GENERAL HEALTH
(January 14,
2005) Health Disparities Experienced by Black or African Americans ---
United States
In the 2000 census, 36.4 million persons,
approximately 12.9% of the U.S. population, identified themselves as
Black or African American; 35.4 million of these persons identified
themselves as non-Hispanic (1). For many health conditions,
non-Hispanic blacks bear a disproportionate burden of disease, injury,
death, and disability.
Although the top three causes and seven of the 10 leading causes of
death are the same for non-Hispanic blacks and non-Hispanic whites
(the largest racial/ethnic population in the United States), the risk
factors and incidence, morbidity, and mortality rates for these
diseases and injuries often are greater among blacks than whites.
In addition, three of the 10 leading causes of death for non-Hispanic
blacks are not among the leading causes of death for non-Hispanic
whites: homicide (sixth), human immunodeficiency virus (HIV) disease
(seventh), and septicemia (ninth) (table). This week's MMWR is
the third in a series* focusing on racial/ethnic health disparities.
Eliminating these disparities will require culturally appropriate
public health initiatives, community support, and equitable access to
quality health care.
In 2002,
non-Hispanic blacks who died from HIV disease had approximately 11
times† as many age-adjusted years of potential life lost
before age 75 years per 100,000 population as non-Hispanic whites.
Non-Hispanic blacks also had substantially more years of potential
life lost than non-Hispanic whites for homicide (nine times as many),
stroke (three times as many), perinatal diseases (three times as
many), and diabetes (three times as many) (2).
Cancer is the second leading cause of death for both
non-Hispanic blacks and non-Hispanic whites (Table). However, in 2001,
the age-adjusted incidence per 100,000 population was substantially
higher for black females than for white females for certain cancers,
including colon/rectal (54.0 versus 43.3), pancreatic (13.0 versus
8.9), and stomach (9.0 versus 4.5) cancers. Among males, the
age-adjusted incidence was higher for black males than for white males
for certain cancers, including prostate (251.3 versus 167.8),
lung/bronchus (108.2 versus 72.8), colon/rectal (68.3 versus 58.9),
and stomach (16.3 versus 10.0) cancers (3).
Stroke is the third leading cause of death for both
non-Hispanic blacks and non-Hispanic whites (Table). However, during
1999--2002, non-Hispanic black males and females aged 20--74 years had
higher† age-adjusted rates per 100,000 population of
hypertension than their white counterparts (36.8 versus 23.9 for
males; 39.4 versus 23.3 for females) (4).
Racial/ethnic health disparities are reflected in
leading indicators of progress toward achievement of the national
health objectives for 2010 (5). In 2002, non-Hispanic blacks
trailed non-Hispanic whites in at least four positive health
indicators†, including percentages of 1) persons aged <65
years with health insurance (81% of non-Hispanic blacks versus 87% of
non-Hispanic whites), 2) adults aged >65 years vaccinated
against influenza (50% versus 69%) and pneumococcal disease (37%
versus 60%), 3) women receiving prenatal care in the first trimester
(75% versus 89%), and 4) persons aged >18 years who
participated in regular moderate physical activity (25% versus 35%).
In addition, non-Hispanic blacks had substantially higher proportions
of certain negative health indicators than non-Hispanic whites,
including 1) new cases of gonorrhea (742 versus 31 per 100,000
population; 2002 data), 2) deaths from homicide (21.6 versus 2.8; 2002
data), 3) persons aged 6--19 years who were overweight or obese (22%
versus 12%; 2000 data), and 4) adults who were obese (40% versus 29%;
2000 data).
Since the 1970s, racial/ethnic disparities in
measles cases and measles-vaccine coverage have been all but
eliminated (6). However, during 1996--2001, the
vaccination-coverage gap between non-Hispanic white and non-Hispanic
black children widened by an average of 1.1% each year for children
aged 19--35 months who were up to date for the 4:3:1:3:3 series of
vaccines (recommended to prevent diphtheria, tetanus, and pertussis;
polio; measles; Haemophilus influenzae type b disease; and
hepatitis B) (7). In 2002, among children aged 19--35 months,
68% of non-Hispanic black children were fully vaccinated, compared
with 78% of non-Hispanic white children.
Reported by:
Office of Minority Health, Office of the Director, CDC.
