Stalled Progress in Reducing Black Mortality Rates: The Role of External Causes and COVID-19

A study examined the trends in excess mortality rates among Black individuals, highlighting significant reductions in deaths from cancer and cardiovascular diseases. However, progress has been hindered by rising mortality from external causes such as assaults and accidents, as well as stagnation in addressing cardiovascular diseases. The COVID-19 pandemic exacerbated these disparities, particularly among vulnerable subgroups.¹

Despite reductions in deaths from cancer and cardiovascular diseases, increased mortality from assaults, accidents, and the COVID-19 pandemic has widened disparities in health outcomes for Black individuals. | Image credit: Andrey Popov - stock.adobe.com

The population-based study is published in JAMA Network Open.

“Understanding the disparities in all-cause mortality rates between racial and ethnic groups is crucial for addressing public health inequities in the US,” wrote the researchers of the study. “We aim to identify the specific causes of death associated with these disparities and their change over time.”

Despite efforts to reduce racial inequities in health care, there is a need to assess recent excess deaths and years of potential life lost among Black individuals compared with White individuals.² From 1999 to 2020, the Black population experienced more than 1.63 million excess deaths and more than 80 million excess years of life lost compared with the White population.

The study utilized CDC Wide-Ranging Online Data for Epidemiologic Research to analyze national death certificate data from 1999 to 2020.¹ Age-adjusted mortality rates (AAMRs) per 100,000 individuals were calculated for Black and White populations, stratified by sex, using the 2000 standard population.

The research focused on 15 primary underlying causes of death, plus COVID-19 for 2020, totaling 18 unique causes. Excess AAMR was determined by subtracting the White AAMR from the Black AAMR, with these causes accounting for 83% to 88% of the total excess AAMR over the study period.

From 1999 to 2020, the mean excess AAMRs per 100,000 individuals were 149 for females and 284 for males. Significant reductions in excess AAMR were observed from 1999 to 2015 for females (5.7% annual decrease) and 1999 to 2011 for males (5.2% annual decrease). For males, the decline was largely driven by reductions in deaths from cancer, heart disease, HIV, and accidents. Among females, reductions in heart disease, diabetes, cancer, and accidents were the primary contributors.

However, between 2012 and 2019, this progress stalled, with increases in excess mortality due to accidents, heart disease, cerebrovascular disease, and assault. In 2020, excess AAMRs surged to levels last seen in 1999 for males and 2004 for females, with COVID-19 responsible for 43.2% and 46.1% of the increases, respectively.

The researchers acknowledged several limitations to their study. There was potential for misclassification biases due to the reliance on death certificate data, which can contain inaccuracies in the reporting of cause of death and demographic details. Additionally, the study did not account for differences within CDC-categorized racial and ethnic groups, such as variations between US-born and non–US-born Black individuals. Geographic variability in health outcomes also presented a challenge, as trends may have differed significantly by region, potentially obscuring more localized disparities or progress in mortality rates.

Despite these limitations, the researchers believe the study highlights both the progress and challenges in reducing excess mortality in the US Black population.

“Because race is a social construct, structural social factors contribute to progress, stagnation, and regression,” wrote the researchers. “There is an urgent need to determine how best to regain the progress and implement evidence-based interventions to promote health equity.”

References

1. Arun A. Caraballo C, Sawano M, et al. Cause-specific mortality rates among the US black population. JAMA Netw Open. Published online September 30, 2024. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2024.36402?guestAccessKey=9dc6459b-610e-4c52-b44d-98f677fce566&utm_source=for_the_media&utm_medium=referral&utm_campaign=ftm_links&utm_content=tfl&utm_term=093024.

2. Caraballo C, Massey DS, Ndumele CD, et al. Excess mortality and years of potential life lost among the black population in the US, 1999-2020. JAMA. 2023;329(19):1662-1670. doi:10.1001/jama.2023.7022