Roesch Pamela T, Saiyed Nazia S, Laflamme Emily, De Maio Fernando G, Benjamins Maureen R
Sinai Urban Health Institute, Chicago, Illinois.
Center for Neighborhood Technology, Chicago, Illinois.
JAMA Netw Open. 2023 Mar 1;6(3):e233146. doi: 10.1001/jamanetworkopen.2023.3146.
US cities have substantial, but varying, levels of racial mortality inequities, a consequence of structural racism. As committed partners increasingly pledge to eliminate health inequities, local data are required to focus and unify efforts.
To analyze the contributions of 26 cause-of-death categories to Black to White life expectancy gaps within 3 large US cities.
DESIGN, SETTING, AND PARTICIPANTS: In this cross-sectional study, data were extracted from the 2018 and 2019 National Vital Statistics System Multiple Cause of Death Restricted Use data files for deaths by race, ethnicity, sex, age, place of residence, and underlying and contributing causes of death in Baltimore, Maryland; Houston, Texas; and Los Angeles, California. Life expectancy at birth was calculated for non-Hispanic Black and non-Hispanic White populations overall and by sex using abridged life tables with 5-year age intervals. Data analysis was performed from February to May 2022.
Using the Arriaga method, the proportion of the Black to White life expectancy gap was calculated overall and by sex for each city that was attributable to 26 cause-of-death categories defined using the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes for underlying and contributing causes of death.
A total of 66 321 death records from 2018 to 2019 were analyzed, with 29 057 individuals (44%) were identified as Black, 34 745 (52%) as male, and 46 128 (70%) as aged 65 years and older. Black to White life expectancy gaps were 7.60 years for Baltimore, 8.06 years for Houston, and 9.57 years for Los Angeles. Circulatory diseases, cancer, injuries, and diabetes and endocrine disorders were top contributors to the gaps, although the order and magnitude varied by city. The contribution of circulatory diseases was 11.3 percentage points higher in Los Angeles than in Baltimore (3.76 years [39.3%] vs 2.12 years [28.0%]). The contribution of injuries to Baltimore's racial gap (2.22 years [29.3%]) was twice as large as in Houston (1.11 years [13.8%]) and Los Angeles (1.36 years [14.2%]).
By assessing the composition of Black to White life expectancy gaps for 3 large US cities and categorizing deaths at a more granular level than past studies, this study provides insight into the differing underpinnings of urban inequities. This type of local data can support local resource allocation that more effectively addresses racial inequities.
美国城市存在严重但程度各异的种族死亡率不平等现象，这是结构性种族主义的结果。随着致力于消除健康不平等的伙伴越来越多，需要地方数据来集中和统一努力。
分析26种死因类别对美国3个大城市中黑人与白人预期寿命差距的影响。
设计、背景和参与者：在这项横断面研究中，从2018年和2019年国家生命统计系统多死因限制使用数据文件中提取了有关种族、族裔、性别、年龄、居住地点以及马里兰州巴尔的摩、得克萨斯州休斯敦和加利福尼亚州洛杉矶的潜在死因和促成死因的数据。使用间隔为5岁的简略寿命表计算了非西班牙裔黑人和非西班牙裔白人总体以及按性别的出生时预期寿命。数据分析于2022年2月至5月进行。
使用阿瑞亚加方法，计算了每个城市总体以及按性别划分的黑人与白人预期寿命差距中可归因于使用《国际疾病和相关健康问题统计分类》第十次修订版代码定义的26种死因类别的比例，这些代码用于潜在死因和促成死因。
共分析了2018年至2019年的66321条死亡记录，其中29057人（44%）被确定为黑人，34745人（52%）为男性，46128人（70%）年龄在65岁及以上。巴尔的摩的黑人与白人预期寿命差距为7.60岁，休斯敦为8.06岁，洛杉矶为9.57岁。循环系统疾病、癌症、伤害以及糖尿病和内分泌失调是造成差距的主要因素，尽管其顺序和程度因城市而异。循环系统疾病在洛杉矶造成的差距贡献比在巴尔的摩高11.3个百分点（3.76年[39.3%]对2.12年[28.0%]）。伤害对巴尔的摩种族差距的贡献（2.22年[29.3%]）是休斯敦（1.11年[13.8%]）和洛杉矶（1.36年[14.2%]）的两倍。
通过评估美国3个大城市中黑人与白人预期寿命差距的构成，并比以往研究更细致地对死亡进行分类，本研究深入了解了城市不平等现象的不同根源。这类地方数据可支持地方资源分配，从而更有效地解决种族不平等问题。
