A Framework for Considering the Value of Race and Ethnicity in Estimating Disease Risk

Excess Mortality Rate in Black Children Since 1950 in the United States: A 70-Year Population-Based Study of Racial Inequalities

BACKGROUND

Black Americans have lower wealth, income, and education and higher mortality rates than White Americans, especially during childhood.

OBJECTIVE

To document the extent and persistence of excess infant and childhood mortality in Black Americans between 1950 and 2019.

DESIGN

Population-based surveillance study.

SETTING

The United States of America.

PATIENTS

The entire population of the United States.

MEASUREMENTS

The investigators analyzed mortality data collected by the Centers for Disease Control and Prevention and the U.S. Census Bureau from 1950 to 2019 and calculated mortality rates, life expectancy, and years of potential life lost for White and Black Americans to estimate the absolute and relative sex- and age-specific excess mortality burden among Black Americans compared with White Americans.

RESULTS

The gaps in absolute life expectancy and age-standardized mortality between Black and White Americans decreased over the 70-year period beginning in 1950, but relative mortality in infants and children increased during this same period. The mortality rates in the 1950s for White and Black infants were 2703 and 5181 deaths per 100 000 persons, respectively, for an excess mortality ratio of 1.92 (95% CI, 1.91 to 1.93). In the 2010s, the mortality rates were 499 deaths per 100 000 persons in White infants and 1073 deaths per 100 000 persons in Black infants, for an excess mortality ratio of 2.15 (CI, 2.13 to 2.17). A total of 5.0 million excess deaths of Black Americans (including 522 617 infants) could have been avoided during these 7 decades if their mortality rates were equal to those of White Americans.

LIMITATION

The effect of health inequities was measured without inquiring about the causes of these differences.

CONCLUSION

Black infants, children, and adults have experienced persistent excess mortality in the United States since the 1950s relative to the White population.

PRIMARY FUNDING SOURCE

None.

Online database of clinical algorithms with race and ethnicity

Some clinical algorithms incorporate an individual's race, ethnicity, or both as an input variable or predictor in determining diagnoses, prognoses, treatment plans, or risk assessments. Inappropriate use of race and ethnicity in clinical algorithms at the point of care may exacerbate health disparities and promote harmful practices of race-based medicine. Using database analysis primarily, we identified 42 risk calculators that use race and ethnicity as predictors, five laboratory test results with reference ranges that differed based on race and ethnicity, one therapy recommendation based on race and ethnicity, 15 medications with race- and ethnicity-based initiation and monitoring guidelines, and five medical devices with differential racial and ethnic performances. Information on these clinical algorithms is freely available at https://www.clinical-algorithms-with-race-and-ethnicity.org/ . This resource aims to raise awareness about the use of race and ethnicity in clinical algorithms and track progress toward eliminating their inappropriate use. The database is actively updated to include clinical algorithms that were missed and additional characteristics of these algorithms.