Progress in Reducing Disparities in Premature Mortality in the USA: a Descriptive Study.

Abstract

Eliminating health disparities among different segments of the US population is an overarching goal of the US Healthy People 2020 objectives. Examine changes in educational, rural-urban, and racial disparities in premature mortality during the past 10 years. Descriptive analysis of US mortality data from 2007 to 2017. Relative and absolute rural-urban, educational attainment, and Black-White disparities in premature mortality for all-cause and top 10 causes of death among persons ages 25-74 years, estimated as rate ratios and rate differences between ≤12 and ≥16 years of education, rural versus urban, and non-Hispanic Black (Black) versus non-Hispanic White (White), respectively, in 2007 and 2017. During 2007-2017, mortality rates in persons aged 25-74 years in the USA increased for several leading causes of death, especially in persons with <16 years of education, rural residents, and White people. As a result, disparity in mortality between 2007 and 2017 widened on both relative and absolute scales for all-cause and for 6 of the top 10 causes of death by education and for all-cause and for 9 of the top 10 causes by rural/urban residence. In contrast, Black-White disparities narrowed for all-cause and for all 7 causes that Black people had a higher rate than White people. For all-cause mortality for example, absolute disparities in the number of deaths per 100,000 person-years between 2007 and 2017 increased from 454.0 (95%CI, 446.0-462.1) to 542.7 (535.6-549.7) for educational attainment and from 85.8 (82.8-88.8) to 140.5 (137.6-143.4) for rural versus urban; in contrast, absolute Black-White disparity decreased from 315.3 (311.0-319.7) to 221.7 (218.1-225.3). Educational and rural-urban disparities in premature mortality widened, whereas Black-White disparities narrowed in the USA between 2007 and 2017, though overall rates remained considerably higher in Black people.