Timothy Waidmann

Excess Mortality Among Blacks and Whites in the United States

BACKGROUND Although the general relations between race, socioeconomic status, and mortality in the United States are well known, specific patterns of excess mortality are not well understood. METHODS Using standard demographic techniques, we analyzed death certificates and census data and made sex-specific population-level estimates of the 1990 death rates for people 15 to 64 years of age. We studied mortality among blacks in selected areas of New York City, Detroit, Los Angeles, and Alabama (in one area of persistent poverty and one higher-income area each) and among whites in areas of New York City, metropolitan Detroit, Kentucky, and Alabama (one area of poverty and one higher-income area each). Sixteen areas were studied in all. RESULTS When they were compared with the nationwide age-standardized annual death rate for whites, the death rates for both sexes in each of the poverty areas were excessive, especially among blacks (standardized mortality ratios for men and women in Harlem, 4.11 and 3.38; in Watts, 2.92 and 2.60; in central Detroit, 2.79 and 2.58; and in the Black Belt area of Alabama, 1.81 and 1.89). Boys in Harlem who reached the age of 15 had a 37 percent chance of surviving to the age of 65; for girls, the likelihood was 65 percent. Of the higher-income black areas studied, Queens--Bronx had the income level most similar to that of whites and the lowest standardized mortality ratio (men, 1.18; women, 1.08). Of the areas where poor whites were studied, Detroit had the highest standardized mortality ratios (men, 2.01; women, 1.90). On the Lower East Side of Manhattan, in Appalachia, and in Northeast Alabama, the ratios for whites were below the national average for blacks (men, 1.90; women, 1.95). CONCLUSIONS Although differences in mortality rates before the age of 65 between advantaged and disadvantaged groups in the United States are sometimes vast, there are important differences among impoverished communities in patterns of excess mortality.

Resolving inconsistencies in trends in old-age disability: Report from a technical working group

In September 2002, a technical working group met to resolve previously published inconsistencies across national surveys in trends in activity limitations among the older population. The 12-person panel prepared estimates from five national data sets and investigated methodological sources of the inconsistencies among the population aged 70 and older from the early 1980s to 2001. Although the evidence was mixed for the 1980s and it is difficult to pinpoint when in the 1990s the decline began, during the mid- and late 1990s, the panel found consistent declines on the order of 1%–2.5% per year for two commonly used measures in the disability literature: difficulty with daily activities and help with daily activities. Mixed evidence was found for a third measure: the use of help or equipment with daily activities. The panel also found agreement across surveys that the proportion of older persons who receive help with bathing has declined at the same time as the proportion who use only equipment (but not personal care) to bathe has increased. In comparing findings across surveys, the panel found that the period, definition of disability, treatment of the institutionalized population, and age standardizing of results were important to consider. The implications of the findings for policy, national survey efforts, and further research are discussed.

Inequality in life expectancy, functional status, and active life expectancy across selected black and white populations in the United States

We calculated population-level estimates of mortality, functional health, and active life expectancy for black and white adults living in a diverse set of 23 local areas in 1990, and nationwide. At age 16, life expectancy and active life expectancy vary across the local populations by as much as 28 and 25 years respectively. The relationship between population infirmity and longevity also varies. Rural residents outlive urban residents, but their additional years are primarily inactive. Among urban residents, those in more affluent areas outlive those in high-poverty areas. For both whites and blacks, these gains represent increases in active years. For whites alone they also reflect reductions in years spent in poor health.

Race and Ethnic Disparities in Health Care Access and Utilization: An Examination of State Variation

Health disparities among racial and ethnic groups have a long history and continue to exist in the United States. The U.S. government has established as a goal for the year 2010 the elimination of racial/ethnic health differences in six areas. This article examines disparities in one of those areas: access to high-quality health care. Several measures of access to and use of health care services are studied both nationally and in 13 diverse states. The authors find that both the magnitude of racial and ethnic disparity and the reasons behind it depend significantly on the state, the ethnic group, and the type of outcome measure being studied. Such information can be valuable for state and national policy makers in targeting resources and in designing effective strategies for the elimination of racial and ethnic disparities.

Trends in Late-Life Activity Limitations in the United States: An Update From Five National Surveys

This article updates trends from five national U.S. surveys to determine whether the prevalence of activity limitations among the older population continued to decline in the first decade of the twenty-first century. Findings across studies suggest that personal care and domestic activity limitations may have continued to decline for those ages 85 and older from 2000 to 2008, but generally were flat since 2000 for those ages 65–84. Modest increases were observed for the 55- to 64-year-old group approaching late life, although prevalence remained low for this age group. Inclusion of the institutional population is important for assessing trends among those ages 85 and older in particular.

