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 – Premature Mortality by Sex

Premature Mortality by Sex

Premature mortality is predominantly a male phenomenon. Although men account for less than half of the total population both within the District of Columbia and nationally, they comprise fully 64.3 percent of all YPLL due to all causes in D.C. and 63.1 percent nationally. When the D.C. data are broken down by specific cause, the magnitude of the differences between the sexes is further highlighted.

As seen in Table 2, the rate of total YPLL from all causes in D.C. is almost twice as high among males as among females. Indeed, among the 10 major causes of death, there is only one – congenital anomalies – in which females are at a slightly greater risk for premature death. This cause is defined as defects occurring from birth and most often reflect development in utero.   For most of the remaining causes, male rates of YPLL are between 1.5 and 2.0 times as high as those for women. Homicides constitute a particularly dramatic case of gender-based differences in premature mortality, the YPLL rate for men being almost 10-fold that for women.

When the sex-specific ratios for D.C. are compared with those for the United States, the differences for all causes tend to be smaller for the country as a whole (1.9 for D.C. vs. 1.7 for the U.S.). But this lower U.S. ratio can be attributed largely to the differential in YPLL due to homicides between the two populations, the 9.8 rate ratio between sexes in D.C. being reduced to a 4-fold difference for the nation.

Two other differences are evident from Table 2. First, the YPLL difference by sex for accidents is higher nationally than it is for D.C. And, second, while suicide is not one of the major causes of death in D.C., the sex differential for this cause of YPLL is quite marked for the U.S. as a whole, the YPLL rate for men being 3.8 times higher than that for women.

Table 2. Rate of Years of Potential Life Lost (YPLL) Before Age 70, District of Columbia and the United States: 2005, All Races, Major Causes of Death, By Sex

Cause of Death

Age-Adjusted YPLL Rate per 100,000 Population

District of Columbia

United States

Male (M)

Female (F)

M:F

Male (M)

Female (F)

M:F

All Causes

12,868.0

6,830.8

1.9

7,172.0

4,159.6

1.7

Cancer

1,446.4

1,082.0

1.3

1,075.3

986.0

1.1

Perinatal Period

1,154.4

807.3

1.4

419.7

341.4

1.2

HIV

1,088.2

735.5

1.5

164.7

*

*

Suicide

*

*

*

480.1

126.2

3.8 

Heart Disease

1,631.7

685.8

2.4

1,075.8

452.0

2.4

Accidents

1,024.5

535.1

1.9

1,430.5

577.9

2.5

Congenital Anomalies

268.7

294.9

0.9

208.3

188.2

1.1

Homicide

2,275.0

231.7

9.8

401.9

99.6

4.0

Stroke

271.4

179.2

1.5

*

117.9

*

Diabetes

241.7

140.8

1.7

148.4

96.6

1.5

Liver Disease

236.5

*

*

166.2

*

*

Septicemia

*

96.8

*

*

*

*

Chronic Lower Respiratory Disease

*

*

*

*

94.7

*

* Data not included because cause of death is not among the top 10 for YPLL for that population.

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