Black-white differences in sentinel causes of death: Counties in large metropolitan areas

The black/white ratio of death rates (before 65 years of age) in 1994-1996 for a group of "sentinel" causes, regarded as preventable by medical treatm ent and as useful in assessing overall quality of health care, was examined for 60 US counties located in large metropolitan areas. Counties with the highest black/white death rate ratios (>3.5) and the highest death rates fo r blacks included the District of Columbia; Essex (Newark), New Jersey; Coo k (Chicago), Illinois; Wayne (Detroit), Michigan; and Dade (Miami), Florida . In these five counties, in contrast to the US, the death rate from the se ntinel causes for blacks had not declined from 1979-1981 to 1994-1996. The findings suggest that racial inequities in health care may be unusually gre at in certain counties in large metropolitan areas, and that further studie s are needed to explain the variation among counties in the black-white rat io of mortality from the sentinel causes.