U.S. black-white life expectancy gap shrinking

By Anne Harding

NEW YORK (Reuters Health) - The life expectancy gap between whites and African Americans in the U.S. has narrowed since 1993, thanks largely to declines in homicide rates, HIV mortality, accidental deaths and heart disease mortality among women, a new report shows.

However, heart disease remains the main reason why white men live 6.3 years longer than African American men, on average, while white women outlive African-American females by 4.5 years, Dr. Sam Harper of McGill University in Montreal and colleagues found. While the study found declines in homicide, HIV infections, and infant deaths, all three "continue to keep the black-white gap unnecessarily large," Harper's group states.

"Yes there's some good news, but we have a long way to go," Harper told Reuters Health in an interview.

The black-white gap in U.S. life expectancy narrowed throughout the 1970s and early 1980s, but widened from 1984 through the early 1990s. It began to narrow again from about 1994 to today, Harper and his team note in the March 21st issue of the Journal of the American Medical Association.

To better understand how causes of death among different age groups were responsible for these trends, Harper and his colleagues analyzed mortality data from 1983 to 2003 in the U.S. National Vital Statistics System.

From 1983 to 1993, the life expectancy gap between blacks and whites increased by 31 percent for males, while it increased by 10 percent for females, the researchers found. But between 1993 and 2003, the gap for both males and females narrowed by 25 percent.

Homicide was the key contributing factor to the life expectancy gap among males for most of the study period, but by 2003 heart disease had become the leading factor, followed by homicide, HIV, and infant deaths.

For women, heart disease was the chief contributor to racial life expectancy disparities throughout the study period, while other key factors included diabetes, stroke and infant deaths.

Sharp declines in HIV and homicide deaths accounted for 55 percent of the reduction of the mortality gap between 1993 and 2003, the researchers found, while declines in death from unintentional injuries accounted for 16 percent. At the same time, the researchers found, deaths by unintentional poisoning, which usually represent overdose among narcotics users, showed a proportional increase among middle-aged whites.

And while cardiovascular disease deaths declined for African American women and for African American men younger than 60, they rose for men 60 years or older, the researchers found.

"Cardiovascular disease accounts for about 30 percent of the existing gap among men and about 40 percent of the existing gap among women," Harper said. A stronger focus on reducing high blood pressure among African Americans could go a long way toward helping to reduce this gap, he added.

Other essential efforts will include trying to bring down homicide rates, helping more people get tested for HIV, and improving access to treatment for the disease, Harper said.

SOURCE: Journal of the American Medical Association, March 21, 2007.