Black-white inequalities in mortality and life expectancy, 1933-1999: Implications for healthy people 2010
Black-white inequalities in mortality and life expectancy, 1933-1999: Implications for healthy people 2010
复制标题
DOI：
10.1093/phr/116.5.474
复制
发表时间：
2001-09-01
影响因子：
3.3
通讯作者：
Hennekens, CH
中科院分区：
文献类型：
--
作者：
Levine, RS;Foster, JE;Hennekens, CH
目标。对《2010年健康人民》消除种族/族裔健康差异的目标的乐观预测是基于预期寿命和死亡率的绝对改善。本研究旨在确定预期寿命和死亡率是否有相对改善（更有效的不平等衡量标准）的证据，以及这种改善如果得到证实，是否预示着未来消除不平等的成功。来自国家卫生统计中心和人口普查局的历史数据被用来预测相对死亡率和预期寿命的未来趋势，采用自回归综合移动平均（ARIMA）模型。还估计了黑人相对于白人的超额死亡率以及死亡率和预期寿命的时间滞后。结果。根据 1945 年至 1999 年的数据，对黑人与白人年龄调整后的全因死亡率以及白人与黑人出生时预期寿命的预测显示出差距不断扩大的趋势。从 1979 年“健康人民”倡议开始到 1998 年，除九种死因之一外，黑人与白人的年龄调整、性别死亡率比率均有所增加，这九种死因占 1998 年美国所有死亡率的 83.4%。从 1980 年到 1998 年，美国黑人每天的超额死亡人数相对于白人平均增加了 20%。 1940 年至 1999 年间，美国黑人比白人有 4.3 至 450 万人过早死亡。结论。 《2010 年健康人口》乐观预测的基本原理是，未来的成功可以建立在过去成功的基础上，但当使用不平等的相对衡量标准时，这一基本原理就得不到支持。自 1945 年以来，全国范围内按年龄调整的死亡率或出生时预期寿命方面的黑人与白人之间的不平等并没有持续下降。如果没有根本性的变化，很可能与医疗和公共卫生从业人员的预防相关活动的培训、评估和补偿方式以及将预防研究结果转化为临床实践的进一步研究有关，很可能只是减少了获得护理和/或医疗的机会差距 将是不够的。数以百万计的非裔美国人将继续过早死亡。
Objectives. Optimistic predictions for the Healthy People 2010 goals of eliminating racial/ethnic disparities in health have been made based on absolute improvements in life expectancy and mortality. This study sought to determine whether there is evidence of relative improvement (a more valid measure of inequality) in life expectancy and mortality, and whether such improvement, if demonstrated, predicts future success in eliminating disparities,Methods. Historical data from the National Center for Health Statistics and the Census Bureau were used to predict future trends in relative mortality and life expectancy, employing an Autoregressive Integrated Moving Average (ARIMA) model. Excess mortality and time lags in mortality and life expectancy for blacks relative to whites were also estimated.Results. Based on data for 1945 to 1999, forecasts for relative black:white age-adjusted, all-cause mortality and white:black life expectancy at birth showed trends toward increasing disparities. From 1979, when the Healthy People initiative began, to 1998, the black:white ratio of age-adjusted, gender-specific mortality increased for all but one of nine causes of death that accounted for 83.4% of all US mortality in 1998. From 1980 to 1998, average numbers of excess deaths per day among American blacks relative to whites increased by 20%. American blacks experienced 4.3 to 4.5 million premature deaths relative to whites in 1940-1999.Conclusions. The rationale that underlies the optimistic Healthy People 2010 forecasts, that future success can be built on a foundation of past success, is not supported when relative measures of inequality are used. There has been no sustained decrease in black-white inequalities in age-adjusted mortality or life expectancy at birth at the national level since 1945. Without fundamental changes, most probably related to the ways medical and public health practitioners are trained, evaluated, and compensated for prevention-related activities, as well as further research on translating the findings of prevention studies into clinical practice, it is likely that simply reducing disparities in access to care and/or medical treatment will be insufficient. Millions of premature deaths will continue to occur among African Americans.