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 Race/Ethnicity – Part 2

Premature Mortality by Race/Ethnicity – Part 2

Table 4 summarizes age-adjusted YPLL rates by major cause of death and subgroup. The rates for all causes show how D.C. differs from the nation as a whole in terms of premature mortality by race/ethnicity. While survivability as measured by YPLL is more favorable in the District than nationally for whites and Hispanics, it is significantly worse for blacks. The breakdown by cause indicates that blacks in the District are at higher risk for all major causes of death than the U.S. black population as a whole. This of course accentuates the existing racial/ethnic disparities. As a result, the District of Columbia is not a microcosm of the nation as a whole, but rather an unfortunate example of how racial and ethnic differences in premature mortality are magnified in the nation’s capital.

Table 4. Rate of Age-Adjusted Years of Potential (YPLL) Before Age 70, District of Columbia and United States: 2005, Blacks, Whites, Hispanics, Both Sexes, 10 Principal Causes of Death

 Cause of Death

Age-adjusted Rate of YPLL per 100,000 Population, by Group

White

Black

Hispanic

D.C.

U.S.

D.C.

U.S.

D.C.

U.S.

All Causes

3,163.1

5,249.6

14,466.0

9,661.6

3,438.7

4,559.9

Cancer

592.1

1,024.8

1,704.3

1,472.9

422.4

709.4

Accidents

440.3

1,069.5

1,042.4

1,030.7

426.7 

873.5

Perinatal Period

468.5

288.4

1,282.8

821.7

251.4

327.9

Heart Disease

208.1

705.4

1,720.9

1,498.1

*

480.1

HIV

203.4

*

1,517.3

525.9

123.7

120.0

Congenital Anomalies

136.8

184.6

328.7

240.1

377.2

206.7

Suicide

120.6

364.9

*

178.1

*

171.8

Homicide

52.4

*

2,275.9

916.0

372.7

313.9

Liver Disease

*

112.8

193.0

*

158.1

161.4

Stroke

54.9

101.2

343.7

320.2

*

127.8

Diabetes

*

102.4

300.3

269.8

126.9

*

Benign Neoplasms

69.8

*

*

*

*

*

Chronic Low Respiratory Disease

*

104.0

*

*

138.1

*

Influenza & Pneumonia

*

*

*

*

135.5

*

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

As shown in Table 4, compared to the other two groups, blacks in D.C. have higher rates of YPLL for all but one cause of the top 10 causes of YPLL overall, the exception being congenital anomalies, for which Hispanics suffer the largest losses.

Overall, the YPLL rate ratio between blacks and whites, and between blacks and Hispanics is more than 4-fold in D.C., as indicated in Table 5. For the U.S. as a whole, the corresponding disparities are still high, but considerably more attenuated, with YPLL for all causes being approximately twice as high for   blacks as for each of the two other groups nationally.

Table 5. Ratio of Age-Adjusted Years of Potential (YPLL) Rates for Blacks, Whites, and Hispanics Compared to Each Other, District of Columbia and United States: 2005, Major Causes of Death, Both Sexes

Cause of Death

YPLL Rate Ratios

Black: White

Hispanic: White

Black: Hispanic

D.C.

U.S.

D.C.

U.S.

D.C.

U.S.

All Causes

4.6

1.8

1.1

0.9

4.2

2.1

Homicide

43.4

*

7.1

*

6.1

2.9

Cancer

2.9

1.5

0.7

0.7

4.0

2.1

Heart Disease

8.3

2.1

*

0.7

*

3.1

HIV

7.5

*

0.6

*

12.3

4.4

Perinatal Period

2.7

2.8

0.5

1.1

5.1

2.5

Accidents

2.4

1.0

1.0

0.8

2.4

1.2

Congenital Anomalies

2.4

1.3

2.8

1.1

0.9

1.2

Stroke

6.3

3.2

*

1.3

*

2.5

Diabetes

*

2.6

*

*

2.4

*

Liver Disease

*

*

*

1.4

1.2

*

Suicide

*

0.5

*

0.5

*

1.0

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

Cause-specific data highlight the extent to which certain conditions are responsible for the differences. While blacks’ rates of YPLL are higher for all causes, the disparity in rates of YPLL between blacks and whites in D.C. is particularly dramatic for deaths due to homicide. The relative risk of blacks losing years of potential life to this violent cause of death is more than 43-fold that for whites.   Blacks are also at very high risk for premature losses as a result of heart disease, HIV and stroke, the difference being more than 6-fold for each of these causes.   Nationally, the black: white ratio of YPLL for all causes is less than half what it is in D.C.; it actually approaches parity with respect to certain causes, such as accidents, congenital anomalies, and suicide.

In the District, overall disparities between Hispanics and whites for all causes are almost negligible. Nevertheless, there are marked differences between the two groups in terms of losses due to specific causes.   As is the case with blacks, although to a lesser extent, years lost due to homicide are much higher for Hispanics than for their white counterparts, with a more than 7-fold difference in YPLL rates. Hispanics are also at particular risk for losses related to congenital anomalies, which include structural defects with which a baby can be born. At the same time, compared to whites, Hispanics have lower YPLL rates for premature losses attributed to cancer, accidents, HIV and conditions related to the perinatal period. When the District ratios are compared to national ratios, the effect of high YPLL attributed to homicide in D.C. is evident, and accounts for the lack of overall parity in YPLL between whites and Hispanics in the District. 

While the differences in premature deaths between Hispanics and blacks are also significant at the national level (the ratio for all causes being 2.1), this disparity is significantly widened in the District.   The ratios of YPLL between blacks and Hispanics in D.C. also reveal dramatic differences with respect to some causes, with blacks being at more than 4-fold greater risk overall than their Hispanic counterparts. The indicator underscores a marked disparity in premature deaths attributed to HIV, the difference being over 12-fold between the two subgroups. And Hispanics in the District have one-fourth the risk for premature losses due to cancer compared to blacks. Only for congenital anomalies do blacks have lower YPLL rates than Hispanics, a situation that is not the case at the national level.

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