Some Years of Progress in Narrowing Black-White Mortality Differences. Then COVID-19 Happened

Health equity can be looked at through many lenses. Some of the starkest but most definitive are differences in mortality and, more specifically, excess mortality and years of potential lost—the difference between the age when people die and their life expectancies at the time of the deaths. A death at age 30 would mean 40 or 50 years of life lost whereas a death at age 70 might mean 10 or so.

César Caraballo, M.D.

César Caraballo, M.D., of the Center for Outcomes Research and Evaluation at Yale New Haven Hospital, and colleagues used death certificate data from Centers for Disease Control and Prevention (CDC) to compare to mortality in the Black population to the White population over the 22-year period from 1999 to 2000. They also used life expectancy figures from the National Center for Health Statistics.

They reported their results in JAMA yesterday. The overall pattern they identified was one of wide gaps that narrowed for about 10-15 years, plateaued for a number of years in the 2010s, and then shot back up in 2020 due to COVID-19. In fact, the total number of excess deaths in the Black population (79,801 among Black males and 47,545 among Black females) was higher in 2020 than in any other year in the study. The excess of years of potential life lost in the Black population relative to the White population also spiked in 2020, reaching its highest number among Black men (2,868,669 years) and matching the number lost in 1999 among Black women (940,604 years)

“Overall, these findings demonstrate the potential for progress but indicate the fragility of the gains and herald a need for new approaches to ensure sustainability of advancements,” wrote Caraballo and his colleagues.

Regardless of the any pre-COVID-19 trends toward less inequity, the difference in mortality and years of life lost (or premature death) between the Black population and the White one is large. During the two decades-plus that they studied, the researchers calculated that there were 1.63 million excess deaths in the Black population and 80 million years of life lost.

The trends starting in 1999 were more encouraging. From 1999 to 2011 the age-adjusted excess mortality rate declined from 404 to 211 excess per 100,000 individuals among Black males. The rate leveled out from 2012 to 2019. In 2020, because of COVID-19, it increased to 395.

For Black females, the age-adjusted excess mortality rate was on a downward trend from 1999, when it was 224 per 100,000 individuals, to 87 in 2015, before it also leveled out. In 2020, the rate among Black females spiked to 192 excess deaths per 100,000 individuals, a level that matched the 2005 rate.

The pattern was similar in potential years of life lost: a steady decline in the difference between the Black and White populations for about 10 years, a flattening that still left a considerable gap, and then a large increase in excess of potential years of life lost in the Black population relative to the White population.