Black-white inequalities in mortality and life expectancy, 1933-1999: Implications for Healthy People 2010

Robert S. Levine, James E. Foster, Robert E. Fullilove, Mindy T. Fullilove, Nathaniel C. Briggs, Pamela C. Hull, Baqar A. Husaini, Charles H. Hennekens

Research output: Contribution to journalArticlepeer-review

189 Scopus citations


Objectives. Optimistic predictions for the Healthy People 2010 goals of eliminating racial/ethnic disparities in health have been made based on absolute improvements in life expectancy and mortality. This study sought to determine whether there is evidence of relative improvement (a more valid measure of inequality) in life expectancy and mortality, and whether such improvement, if demonstrated, predicts future success in eliminating disparities. Methods. Historical data from the National Center for Health Statistics and the Census Bureau were used to predict future trends in relative mortality and life expectancy, employing an Autoregressive Integrated Moving Average (ARIMA) model. Excess mortality and time lags in mortality and life expectancy for blacks relative to whites were also estimated. Results. Based on data for 1945 to 1999, forecasts for relative black:white age-adjusted, all-cause mortality and white:black life expectancy at birth showed trends toward increasing disparities. From 1979, when the Healthy People initiative began, to 1998, the black:white ratio of age-adjusted, gender-specific mortality increased for all but one of nine causes of death that accounted for 83.4% of all US mortality in 1998. From 1980 to 1998, average numbers of excess deaths per day among American blacks relative to whites increased by 20%. American blacks experienced 4.3 to 4.5 million premature deaths relative to whites in 1940-1999. Conclusions. The rationale that underlies the optimistic Healthy People 2010 forecasts, that future success can be built on a foundation of past success, is not supported when relative measures of inequality are used. There has been no sustained decrease in black-white inequalities in age-adjusted mortality or life expectancy at birth at the national level since 1945. Without fundamental changes, most probably related to the ways medical and public health practitioners are trained, evaluated, and compensated for prevention-related activities, as well as further research on translating the findings of prevention studies into clinical practice, it is likely that simply reducing disparities in access to care and/or medical treatment will be insufficient. Millions of premature deaths will continue to occur among African Americans.

Original languageEnglish
Pages (from-to)474-483
Number of pages10
JournalPublic Health Reports
Issue number5
StatePublished - 2001

Bibliographical note

Funding Information:
This study was supported in part by Cooperative Agreement # 1 U18HS11131 between Meharry Medical College and the Agency for Healthcare Research and Quality (authors RSL, BAH), by grant number US2MP95 from the Health Care Financing Administration and Office of Minority Health to Meharry Medical College (RSL), by US Army Medical Research Material Command grant number DAMD 17-99-1-9289 (RSL), and by the Robert Wood Johnson Foundation's Investigator Awards in Health Policy Research Program (JEF, MTF). The authors thank Michael Epelbaum, PhD, Bruce Kennedy, PhD, David Mechanic, PhD, William Rodney, MD, Moto Shintani, PhD, and David Williams, PhD, for helpful comments.

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


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