Trends in the black-white life expectancy gap in the United States, 1983-2003.
BACKGROUND
Since the early 1980s, the black-white gap in life expectancy at birth increased sharply and subsequently declined, but the causes of these changes have not been investigated.


OBJECTIVE
To determine the contribution of specific age groups and causes of death contributing to the changes in the black-white life expectancy gap from 1983-2003.


METHODS
US vital statistics data from the US National Vital Statistics System, maintained by the National Center for Health Statistics. Standard life table techniques were used to decompose the change in the black-white life expectancy gap by combining absolute changes in age-specific mortality with relative changes in the distribution of causes of death.


METHODS
The gap in life expectancy at birth between blacks and whites.


RESULTS
Among females, the black-white life expectancy gap increased 0.5 years in the period 1983-1993, primarily due to increased mortality from human immunodeficiency virus (HIV) (0.4 years) and slower declines in heart disease (0.1 years), which were somewhat offset by relative improvements in stroke (-0.1 years). The gap among males increased by 2 years in the period 1983-1993, principally because of adverse changes in HIV (1.1 years), homicide (0.5 years), and heart disease (0.3 years). Between 1993 and 2003, the female gap decreased by 1 year (from 5.59 to 4.54 years). Half of the total narrowing of the gap among females was due to relative mortality improvement among blacks in heart disease (-0.2 years), homicide (-0.2 years), and unintentional injuries (-0.1 years). The decline in the life expectancy gap was larger among males, declining by 25% (from 8.44 to 6.33 years). Nearly all of the 2.1-year decline among males was due to relative mortality improvement among blacks at ages 15 to 49 years (-2.0 years). Three causes of death accounted for 71% of the narrowing of the gap among males (homicide [-0.6 years], HIV [-0.6 years], and unintentional injuries [-0.3 years]), and lack of improvement in heart disease at older ages kept the gap from narrowing further.


CONCLUSIONS
After widening during the late 1980s, the black-white life expectancy gap has declined because of relative mortality improvements in homicide, HIV, unintentional injuries, and, among females, heart disease. Further narrowing of the gap will require concerted efforts in public health and health care to address the major causes of the remaining gap from cardiovascular diseases, homicide, HIV, and infant mortality.
Harper
Sam
S
Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec.
Lynch
John
J
Burris
Scott
S
Davey Smith
George
G
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044383:Black People / Q000706:statistics & numerical data*; D002423:Cause of Death / Q000639:trends; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008017:Life Expectancy / Q000208:ethnology / Q000639:trends; D008297:Male; D008875:Middle Aged; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data*; D001741:Black or African American