Jim Crow and premature mortality among the US Black and White population, 1960-2009: an age-period-cohort analysis.
Jim Crow and premature mortality among the US Black and White population, 1960-2009: an age-period-cohort analysis.
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DOI：
10.1097/ede.0000000000000104
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发表时间：
2014-07
期刊：
影响因子：
--
通讯作者：
Waterman PD
中科院分区：
文献类型：
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作者：
Krieger N;Chen JT;Coull BA;Beckfield J;Kiang MV;Waterman PD
很少有研究分析废除吉姆·克劳（Jim Crow，即被美国1964年民权法案推翻的法律的种族歧视）对健康的影响。我们使用分层年龄阶段队列模型分析了1960-2009年美国全国黑人和白色人的过早死亡率（65岁之前死亡）。在美国黑人和白色人过早死亡率下降以及吉姆·克劳和非吉姆·克劳州黑人过早死亡风险持续2倍的背景下，包括随机期、队列、州和县效应以及固定县收入效应在内的分析发现，在黑人人口中，最大的吉姆·克劳时期互动发生在1960-1964年（死亡率比[MRR] = 1.15 [95%置信区间= 1.09-1.22]），得出最大的总体特定时期吉姆·克劳效应MRR为1.27，随后没有观察到这种相互作用。此外，1901年至1945年出生队列的吉姆·克劳效应最高（MRR范围= 1.05-1.11），转化为1921年至1945年出生队列的总体特定吉姆·克劳效应MRR最大（MRR约1.2），随后未观察到此类相互作用。在白色人群中，吉姆·克劳与任何时期或队列之间都没有发生这种相互作用。总之，研究结果提供了令人信服的证据，证明吉姆·克劳及其废除对美国黑人人口过早死亡率的持久影响，尽管不足以消除1960年至2009年吉姆·克劳和非吉姆·克劳州持续存在的2倍黑人超额风险。
Scant research has analyzed the health impact of abolition of Jim Crow (ie, legal racial discrimination overturned by the US 1964 Civil Rights Act). We used hierarchical age–period–cohort models to analyze US national black and white premature mortality rates (death before 65 years of age) in 1960–2009. Within a context of declining US black and white premature mortality rates and a persistent 2-fold excess black risk of premature mortality in both the Jim Crow and non-Jim Crow states, analyses including random period, cohort, state, and county effects and fixed county income effects found that, within the black population, the largest Jim Crow-by-period interaction occurred in 1960–1964 (mortality rate ratio [MRR] = 1.15 [95% confidence interval = 1.09–1.22), yielding the largest overall period-specific Jim Crow effect MRR of 1.27, with no such interactions subsequently observed. Furthermore, the most elevated Jim Crow-by-cohort effects occurred for birth cohorts from 1901 through 1945 (MRR range = 1.05–1.11), translating to the largest overall cohort-specific Jim Crow effect MRRs for the 1921–1945 birth cohorts (MRR ~ 1.2), with no such interactions subsequently observed. No such interactions between Jim Crow and either period or cohort occurred among the white population. Together, the study results offer compelling evidence of the enduring impact of both Jim Crow and its abolition on premature mortality among the US black population, although insufficient to eliminate the persistent 2-fold black excess risk evident in both the Jim Crow and non-Jim Crow states from 1960 to 2009.