Geronimus A T, Bound J, Waidmann T A, Hillemeier M M, Burns P B
Department of Health Behavior and Health Education, School of Public Health, Ann Arbor, MI 48109-2029, USA.
N Engl J Med. 1996 Nov 21;335(21):1552-8. doi: 10.1056/NEJM199611213352102.
Although the general relations between race, socioeconomic status, and mortality in the United States are well known, specific patterns of excess mortality are not well understood.
Using standard demographic techniques, we analyzed death certificates and census data and made sex-specific population-level estimates of the 1990 death rates for people 15 to 64 years of age. We studied mortality among blacks in selected areas of New York City, Detroit, Los Angeles, and Alabama (in one area of persistent poverty and one higher-income area each) and among whites in areas of New York City, metropolitan Detroit, Kentucky, and Alabama (one area of poverty and one higher-income area each). Sixteen areas were studied in all.
When they were compared with the nationwide age-standardized annual death rate for whites, the death rates for both sexes in each of the poverty areas were excessive, especially among blacks (standardized mortality ratios for men and women in Harlem, 4.11 and 3.38; in Watts, 2.92 and 2.60; in central Detroit, 2.79 and 2.58; and in the Black Belt area of Alabama, 1.81 and 1.89). Boys in Harlem who reached the age of 15 had a 37 percent chance of surviving to the age of 65; for girls, the likelihood was 65 percent. Of the higher-income black areas studied, Queens--Bronx had the income level most similar to that of whites and the lowest standardized mortality ratio (men, 1.18; women, 1.08). Of the areas where poor whites were studied, Detroit had the highest standardized mortality ratios (men, 2.01; women, 1.90). On the Lower East Side of Manhattan, in Appalachia, and in Northeast Alabama, the ratios for whites were below the national average for blacks (men, 1.90; women, 1.95).
Although differences in mortality rates before the age of 65 between advantaged and disadvantaged groups in the United States are sometimes vast, there are important differences among impoverished communities in patterns of excess mortality.
尽管美国种族、社会经济地位与死亡率之间的总体关系已为人熟知，但超额死亡率的具体模式却尚未得到充分理解。
我们运用标准人口统计学技术，分析了死亡证明和人口普查数据，并针对15至64岁人群按性别进行了1990年人口水平死亡率的估算。我们研究了纽约市、底特律、洛杉矶和阿拉巴马州特定区域（各有一个持续贫困地区和一个高收入地区）的黑人死亡率，以及纽约市、底特律大都市区、肯塔基州和阿拉巴马州（各有一个贫困地区和一个高收入地区）的白人死亡率。总共研究了16个地区。
与全国白人年龄标准化年死亡率相比，各贫困地区男女死亡率均过高，尤其是黑人（哈莱姆区男性和女性的标准化死亡比分别为4.11和3.38；瓦茨区为2.92和2.60；底特律市中心为2.79和2.58；阿拉巴马州黑带地区为1.81和1.89）。在哈莱姆区，15岁的男孩活到65岁的几率为37%；女孩的几率为65%。在研究的高收入黑人地区中，皇后区 - 布朗克斯区的收入水平与白人最接近，标准化死亡比最低（男性为1.18；女性为1.08）。在研究贫困白人的地区中，底特律的标准化死亡比最高（男性为2.01；女性为1.90）。在曼哈顿下东区、阿巴拉契亚地区和阿拉巴马州东北部，白人的死亡率低于全国黑人平均水平（男性为1.90；女性为1.95）。
尽管美国优势群体和弱势群体在65岁之前的死亡率差异有时很大，但贫困社区在超额死亡率模式上存在重要差异。