Disability Transfers, Self-Reported Health, and the Labor Force Attachment of Older Men: Evidence from the Historical Record

We use trends in self-reported disability to gauge the impact of the growth of disability transfer programs on the labor force attachment of older working-aged men. Our tabulations suggest that between 1949 and 1987, about half of the 4.9 percentage point drop in the labor force participation of men aged 45–54 and between one quarter and one third of the 19.9 point drop among men aged 55–64 represented a movement of men out of the labor force and onto the rolls of transfer programs targeted at the disabled. Since the expansion of transfer programs represents only one of the forces behind this movement, these figures represent upper bounds on the impact of such programs on work force attachment.

Poverty, time, and place: variation in excess mortality across selected US populations, 1980-1990.

STUDY OBJECTIVE: To describe variation in levels and causes of excess mortality and temporal mortality change among young and middle aged adults in a regionally diverse set of poor local populations in the USA. DESIGN: Using standard demographic techniques, death certificate and census data were analysed to make sex specific population level estimates of 1980 and 1990 death rates for residents of selected areas of concentrated poverty. For comparison, data for whites and blacks nationwide were analysed. SETTING: African American communities in Harlem, Central City Detroit, Chicagos south side, the Louisiana Delta, the Black Belt region of Alabama, and Eastern North Carolina. Non-Hispanic white communities in Cleveland, Detroit, Appalachian Kentucky, South Central Louisiana, Northeastern Alabama, and Western North Carolina. PARTICIPANTS: All black residents or all white residents of each specific community and in the nation, 1979-1981 and 1989-1991. MAIN RESULTS: Substantial variability exists in levels, trends, and causes of excess mortality in poor populations across localities. African American residents of urban/northern communities suffer extremely high and growing rates of excess mortality. Rural residents exhibit an important mortality advantage that widens over the decade. Homicide deaths contribute little to the rise in excess mortality, nor do AIDS deaths contribute outside of specific localities. Deaths attributable to circulatory disease are the leading cause of excess mortality in most locations. CONCLUSIONS: Important differences exist among persistently impoverished populations in the degree to which their poverty translates into excess mortality. Social epidemiological inquiry and health promotion initiatives should be attentive to local conditions. The severely disadvantageous mortality profiles experienced by urban African Americans relative to the rural poor and to national averages call for understanding.

Undocumented Immigrants, Left Out Of Health Reform, Likely To Continue To Grow As Share Of The Uninsured

The increase in undocumented immigration between 1999 and 2007 contributed to an increase in the number of uninsured people in the United States. During this period, the number of undocumented immigrants increased from an estimated 8.5 million to 11.8 million, leading to an estimated additional 1.8 million uninsured. These uninsured and undocumented immigrants were estimated to represent 27 percent of the overall increase of 6.9 million uninsured people during this period. Undocumented immigrants accounted for one in seven of the uninsured in 2007, up from one in eight in 1999. These undocumented immigrants will not be eligible for public insurance or any type of private coverage obtained through exchanges under the Affordable Care Act of 2010. As a result, members of this group will eventually constitute a larger percentage of the uninsured population, unless other policy actions are taken to provide for their coverage, or their immigration status is changed.

Accounting for Recent Declines in Employment Rates among Working-Aged Men and Women with Disabilities.

During the 1990s, while overall employment rates for working-aged men and women either remained roughly constant (men) or rose (women), employment rates for people with disabilities fell. During the same period the fraction of the working-aged population receiving Social Security Disability Insurance (DI) benefits increased quite dramatically. We present simple time series and cross-state evidence suggesting that the growth in the DI program can account for much of the decline in the relative employment position of men and women with disabilities.

Health Inequality and Population Variation in Fertility-Timing

We estimate the impact of fertility-timing on the chances that children in poor urban African American communities will have surviving and able-bodied parents until maturity. To do so, we use census and vital statistics data to compute age- and sex-specific rates of mortality and functional limitation among prime-aged adult residents of impoverished African American areas in Harlem, Detroit, Chicago, and the Watts area of Los Angeles and for blacks and whites nationwide. Findings are consistent with the hypothesis that the early fertility-timing characteristic of poor urban African American populations mitigates some of the costs to families associated with excess mortality and early health deterioration in young through middle adulthood.