Life expectancy by county, race, and ethnicity in the USA, 2000-19: a systematic analysis of health disparities.
Life expectancy by county, race, and ethnicity in the USA, 2000-19: a systematic analysis of health disparities.
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DOI：
10.1016/s0140-6736(22)00876-5
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发表时间：
2022-07-02
期刊：
影响因子：
168.9
通讯作者：
Mokdad, Ali H.
中科院分区：
文献类型：
--
作者：
Dwyer-Lindgren, Laura;Kendrick, Parkes;Kelly, Yekaterina;Sylte, Dillon;Schmidt, Chris;Blacker, Brigette F.;Daoud, Farah;Abdi, Amal A.;Baumann, Mathew;Mouhanna, Farah;Kahn, Ethan;Hay, Simon, I;Mensah, George A.;Napoles, Anna M.;Perez-Stable, Eliseo J.;Shiels, Meredith;Freedman, Neal;Arias, Elizabeth;George, Stephanie A.;Murray, David M.;Phillips, John W. R.;Spittel, Michael L.;Murray, Christopher J. L.;Mokdad, Ali H.
在美国，种族/族裔群体之间的预期寿命存在着巨大而持久的差异，但人们并不清楚这些模式在地方范围内的地理差异程度。这项分析估计了五个种族/民族群体的预期寿命，在3110个县，超过20年，描述预期寿命的时空变化和种族/民族群体之间的差距。我们将新的小区域估计模型应用于国家生命统计系统的死亡登记数据和国家卫生统计中心的人口数据，以估计按县和种族/民族分层的年度性别和年龄特异性死亡率（非拉丁美洲白色[白色]、非拉丁美洲黑人[黑人]、非拉丁美洲印第安人和阿拉斯加原住民[AIAN]、非拉丁美洲亚洲人和太平洋岛民[API]，和拉丁裔或西班牙裔[拉丁裔]）从2000年到2019年。我们调整了这些死亡率，以纠正死亡证明上种族和民族的误报，然后构建了简化的生命表来估计出生时的预期寿命。在2000年至2019年期间，不同种族/族裔群体和各县之间的预期寿命水平和趋势存在差异。在全国范围内，黑人的预期寿命增加了（3·9年[95%不确定性区间3·8 - 4·0]至75·3年[75·2 - 75·4]），API（2·9岁[2·7 - 3·0]至85·7岁[85·3 - 86·0]），拉丁裔（2·7年[2·6 - 2·8]至82·2年[82·0 - 82·5]），和白色（1·7岁[1·6 - 1·7]至78·9岁[78·9 - 79·0]）人群，而AIAN人群保持不变（0·0年[-0统计3至0·4]至73·1年[71·5 - 74·8]）。在国家一级，黑人与白色人口的预期寿命负差距在此期间有所缩小，而印第安纳土著人与白色人口的预期寿命负差距有所扩大;在这两种情况下，这些模式在各州都很普遍。从2000年到2019年，API和拉丁裔人口与白人人口的预期寿命的正差距在全国范围内增加;然而，拉丁裔人口的这一差距在相当大的少数县（1465个县中的615个县[42.0%]）和API人口的大多数县（666个县中的401个县[60.2%]）中有所下降。对于所有种族/族裔群体，与2010 - 2019年相比，2000 - 2010年各县的预期寿命改善更为普遍。种族/族裔群体之间的预期寿命差距普遍存在，而且长期存在。地方一级的数据对于解决美国弱势群体健康状况不佳和过早死亡的根本原因、消除健康差距和延长所有人的寿命至关重要。国家少数民族健康和健康差异研究所;国家心脏、肺和血液研究所;国家癌症研究所;国家老龄化研究所;国家关节炎、肌肉骨骼和皮肤疾病研究所;疾病预防办公室;以及国家卫生研究院行为和社会科学研究办公室（合同编号75N94019C00016）。
There are large and persistent disparities in life expectancy among racial/ethnic groups in the United States, but it is not well understood to what extent these patterns vary geographically on a local scale. This analysis estimated life expectancy for five racial/ethnic groups, in 3110 counties, over 20 years to describe spatialtemporal variation in life expectancy and disparities across racial/ethnic groups. We applied novel small area estimation models to death registration data from the National Vital Statistics System and population data from the National Center for Health Statistics in order to estimate annual sex- and age-specific mortality rates stratified by county and racial/ethnic group (non-Latino White [White], non-Latino Black [Black], non-Latino American Indian and Alaska Native [AIAN], non-Latino Asian and Pacific Islander [API], and Latino or Hispanic [Latino]) from 2000 to 2019. We adjusted these mortality rates to correct for misreporting of race and ethnicity on death certificates and then constructed abridged life tables to estimate life expectancy at birth. Between 2000 and 2019, the level and trend in life expectancy differed among racial/ethnic groups and among counties. Nationally, life expectancy increased for the Black (3·9 years [95% uncertainty interval 3·8–4·0] to 75·3 years [75·2–75·4]), API (2·9 years [2·7–3·0] to 85·7 years [85·3–86·0]), Latino (2·7 years [2·6–2·8] to 82·2 years [82·0–82·5]), and White (1·7 years [1·6–1·7] to 78·9 years [78·9–79·0]) populations while remaining the same for the AIAN population (0·0 years [–0·3 to 0·4] to 73·1 years [71·5–74·8]). At the national level, the negative gap in life expectancy for the Black compared to the White population decreased over this period, while the negative gap for the AIAN compared to the White population increased; in both cases, these patterns were widespread among counties. The positive gap in life expectancy for the API and Latino populations compared to the White population increased at the national level from 2000 to 2019; however, this gap declined in a sizeable minority of counties (615 of 1465 counties [42·0%]) for the Latino population and in most counties (401 of 666 counties [60·2%]) for the API population. For all racial/ethnic groups, improvements in life expectancy were more widespread across counties and larger from 2000–2010 compared to 2010–2019. Disparities in life expectancy among racial/ethnic groups are widespread and enduring. Local-level data are critical to address root causes of poor health and early death among disadvantaged groups in the United States, eliminate health disparities, and increase longevity for all. National Institute on Minority Health and Health Disparities; National Heart, Lung, and Blood Institute; National Cancer Institute; National Institute on Aging; National Institute of Arthritis and Musculoskeletal and Skin Diseases; Office of Disease Prevention; and Office of Behavioral and Social Science Research, National Institutes of Health (contract #75N94019C00016).