Mortality and Morbidity in the United States

In the United States, African Americans, in comparison with whites, suffer enormous disadvantages in health status. In general, African Americans are at greater health risks throughout their life span. Because of this inequality, they do not live as long as whites.

Infant Mortality

Over the past decades, infant mortality declined rapidly in the United States. Despite these declines, the United States still ranks twentieth worldwide in infant mortality. The rate varies considerably by race in the United States. For example, despite the improvements that have been made, in 2002 an African-American child was about 2.5 times as likely as a white child to die within the first year of life. Between 1960 and 2002 the infant-mortality rate for whites declined from 22.9 per 1,000 live births to 5.8 per 1,000 live births, whereas the African-American infant-mortality rate dropped from 44.3 per 1,000 to 14.4 per 1,000 live births. In some cities with large African-American populations, such as Washington, D.C., and Detroit, the infant-mortality rate of African-American babies exceeds that of some developing countries of Central America. In 2002, if the African-American and white infant mortality rates were equal, approximately 5,100 additional African-American babies would have survived.

In the United States the two leading causes of infant mortality are birth defects (19.2 percent) and length of gestation/low birth weight/fetal malnutrition (16.8 percent). While birth defects are the leading cause, it is developmental disabilities that result from low birth weights that appear to differentiate more greatly along racial lines. For example, African-American infants are 1.95 times as likely as white infants to be low weight (5.5 pounds or less). To a large extent these racial disparities may be explained by the vestiges of poverty, including poor or no prenatal care, poor nutrition, and lack of information about health care during pregnancy.

Typically, maternal mortality is defined as the number of deaths to women per 100,000 live births due to complications of pregnancy or childbirth or within ninety days postpartum. The disparities between African-American and white maternal-mortality rates actually exceed the infant-mortality rate differences. Despite overall reductions in maternal-mortality rates for both races, African-American mothers continue to experience a mortality rate that is greater than five times that of whites. In 2002, for example, the maternal-mortality rate for African Americans was 24.9, compared with only 4.8 for whites. There is considerable evidence that many of these deaths could have been prevented through early and adequate prenatal care.

Life Expectancy

In 1960 white Americans could expect to live about 69.1 years, while African Americans and other races could expect to live roughly 8.3 years less. By 2002 the life expectancy of white and African Americans had climbed to 77.7 and 72.3 years, respectively, a difference of 5.4 years. Throughout this forty-two-year period, the gap between white and African-American life expectancy continued to decline, yet the persistence of this difference is still disturbing to health officials. Much of the variability in life expectancy is due to the continuing and alarmingly high death rates of young African-American males. In 2002 the life expectancy of African-American males was 6.8 years less than that of African-American females, and where the cause of death was homicide, the rate for African-American males was 38.4 per 100,000 while it was only 6.1 for everyone else. The death rate for African-American females aged fifteen to twenty-four is 54.4 per 100,000, while the rate for African-American males is 172.6; black males in this age cohort are three times more likely to die due to preventable risk factors.

Leading Causes of Death

Heart disease and stroke account for 35.5 percent of all excess deaths for African Americans under age seventy. (Excess deaths refers to the differential between the actual deaths and the number that would have occurred had African Americans and whites had the same death rates for each cohort and both sexes.) In 2002 there was a higher prevalence among African Americans than whites for cancer of the esophagus, larynx, lung, stomach, cervix, and pancreas. Generally, African-American women are 28 percent less likely than white women, and African-American men are 20 percent more likely than white men, to have cancer.

African Americans have lower five-year survival rates for all of the major cancer categories tracked by the National Cancer Institute, with the highest differentials in survival in uterine, bladder, and malignant neoplasms of the larynx.

Other Diseases

The rate of blindness and visual impairment among African Americans is nearly twice that of whites. Among white and African Americans between the ages of forty and seventy-nine, African Americans have a higher rate of visual impairment. While African Americans represent approximately 12 percent of the population, they are overrepresented with 18 percent of the cases of blindness and visual impairment.

A goal of the U.S. Department of Health and Human Services is to eliminate childhood lead poisoning in the country by 2010. The percentage of persons with elevated blood lead levels is 5.3 for African Americans and only 1.5 for white Americans. This disparity represents a 350 percent higher rate of lead poisoning in African Americans. Lead poisoning has been associated with a number of social problems, including higher school dropout rates, higher incidence of reading disabilities, and lower performance and achievement in school.

In 2002 African Americans were diagnosed with end stage renal disease (ESRD) at a rate 3.9 times that of white Americans, and approximately 33 percent of the kidney failure incidence among African Americans can be attributed to hypertension. Additionally, African Americans were four times more likely to have ESRD as a result of diabetes than white Americans. Of the Americans in dialysis, 19.9 percent are African American. However, for those who receive transplants within three years of their initial diagnosis, the percentage for white Americans is 26.2 percent and only 11.6 percent for African Americans. These disparities could be greatly reduced by eliminating existing cultural barriers in organ donations and by aggressive action to find suitable matches between donors and recipients.

In 1981 acquired immune deficiency syndrome (AIDS) first received national media attention. The disease was widely regarded to be a gay disease, mostly affecting white males. During much of the 1980s the African-American community was reluctant to acknowledge the problem among its citizens. Some scholars attributed this denial to the strong cultural taboo against homosexuality. As the disease spread to other segments of the population, African Americans could no longer deny the problem. According to reports published in 1989 by the Federal Centers for Disease Control, African Americans were twice as likely as whites to contract AIDS. The reports concluded that more than half of all women afflicted with the disease in this country are African Americans; about 70 percent of babies born with the AIDS virus are African Americans, as are nearly one-fourth of all males with the disease. Unfortunately, these statistics have gotten progressively worse. In 2003 the AIDS rate for every 100,000 African-American males was eight times that of white males; for African-American females, the rate was twenty-two times that of white females. This differential rate in females also translates into a fifteen-fold difference in AIDS in African-American children compared to white children. The incidence of AIDS in the African-American community is attributable, in large measure, to the higher rate of intravenous drug use, in which drug users frequently exchange dirty needles. This practice of sharing needles is further complicated when the intravenous drug users engage in sexual practices that put themselves, their partners, and unborn children at risk.

See also AIDS in the Americas; Race and Science

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willie j. pearson, jr. (1996)

norris white gunby, jr. (2005)