Contributors to Wisconsin’s persistent black-white gap in life expectancy

Abstract

BackgroundAlthough the black-white gap in life expectancy has narrowed in the U.S., there is considerable variability across states. In Wisconsin, the black-white gap exceeds 6\u2009years, well above the national average. Reducing this disparity is an urgent public health priority, but there is limited understanding of what contributes to Wisconsin’s racial gap in longevity. Our investigation identifies causes of death that contribute most to Wisconsin’s black-white gap in life expectancy among males and females, and highlights specific ages where each cause of death contributes most to the gap.MethodsOur study employs 1999–2016 restricted-use mortality data provided by the National Center for Health Statistics. After generating race- and sex-specific life tables for each 3-year period of observation (e.g., 1999–2001), we trace recent trends in the black-white life expectancy gap in Wisconsin. We subsequently conduct a series of analyses to decompose the black-white gap in three time periods into 13 separate causes and 19 different age groups.ResultsIn 2014–16, Wisconsin’s black-white gap in life expectancy was 7.34\u2009years for males (67% larger than the national gap), and 5.61\u2009years for females (115% larger than the national gap). Among males, homicide was the single largest contributor, accounting for 1.56\u2009years of the total gap. Heart disease and cancer followed, contributing 1.43 and 1.42\u2009years, respectively. Among females, heart disease and cancer were the two leading contributors to the gap, accounting for 1.12 and 1.00\u2009years, respectively. Whereas homicide contributed most to the racial gap in male longevity during late adolescence and early adulthood, heart disease and cancer exerted most of their influence between ages 50–70 for both males and females. Other notable contributors were unintentional injuries (males), diabetes and cerebrovascular disease (females), and perinatal conditions (males and females).ConclusionsOur study identifies targets for future policy interventions that could substantially reduce Wisconsin’s racial gap in life expectancy. Concerted efforts to eliminate racial disparities in perinatal mortality and homicide early in the life course, and chronic conditions such as cancer and heart disease in later life, promise to help Wisconsin achieve the public health objective of racial parity in longevity.