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What Disparities Across the Life Span Are Most Responsible for the Decrease in Life Expectancy Among Racial/Ethnic Minorities?

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For racial and ethnic minorities in the United States, health disparities take on many forms, including higher rates of chronic disease and premature death compared to the rates among whites. It is important to note that this pattern is not universal. Some minority groups—most notably, Hispanic immigrants—have better health outcomes than whites. This “immigrant paradox” appears to diminish with time spent in the United States, however. For other indicators, disparities have shrunk, not because of improvements among minorities but because of declines in the health of majority groups.

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It has long been known that despite well-documented improvements in longevity for most Americans, alarming disparities persist among racial groups and between the well-educated and those with less education. In this article we update estimates of the impact of race and education on past and present life expectancy, examine trends in disparities from 1990 through 2008, and place observed disparities in the context of a rapidly aging society that is emerging at a time of optimism about the next revolution in longevity

We found that in 2008 US adult men and women with fewer than twelve years of education had life expectancies not much better than those of all adults in the 1950s and 1960s. When race and education are combined, the disparity is even more striking. In 2008 white US men and women with 16 years or more of schooling had life expectancies far greater than black Americans with fewer than 12 years of education—14.2 years more for white men than black men, and 10.3 years more for white women than black women. These gaps have widened over time and have led to at least two “Americas,” if not multiple others, in terms of life expectancy, demarcated by level of education and racial-group membership. The message for policy makers is clear: implement educational enhancements at young, middle, and older ages for people of all races, to reduce the large gap in health and longevity that persists today. Overall, the populations of the United States and other developed nations have enjoyed more than a century of rarely interrupted rising life expectancy and notable improvements in quality of life. Striking among these transitions in health and longevity were the rapid declines in mortality at early ages observed at the beginning of the twentieth century, reductions in mortality from heart disease during the last third of that century, and declining mortality in old age in recent decades. There is reason to be optimistic about the future of health and longevity in the United States and the positive impact that increased longevity could have on national and global economies. Advances in medicine and biomedical technology, including an understanding of the genetics of exceptional longevity, are occurring at an accelerated pace; 6 genetic engineering could cure or control some inherited diseases; the prevalence of smoking has declined; recent efforts to attack childhood and adult obesity are encouraging; new approaches to reducing health disparities have been proposed; and scientists may be on the verge of finding a way to slow biological aging.

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Age-adjusted death rates for blacks and whites of all ages (including children) and also age-specific trends for the leading selected causes of death among blacks for four adult age groups (18–34, 35–49, 50–64, and ≥65 years) were examined for the period 1999–2015. In addition, age-specific sociodemographic characteristics and death rates were examined and compared by race and age group

Age-specific prevalences of selected self-reported chronic diseases, related health behaviors, health-related quality of life indicators, and health care utilization practices were also examined and compared by race and age group. Mortality data were analyzed using the CDC WONDER system, an interactive Web-based tool.* CDC WONDER mortality data are provided by the National Vital Statistics System and are based on information from all resident death certificates filed in the 50 states and the District of Columbia (Hyattsville, MD, 2015). CDC WONDER queries generated age-specific death rates and 95% confidence intervals for blacks and whites for all causes of death and leading causes of death among blacks compared with whites in each age group during 1999–2015. Age-adjusted death rates also were obtained for all ages combined, including children. Rate ratios compared death rates for blacks to those for whites; the 95% confidence interval (CI) for each rate ratio was calculated (6), and statistical significance was determined at alpha = 0.05; 95% CIs that did not include 1.0 were considered indicative of a statistically significant difference between blacks and whites. Population numbers, the sex distribution, and the percentage of each race with a Hispanic origin were obtained for each age group from the most recent available estimated postcensal population counts for 2014§ from the U.S. Census Bureau. Selected socioeconomic characteristics (U.S. nativity, <12 years education, household poverty, home ownership by the household head, and lack of health insurance) of the 2014 population by race and age group were obtained from the 2014 American Community Survey Public Use Microdata Sample, which is an ongoing national household survey of the U.S. Census Bureau )Colby SL, Ortman JM, 2014).

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Thus, child health advocates should understand that a life-course perspective offers a very powerful argument for more investment in childhood because of the impact of childhood experiences on later adult health

They should understand, however, that the evidence indicates that investment in medical care alone will not achieve the desired effect; investment in children's living and learning conditions is required. Adult health effects might be more compelling than child health effects to many policy makers, because adults can vote and adult health translates into economic productivity.

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Colby SL, Ortman JM. Projections of the size and composition of the U.S. population: 2014 to 2060. Washington, DC: US Department of Commerce, Economics and Statistics and Administration, Bureau of the Census; 2014.

National Center for Health Statistics. Health, United States 2015: with special feature on racial and ethnic disparities.

Hyattsville, MD: US Department of Health and Human Services, CDC, National Center for Health Statistics, 2015.

Mensah GA, Mokdad AH, Ford ES, Greenlund KJ, Croft JB. State of disparities in cardiovascular health in the United States. Circulation 2005;111:1233–41. CrossRefExternal PubMedExternal

Braveman P, Barclay C. Health disparities beginning in childhood: a life-course perspective. Pediatrics 2009;124(Suppl 3):S163–75.

Rothman KJ, Greenland S, Lash TL. Modern epidemiology. 3rd ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2008.

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