Study Reveals 1.63 Million Early Deaths in US Black Population Over Two Decades.

As you may know, over the last three years, I’ve been studying excess mortality in order to quantify the magnitude of the Covid-19 pandemic. (Excess mortality is the number of people who died above and beyond anticipated numbers from all causes during a specific time period.)

Early on, the team with whom I have been collaborating with on this—Yale’s Center for Outcomes Research and Evaluation—realized that the same approach could be used to quantify the disparity of mortality between Black and White people in the United States over a longer period.

New study sheds light on mortality disparities.

Today, we published the findings of an extensive study we conducted in the Journal of the American Medical Association. The work, led by Dr. César Caraballo and Dr. Harlan Krumholz, reveals something as undeniably important as it is grim: From 1999 to 2020 there were 1.63 million excess deaths among the Black population. That is, there were 1.63 million more deaths in the US Black population than there would have been had Black people experienced the same mortality rate as White people. These findings are adjusted for age differences across the populations

Caraballo et al. JAMA. Annotations: Inside Medicine.

Things had been improving over time (and there’s no meaningful biological explanation for these differences). But the Covid-19 pandemic set us back to conditions similar to those at the turn of the century.

80 million years of life lost.

Of course, in the long run, there is no such thing as permanent “excess mortality.” Everyone dies once. So, in the end, what we call excess mortality is really just early mortality. That’s why in a study that spanned decades, there’s another figure that we wanted to measure: the number of years of lost life that resulted from those early deaths. The answer? 80 million. That’s 80 million years of lost life among Black people in the United States due to early deaths over a 22-year study period. Just ponder that and let it anger you. We are publishing this to shine light on the truth and to inspire action.

Now, simple division says that this corresponds to 49 years of life per early death. If that seems like a lot, it is. Especially because the life expectancy of Black and White people are not decades apart (it’s currently 5-6 years, which is not decades, but is substantial).

The reason behind this figure is that there are three kinds of early deaths: early deaths in infants, early deaths in young-ish people, and early deaths in older adults. I break these up because the deaths in each category tend to happen for different reasons.

Think about infant mortality; each infant death could lead to 70+ years of lost life (some would be a lot less, some more). For young people, differences due to unnatural causes can also correspond to decades of lost life for each early death. Then, as we progress up in the age brackets, we start to see to differences is the “usual suspects,” things like heart disease and cancer. For these deaths, the number of years lost varies, from less than 1 year, to a few years, and sometimes again to decades.

When do disparities reverse?

If you can only die once, and Black people die earlier, then it follows that at some point, two things must occur: 1. The disparities must eventually reverse; 2. Eventually, at the end, all disparities should even out (i.e., the reversed disparity should “resolve”).

Again, this is because in the final analysis there is no such thing as “permanent” excess mortality. The way I think about it is that excess mortality is eventually “recovered,” once everyone in a cohort has died. In contrast, “years of lost life” can never be reclaimed.

So, at what age does White mortality finally exceed Black mortality?

Deaths per 100,000 people, by age group, and race. Data: CDC (2010-2019). Image: Inside Medicine

The answer is at age 85. At this point, White people do die at a higher rate than Black people. The reason (other than the math, as above), is that by age 85, the average White person is actually less healthy overall than the average Black person. This may sound counterintuitive, given what we’ve said about disparities so far, but it computes. In essence, there are a bunch of White people aged 85 and up who have chronic medical conditions that they survived with to reach the age of 85+ years old with. By contrast, Black people with those same chronic illnesses lacked medical care and resources to survive until age 85 or older. The mortality rate for Black people ages 85+ is lower because of a “healthy survivor effect.” There are fewer Black people alive at age 85 than there ought to be, but those who have survived are, on average, healthier individuals than people who already died.

One could say, then, that in America, you can live to be 85 and have serious medical problems, but it’s a lot more likely if you are White. Another realist, if cynical, way to say this is that this system does not “allow” Black people to grow old if they have chronic diseases (painfully, some of which are increased by the poverty stemming from redlining and other structural policies), whereas White people are allowed to. I’m speaking in absolutes and averages here, to make the point.

You’ll note that the graph above only shows the first prediction coming true (i.e., that at some age, the disparities must reverse). But it does not show the second prediction. So, at what age do White and Black finally people die at the same rate? I looked at this a couple of years ago. Using some population estimates, I calculated that the answer is just around 100 years old. At age 100 and after, Black and White people finally have around the same mortality rates. It takes 100 years for the disparities to play out, reverse as predicted, and finally even out. I find that to be a disgraceful commentary on the state of public health in this country—albeit, likely, we are not alone in this among peer nations. (That does not make it better.)

Until the described mortality disparities vanish across all age groups, those losses—80 million years lost in just 2+ decades—will keep accruing. We must track these figures annually and act. We can’t look away until these disparities are thing of the past.