Bayesian time-series model to smooth and impute mortality rates and decomposition methods to estimate trends in sex- and age-specific contributions of CODs to the racial gap in life expectancy.
The racial gap in life expectancy at birth decreased in all 4 states, especially among men in New York (from 8.8 to 1.1 years) and women in Georgia (from 8.0 to 1.7 years). Although few deaths occurred among persons aged 1-39, racial differences in mortality at these ages (mostly from injuries and infant mortality) contributed to the racial gap in life expectancy, especially among men in California (1.0 year of the 4.3-year difference in 2013) and Illinois (1.9 years of the 6.7-year difference in 2013). Cardiovascular deaths contributed most to the racial gap in life expectancy for adults aged 40-64, but contributions decreased among women aged 40-64, especially in Georgia (from 2.8 to 0.5 years). The contribution of cancer deaths to inequality increased in California and Illinois, whereas New York had the greatest reductions in inequality attributable to cancer deaths (from 0.6 to 0.2 years among men and from 0.2 to 0 years among women).
Future research should identify policy innovations and economic changes at the state level to better understand New York's success, which may help other states emulate its performance.
美国的死亡率存在种族差异，且这种差异因时间和地点而异。本研究的目的是：(1) 检测加利福尼亚州、佐治亚州、伊利诺伊州和纽约州这 4 个州的白人和黑人之间的预期寿命差距（以下简称预期寿命种族差距）；(2) 按年龄组估计主要死因对预期寿命种族差距的贡献趋势。
我们提取了各州、性别、种族、年龄组和 6 种主要死因的 1969-2013 年的死亡人数和人口规模数据。我们使用贝叶斯时间序列模型来平滑和推断死亡率，并采用分解方法来估计性别和年龄特异性死因对预期寿命种族差距的贡献趋势。
在这 4 个州，预期寿命种族差距均有所缩小，其中纽约州男性（从 8.8 岁降至 1.1 岁）和佐治亚州女性（从 8.0 岁降至 1.7 岁）的差距缩小最为明显。虽然 1-39 岁人群的死亡人数较少，但这些年龄组的死亡率差异（主要来自伤害和婴儿死亡率）对预期寿命种族差距仍有影响，尤其是加利福尼亚州男性（2013 年 4.3 岁差距中的 1.0 岁）和伊利诺伊州男性（2013 年 6.7 岁差距中的 1.9 岁）。心血管疾病死亡对 40-64 岁成年人的预期寿命种族差距贡献最大，但佐治亚州 40-64 岁女性的这一贡献有所下降（从 2.8 岁降至 0.5 岁）。加利福尼亚州和伊利诺伊州的癌症死亡对不平等的贡献增加，而纽约州癌症死亡导致的不平等程度降低幅度最大（男性从 0.6 岁降至 0.2 岁，女性从 0.2 岁降至 0 岁）。
未来的研究应确定州一级的政策创新和经济变化，以更好地了解纽约州成功的原因，这可能有助于其他州效仿其表现。
