More Information on Health Disparities

A Tale of Three Cities: Racial and Ethnic Disparities in Premature Mortality in the District of Columbia, 2005

October 22, 2008
Annette B. Ramirez de Arellano, Dr.PH., Sidney Wolfe, M.D., Kate Resnevic, Alejandro Necochea, M.D., M.P.H.

Full Report (pdf)
Introduction and Methods
Overall Years of Potential Life Lost
Premature Mortality by Sex
Premature Mortality by Race/Ethnicity - Part 1
Premature Mortality by Race/Ethnicity - Part 2
Sex Differentials within Subgroups - Part 1
Sex Differentials within Subgroups - Part 2
Discussion and Implications for Policy

Results – Overall Years of Potential Life Lost

RESULTS

Tables 1 and 3 that follow show the YPLL rates for each group and how these are distributed by cause. The percentage shows the relative importance of the causes within each group, while the age-adjusted YPLL rates and the rate ratios allow comparisons between groups.  As in the WISQARS database, the rates are expressed in terms of YPLL per 100,000 population.

Overall YPLL
Table 1 summarizes the YPLL rates for the 10 principal causes of death for the District of Columbia and the United States as a whole.

Table 1. Rate of Years of Potential Life Lost (YPLL) Before Age 70 per 100,000 Population, District of Columbia and the United States: 2005, All Races, Both Sexes, All Deaths and Selected Causes

Cause of Death

District of Columbia

United States

 

Rate Ratio

D.C.: U.S.

Age-Adjusted YPLL

Percent of Total YPLL

Age-Adjusted YPLL

Percent of Total YPLL

All Causes

9,714.6

100.0

5,663.6

100.0

1.7

Cancer

1,250.1

12.9

1,028.4

18.2

1.2

Homicide

1,209.5

12.5

253.5

4.5

4.8

Heart Disease

1,130.0

11.6

757.9

13.4

1.5

Perinatal Period

985.0

10.1

381.4

6.7

2.6

HIV

906.0

9.3

*

*

*

Accidents

765.5

7.9

1,008.6

17.8

0.8

Suicide

*

*

304.5

5.4

*

Congenital Anomalies

282.4

2.9

198.5

3.5

1.4

Stroke

222.6

2.3

130.2

2.3

1.7

Diabetes

189.0

1.9

122.0

2.2

1.6

Liver Disease

147.0

1.5

117.2

2.1

1.3

* Data not included because cause of death is not among the top 10 for YPLL for that population. Source for all tables: Office of Statistics and Programming, National Center for Injury Prevention and Control, National Center for Health Statistics (NCHS) Vital Statistics System, CDC.

As Table 1 indicates, cancer is the principal cause for YPLL in both the District of Columbia and the United States as a whole. But the relative importance of this cause of premature death varies significantly between the two populations. While the YPLL rate for cancer is higher in the District, cancer accounts for a significantly larger proportion of all YPLL for the nation as a whole. The table also indicates the importance of homicide in premature losses in the District. This cause ranks second in D.C. and accounts for one in eight years of potential life lost. Nationally, homicide ranks 6th and accounts for fewer than one in 20 of the total YPLL. These differences are highlighted in the rate ratio for homicide, which is 4.8-fold higher in the District.  As can be calculated from Table 1, the six principal causes of premature mortality in the District comprise 64.3 percent of total YPLL; the top six causes nationally account for 66.0 percent of total YPLL. In both cases, there is a significant decrease between the top six causes and the remaining causes.

Three other causes for which the D.C. experience is different from the national one are HIV, accidents and suicide. HIV is the 5th cause of YPLL in the District but does not even rank among the top 10 causes of premature loss nationally.[1] Accidents – which include falls, motor vehicle accidents, occupational accidents, and deaths by unintentional fire or poisoning – rank 2nd nationally but only 6th in D.C. This is partly explained by the District’s reliance on public transportation, which reduces the number of persons at risk for automobile accidents, one of the major causes in this category. And while suicide ranks 5th nationally, it does not place among the top 10 causes of YPLL in the nation’s capital.



[1]  Between 1996 and 1997, HIV declined abruptly as a major cause of death at the national level. In 1996, HIV was the 8th leading cause of death. A year later, it had declined 47 percent, and ranked 14th among the leading causes of death. SJ Ventura, RN Anderson, BL Smith. Births and deaths: Preliminary data for 1997. National Vital Statistics Reports 47 (4). Hyattsville, MD: National Center for Health Statistics, CDC. 1998.

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