Thursday, August 21, 2014

Racial differences in life expectancy, rural edition

A new article in Health Affairs examines the life expectancy gap between whites and blacks in the US, over a 20 year time period.  They found positive results, namely:

Nationally, the black-white difference in life expectancy at birth shrank during the period by 2.7 years for males (from 8.1 to 5.4 years) and by 1.7 years for females (from 5.5 to 3.8 years). 

 However, they also found considerable variations by census region and state, with some areas experiencing a much smaller decrease in life expectancy gap.  The good news is that virtually all areas saw a decrease in the gap, driven by an increase in life expectancy within black populations.

These data do not tell the full story, however.  Dr. Probst published a study in Health Affairs describing mortality differences among rural populations:
In an analysis controlling only for sex and age at interview, we found that rural whites and both rural and urban blacks were at greater risk of death by 2006 than were similar urban whites. 
And further:
When personal characteristics and circumstances were held statistically equal, only urban blacks had a higher risk of death than urban whites, while urban Hispanics were at a reduced risk of death (Exhibit 2). This suggests that much of the increased risk of death among rural whites and blacks is associated with personal characteristics more prevalent in the rural population, such as low education, poorer health, and lack of private insurance. 
These results show how important it is to not lose sight of individual characteristics in regards to studies in disparities.  While Harper et al found important and good news regarding life expectancy, small populations (e.g. rural minorities) may not experience such an improvement.  State-based studies are not discrete enough to measure the experiences of these subgroups, and should not be taken as positive results for all.

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