title: Cause-of-death disparities in the African diaspora: exploring differences among shared-heritage populations.
abstract: OBJECTIVE
  We investigated changes in life expectancy (LE) and cause-specific mortality over time, directly comparing African-descent populations in the United States and the Caribbean.
  
  
  METHODS
  We compared LE at birth and cause-specific mortality in 6 disease groups between Caribbean countries with a majority (> 90%) African-descent population and US African Americans.
  
  
  RESULTS
  The LE improvement among African Americans exceeded that of Afro-Caribbeans so that the LE gap, which favored the Caribbean population by 1.5 years in 1990, had been reversed by 2009. This relative improvement among African Americans was mainly the result of the improving mortality experience of African American men. Between 2000 and 2009, Caribbean mortality rates in 5 of the 6 disease groups increased relative to those of African Americans. By 2009, mortality from cerebrovascular diseases, cancers, and diabetes was higher in Afro-Caribbeans relative to African Americans, with a diabetes mortality rate twice that of African Americans and 4 times that of White Americans.
  
  
  CONCLUSIONS
  The Caribbean community made important mortality reductions between 2000 and 2009, but this progress fell short of African American health improvements in the same period, especially among men.
authors.affiliation: Ian R. Hambleton, Christina Howitt, and Anselm J. Hennis are with the Chronic Disease Research Centre, Tropical Medicine Research Institute, University of the West Indies, Bridgetown, Barbados. Selvi Jeyaseelan and Natasha Sobers-Grannum are with the Faculty of Medical Sciences, University of the West Indies, Cave Hill, Barbados. Rainford J. Wilks is with the Epidemiology Research Unit, Tropical Medicine Research Institute, University of the West Indies, Kingston, Jamaica. E. Nigel Harris is with the University of the West Indies, Kingston. Marlene MacLeish and Louis W. Sullivan are with the Sullivan Alliance, Alexandria, Virginia.
authors.forename: Ian R
authors.initials: IR
authors.lastname: Hambleton
authors.forename: Selvi
authors.initials: S
authors.lastname: Jeyaseelan
authors.forename: Christina
authors.initials: C
authors.lastname: Howitt
authors.forename: Natasha
authors.initials: N
authors.lastname: Sobers-Grannum
authors.forename: Anselm J
authors.initials: AJ
authors.lastname: Hennis
authors.forename: Rainford J
authors.initials: RJ
authors.lastname: Wilks
authors.forename: E Nigel
authors.initials: EN
authors.lastname: Harris
authors.forename: Marlene
authors.initials: M
authors.lastname: MacLeish
authors.forename: Louis W
authors.initials: LW
authors.lastname: Sullivan
mesh_terms: D000349:Africa / Q000208:ethnology; D000368:Aged; D000369:Aged, 80 and over; D017691:Caribbean Region / Q000453:epidemiology; D002423:Cause of Death; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D008017:Life Expectancy / Q000208:ethnology*; D008297:Male; D012307:Risk Factors; D014481:United States / Q000453:epidemiology