Breaching the Gap: Racial Discrepancies in Healthcare?

The longevity gap between Black and White men has remained constant over the past decade despite contemporary improvements in American healthcare. In 1900 the Black-White differential in death probability between the two races was 18%, while from 1992-2006 the differential was 17%.

A 2010 article published in the American Journal of Public Health with Dr.’s Ayyagari and Salm and fellow Duke researcher Dan Grossman reached this conclusion by compiling data from Union Army pension plans at the turn of the century and the 1900 Census and comparing this with data from the 1992 to 2006 Health and Retirement Study. The investigation controlled for factors such as age, marital status, foreign birth, occupation, home ownership, urbanization, and education.

Previous research had already postulated that the Black-White mortality rate in America varies little over time, but this particular study reinforces that conclusion by controlling for other factors (such as education level, income, and employment) that proved in the course of research to have an impact on mortality differentials.

Although Black-White mortality rates appear to remain constant across the twenty-first century, mortality rates for Blacks drop by 19 percentage points between the 1900 and 1992 baselines. This suggests that there has been improvement in mortality rates for Blacks, but as White mortality rates also drop, the differential for the two races remains essentially constant in the long run.

The researchers acknowledge some limitations in their findings. The Union Army data, for instance, represents a certain geographic area; some national representativeness may thus be lost. Many veterans could not be matched with the Census data, but hazard ratios for missing values indicate that these individuals had the same probability of death as matched veterans. Blacks may also have been less likely than Whites to receive military pensions in the first place, which other research suggests would have a detrimental effect on longevity. Even considering these constraints, however, the parameters used appear strong enough to establish a true trend in the Black-White differential death probability.

The persistency of this discrepancy is cause for attention as health policy makers implement the new healthcare legislation. Nothing, perhaps, illustrates this better than the White House’s recent articulation of a national strategy to address HIV/AIDS. The strategy aims to cut infection rates across the nation, with special emphasis on the gay and bisexual community and on Blacks. In urban communities like Milwaukee and D.C., reports of non-profit hospitals in these cities which primarily serve Blacks and other minority groups being bought by larger hospital and medical technology conglomerates further illustrate the timeliness of attention to race in providing equalized medical care.


For a more detailed description of research and analysis methods, see:
Sloan, Frank A., Padmaja Ayyagari, Martin Salm, and Daniel Grossman. "The Longevity Gap Between Black and White Men in the United States at the Beginning and End of the 20th Century." American Journal of Public Health. 100.2 (2010): 357-63. Print.

-Sabrina McCutchan