Editorial Note (By the CDC):
Multiple factors contribute to racial/ethnic health
disparities, including socioeconomic factors (e.g., education,
employment, and income), lifestyle behaviors (e.g., physical activity
and alcohol intake), social environment (e.g., educational and
economic opportunities, racial/ethnic discrimination, and neighborhood
and work conditions), and access to preventive health-care services
(e.g., cancer screening and vaccination) (8). Recent immigrants
also can be at increased risk for chronic disease and injury,
particularly those who lack fluency in English and familiarity with
the U.S. health-care system or who have different cultural attitudes
about the use of traditional versus conventional medicine.
Approximately 6% of persons who identified themselves as Black or
African American in the 2000 census were foreign-born.
For blacks
in the United States, health disparities can mean earlier deaths,
decreased quality of life, loss of economic opportunities, and
perceptions of injustice. For society, these disparities translate
into less than optimal productivity, higher health-care costs, and
social inequity. By 2050, an estimated 61 million black persons will
reside in the United States, amounting to approximately 15% of the
total U.S. population (9).
To promote consistency in measuring progress toward
achieving the national health objectives, a workgroup appointed by the
U.S. Department of Health and Human Services (DHHS) has recommended
that 1) progress toward eliminating disparities for individual
subpopulations be measured by the percentage difference between each
subpopulation rate and the most favorable or best subpopulation rate
in each domain and 2) all measures be expressed in terms of adverse
events (10). DHHS conducts periodic reviews to monitor progress
toward achieving the national health objectives, and progress toward
elimination of health disparities is part of those reviews.
The reports in this week's MMWR describe
health disparities experienced by blacks in stroke, hypertension,
nationally notifiable diseases, and childhood asthma.
Information about ongoing
public awareness initiatives to eliminate racial/ethnic health
disparities (e.g., Closing the Health Gap and Take a Loved One to the
Doctor Day) is available at http://www.cdc.gov/omh/aboutus/disparities.htm.
References
1. McKinnon J. The black population 2000. Census 2000 brief.
Washington, DC: US Department of Commerce, US Census Bureau; 2001.
Available at http://www.census.gov/prod/2001pubs/c2kbr01-5.pdf.
2. CDC. Health, United States, 2004: table 30. Hyattsville, MD:
US Department of Health and Human Services, CDC, National Center for
Health Statistics; 2004. Available at http://www.cdc.gov/nchs/data/hus/hus04trend.pdf#03.
3. CDC. Health, United States, 2004: table 53. Hyattsville, MD:
US Department of Health and Human Services, CDC, National Center for
Health Statistics; 2004. Available at http://www.cdc.gov/nchs/data/hus/tables/2004/04hus053.pdf.
4. CDC. Health, United States, 2004: table 67. Hyattsville, MD:
US Department of Health and Human Services, CDC, National Center for
Health Statistics; 2004. Available at http://www.cdc.gov/nchs/data/hus/hus04trend.pdf#067.
5. US Department of Health and Human Services. Data 2010: the
healthy people 2010 database. Hyattsville, MD: US Department of Health
and Human Services, CDC, National Center for Health Statistics; 2004.
Available at http://wonder.cdc.gov/data2010/focus.htm.
6. Hutchins SS, Jiles R, Bernier R. Elimination of measles and
of disparities in measles childhood vaccine coverage among racial and
ethnic minority populations in the United States. J Infect Dis
2004;189 (Suppl 1):S146--52.
7. Chu SY, Barker LE, Smith PJ. Racial/ethnic disparities in
preschool immunizations: United States, 1996--2001. Am J Public Health
2004;94:973--7.
8. Williams DR, Neighbors HW, Jackson JS. Racial/ethnic
discrimination and health: findings from community studies. Am J
Public Health 2003;93:200--8.
9. US Census Bureau. U.S. interim projections by age, sex,
race, and Hispanic origin. Washington, DC: US Department of Commerce,
US Census Bureau; 2004. Available at http://www.census.gov/ipc/www/usinterimproj.
10. Keppel KG, Pearcy JN, Klein RJ. Measuring progress in Healthy
People 2010. Healthy People 2010 Stat Notes 2004;25:1--16.
* See also: CDC. Health disparities experienced by racial/ethnic
minority populations. MMWR 2004;53:755. CDC. Health disparities
experienced by Hispanics---United States. MMWR 2004;53:935--7.
† Differences not tested for statistical significance.
Table
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