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 – Sex Differentials within Subgroups, Part 2

Sex Differentials within Subgroups - Part 2

Sex differences among Hispanics
The gender divide in the rate of YPLL is much wider among Hispanics in D.C. than it is among other subgroups. Because gender-based disparities among this population are much more dramatic than they are among Hispanics nationally, some of the disparities may reflect the volatility of small numbers. Hispanics constitute a minority within the District, and the federal government’s statistical reports invariably include a caveat stating that death rates for Hispanics should be interpreted with caution because of inconsistencies in reporting Hispanic origin on death certificates.[1] As a result, as Table 8 also indicates, the two sexes tend to have different causes of premature death. This is particularly dramatic in D.C. Indeed, the two main causes of YPLL for men – accidents and homicide – seem to play a negligible role in the premature mortality of Hispanic women in the District, who appear to be shielded from these violent deaths. At the same time, there are four causes of YPLL losses that are specific to Hispanic women, and that do not rank among the principal causes of YPLL for their male counterparts in D.C. These are suicide, diabetes, nephritis and septicemia. 

When Hispanic men and women are compared at the national level, men appear to be at much greater risk for premature losses due to three causes: homicide, suicide, and liver disease. Of these, two are violent deaths and the third is associated with alcohol consumption.

Table 8. Rate of Years of Potential Life Lost (YPLL) Before Age 70, District of Columbia: 2005, Hispanics, All Deaths, by Cause of Death and Sex

Cause of Death

Rate of Age-Adjusted YPLL Per 100,000 Population

Male (M)

Female (F)

M : F

D.C.

U.S.

D.C.

U.S.

D.C.

U.S.

All Causes

5,544.5

5,939.7

1,184.3

3,083.9

4.7

1.9

Accidents

804.4

1,283.2

*

413.9

*

3.1

Homicide

704.7

505.1

*

95.6

*

5.3

Congenital Anomalies

505.8

213.0

250.0

200.0

2.0

1.1

Cancer

772.6

731.5

67.8

694.5

11.4

1.1

Perinatal Period

505.8

367.8

*

286.4

*

1.3

Liver Disease

296.3

253.2

*

68.4

*

3.7

HIV

220.7

184.1

*

*

*

*

Chronic Lower Respiratory Disease

271.4

*

*

*

*

*

Heart Disease

205.7

692.2

54.4

268.4

3.8

2.6

Influenza & Pneumonia

266.2

*

*

*

*

*

Suicide

*

272.38

115.0

58.8

*

4.6

Diabetes

*

*

151.5

102.3

*

*

Nephritis

*

*

83.1

*

*

*

Septicemia

*

*

83.1

*

*

*

Stroke

*

149.9

*

105.8

*

1.4

* Data not included because cause is not among the top 10 for that particular subgroup.

As reflected in Table 8, the Hispanic male-to-female rate ratios cannot be computed for most of the top 10 causes of YPLL in D.C. because Hispanic men and women are at risk for different causes of premature death.  Among Hispanics in the District, there are only three shared causes of premature losses (i.e., conditions that constitute top risks for both genders). For these three – congenital anomalies, cancer and heart disease – men are at greater risk than women for all three but are particularly more vulnerable to premature death due to cancer (a more than 11-fold difference). The latter is at odds with the situation both nationally and for the District as a whole, where losses due to cancer are not as marked between genders (see Table 2).


[1]  RA Leon et al. Expressions of machismo in Latino relationships. International AIDS Conference, July 11-16, 2004. Abstract #ThPed7906. gateway.nlm.nih.gov/MeetingAbstracts/102281670.html; Machismo Attitudes Keep Hispanic Men from Going to the Doctor. www.hispanicprwire.com/news.phpl=in&id=149=cha=9

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