EXCESS MORTALITY AMONG BLACKS AND WHITES IN THE UNITED-STATES

Background Although the general relations between race, socioeconomic status, and mortality in the United States are well known, specific pa tterns of excess mortality are not well understood. Methods Using stan dard demographic techniques, we analyzed death certificates and census data and made sex-specific population-level estimates of the 1990 dea th rates for people 15 to 64 years of age. We studied mortality among blacks in selected areas of New York City, Detroit, Los Angeles, and A labama (in one area of persistent poverty and one higher-income area e ach) and among whites in areas of New York City, metropolitan Detroit, Kentucky, and Alabama (one area of poverty and one higher-income area each). Sixteen areas were studied in all. Results When they were comp ared with the nationwide age-standardized annual death rare for whites , the death rates for both sexes in each of the poverty areas were exc essive, especially among blacks (standardized mortality ratios for men and women in Harlem, 4.11 and 3.38; in Watts, 2.92 and 2.60; in centr al Detroit, 2.79 and 2.58; and in the Black Belt area of Alabama, 1.81 and 1.89). Boys in Harlem who reached the age of 15 had a 37 percent chance of surviving to the age of 65; for girls, the likelihood was 65 percent, Of the higher-income black areas studied, Queens-Bronx had t he income level most similar to that of whites and the lowest standard ized mortality ratios (men, 1.18; women, 1.08). Of the areas where poo r whites were studied, Detroit had the highest standardized mortality ratios (men, 2.01; women, 1.90). On the Lower East Side of Manhattan, in Appalachia, and in Northeast Alabama, the ratios for whites were be low the national average for blacks (men, 1.90; women, 1.95). Conclusi ons Although differences in mortality rates before the age of 65 betwe en advantaged and disadvantaged groups in the United States are someti mes vast, there are important differences among impoverished communiti es in patterns of excess mortality. (C) 1996, Massachusetts Medical So ciety.