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Showing content from https://pubmed.ncbi.nlm.nih.gov/16968116/ below:

Eight Americas: investigating mortality disparities across races, counties, and race-counties in the United States

Comparative Study

doi: 10.1371/journal.pmed.0030260. Eight Americas: investigating mortality disparities across races, counties, and race-counties in the United States

Affiliations

Affiliation

¹ Harvard School of Public Health, Boston, Massachusetts, United States of America.

PMID: 16968116
PMCID: PMC1564165
DOI: 10.1371/journal.pmed.0030260

Item in Clipboard

Comparative Study

Eight Americas: investigating mortality disparities across races, counties, and race-counties in the United States

Christopher J L Murray et al. PLoS Med. 2006 Sep.

doi: 10.1371/journal.pmed.0030260. Affiliation

¹ Harvard School of Public Health, Boston, Massachusetts, United States of America.

PMID: 16968116
PMCID: PMC1564165
DOI: 10.1371/journal.pmed.0030260

Item in Clipboard

Erratum in

PLoS Med. 2006 Dec;3(12):e545

Abstract

Background: The gap between the highest and lowest life expectancies for race-county combinations in the United States is over 35 y. We divided the race-county combinations of the US population into eight distinct groups, referred to as the "eight Americas," to explore the causes of the disparities that can inform specific public health intervention policies and programs.

Methods and findings: The eight Americas were defined based on race, location of the county of residence, population density, race-specific county-level per capita income, and cumulative homicide rate. Data sources for population and mortality figures were the Bureau of the Census and the National Center for Health Statistics. We estimated life expectancy, the risk of mortality from specific diseases, health insurance, and health-care utilization for the eight Americas. The life expectancy gap between the 3.4 million high-risk urban black males and the 5.6 million Asian females was 20.7 y in 2001. Within the sexes, the life expectancy gap between the best-off and the worst-off groups was 15.4 y for males (Asians versus high-risk urban blacks) and 12.8 y for females (Asians versus low-income southern rural blacks). Mortality disparities among the eight Americas were largest for young (15-44 y) and middle-aged (45-59 y) adults, especially for men. The disparities were caused primarily by a number of chronic diseases and injuries with well-established risk factors. Between 1982 and 2001, the ordering of life expectancy among the eight Americas and the absolute difference between the advantaged and disadvantaged groups remained largely unchanged. Self-reported health plan coverage was lowest for western Native Americans and low-income southern rural blacks. Crude self-reported health-care utilization, however, was slightly higher for the more disadvantaged populations.

Conclusions: Disparities in mortality across the eight Americas, each consisting of millions or tens of millions of Americans, are enormous by all international standards. The observed disparities in life expectancy cannot be explained by race, income, or basic health-care access and utilization alone. Because policies aimed at reducing fundamental socioeconomic inequalities are currently practically absent in the US, health disparities will have to be at least partly addressed through public health strategies that reduce risk factors for chronic diseases and injuries.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures
Figure 1. County Life Expectancies by Race

Figure 1. County Life Expectancies by Race

Deaths were averaged for 1997–2001 to reduce sensitivity…

Figure 1. County Life Expectancies by Race

Deaths were averaged for 1997–2001 to reduce sensitivity to small numbers and outliers. (A) Life expectancy at birth for black males and females. Only counties with more than five deaths for any 5-y age group (0–85) were mapped, to avoid unstable results. (B) Life expectancy at birth for white males and females.

Figure 2. Construction of the Eight Americas…

Figure 2. Construction of the Eight Americas from 8,288 Race-County Units
Figure 2. Construction of the Eight Americas from 8,288 Race-County Units
Figure 3. Life Expectancy at Birth in…

Figure 3. Life Expectancy at Birth in the Eight Americas (1982–2001)

Estimates for Americas 1…

Figure 3. Life Expectancy at Birth in the Eight Americas (1982–2001)

Estimates for Americas 1 and 3 have been adjusted for differential underestimation of population and mortality among Asians (see Methods).

Figure 4. Probability of Dying in Specific…

Figure 4. Probability of Dying in Specific Age Ranges in the Eight Americas

(A) Probability…

Figure 4. Probability of Dying in Specific Age Ranges in the Eight Americas

(A) Probability of death by sex, age, and disease for the eight Americas in 2001. (B) Probability of death by sex, age, and disease for Americas 1 and 8 compared to Japan, UK, the Russian Federation, and high-mortality countries in sub-Saharan Africa (AFR-high-mortality; made up largely of countries in West Africa and excluding countries with very high mortality due to HIV/AIDS) in 2001. Results are not shown for ages 5–14 y because there are few deaths in this age range in the US.

Figure 5. Probability of Death between the…

Figure 5. Probability of Death between the Ages of 15 and 59 y in the…
Figure 5. Probability of Death between the Ages of 15 and 59 y in the Eight Americas

(A) Probability of death between the ages of 15 and 59 y in the eight Americas from all causes. (B) Probability of death between the ages of 15 and 59 y in the eight Americas after deleting deaths from homicide and HIV.

Figure 6. Health Plan Coverage and Health…

Figure 6. Health Plan Coverage and Health Service Utilization in the Eight Americas
Figure 6. Health Plan Coverage and Health Service Utilization in the Eight Americas
Figure 7. Burden of Disease Attributable to…

Figure 7. Burden of Disease Attributable to the Ten Leading Risk Factors in the very-low-mortality…
Figure 7. Burden of Disease Attributable to the Ten Leading Risk Factors in the very-low-mortality countries of the Region of Americas

The estimates refer to the Global Burden of Disease epidemiological region that includes Canada, Cuba, and the US [45]; more than 85% of this region's population live in the US and most data sources apply to the US.