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:

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.

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