Black/White Comparisons of Deaths Preventable by Medical Intervention: United States and the District of Columbia 1980–1986

Schwartz E (Commission of Public Health, Washington, DC 20001, USA), Kofie V Y, Rivo M and Tuckson R V. Black/White comparisons of deaths preventable by medical intervention: United States and the District of Columbia 1980–1986. International Journal of Epidemiology 1990; 19: 591–598. Blacks in the US experience increased mortality (1113 versus 745 per 100 000 males; 631 versus 411 per 100 000 females) and decreased life expectancy (63.7 years versus 70.7 years for males; 72.3 years versus 78.1 years for females); compared to Whites. In an effort to determine if the excess mortality among Black Americans might be explained by differences in access or quality of health care services, we performed a race-specific analysis of conditions for which mortality is largely avoidable given timely and appropriate medical care. Using methodology proposed by Rutstein and Charlton, mortality due to 12 causes was evaluated including tuberculosis, cervical cancer, Hodgkin's disease, rheumatic heart disease, hypertensive heart disease, acute respiratory disease, pneumonia and bronchitis, influenza, asthma, appendicitis, hernias and cholecystitis. In the US, during 1980 to 1986, an average of 17 366 deaths and 286 813 years of potential life (YPLL) before age 65 were lost each year due to all 12 sentinel causes combined. Of these causes, hypertensive heart disease, pneumonia and bronchitis, cervical cancer and asthma accounted for the greatest number of deaths. The mortality rate for all 12 causes combined among Blacks was 4.5 times that of Whites. The highest relative rates among Blacks compared to Whites were observed for tuberculosis, hypertensive heart disease and asthma. The overall mortality rate in the District of Columbia for the selected causes was 3.7 times the national rate. Compared to national rates, statistically significant elevated rates in the District were observed for tuberculosis, hypertensive heart disease and pneumonia and bronchitis. These data suggest a discordance between health care needs and health care services in the US among both the Black and White populations. The excess mortality rate experienced by Blacks cannot be fully explained by an increased incidence of disease and probably reflects racial inequities in access and quality of health care services. Continued efforts to reduce the differential mortality experience among the US Black population will require addressing both the social conditions that may cause disease as well as the factor