Jim Crow and premature mortality among the US Black and White population, 1960-2009: an age-period-cohort analysis.
BACKGROUND
Scant research has analyzed the health impact of abolition of Jim Crow (ie, legal racial discrimination overturned by the US 1964 Civil Rights Act).


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
From the aDepartment of Social and Behavioral Sciences, Harvard School of Public Health (HSPH), Boston, MA; bDepartment of Biostatistics, HSPH, Boston, MA; and cDepartment of Sociology, Harvard University, Cambridge, MA.
Nancy
N
Krieger
Jarvis T
JT
Chen
Brent A
BA
Coull
Jason
J
Beckfield
Mathew V
MV
Kiang
Pamela D
PD
Waterman
D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D015331:Cohort Studies; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D008875:Middle Aged; D061213:Mortality, Premature / Q000266:history; D063505:Racism / Q000266:history / Q000331:legislation & jurisprudence; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data*