Groundbreaking research revealed that the progress made in reducing racial mortality disparities in the U.S. has stalled and even reversed in recent years. The study, published in the JAMA Network Open, highlights the urgent need to address this crisis and regain the momentum towards achieving health equity. Health equity remains a critical goal, as the disproportionate impact of various diseases and causes of death on the Black population underscores the systemic challenges that persist.
A Troubling Reversal
The study, led by researchers at the Yale School of Medicine observed the trends in age-adjusted mortality rates (AAMRs) for 15 primary underlying causes of death from 1999 to 2020 among Black and White US populations. The conclusions it reaches are alarming.
From 1999 to 2016 for Black women and from 1999 to 2011 for Black men, the excess AAMR declined, suggesting that racial disparities were shrinking during this time period. But then except for the positive development it has stagnated at best or even be regressive in the years that followed. The initial reduction in excess mortality for Black men was primarily due to causes including cancer, heart disease, accidents, and HIV; for Black women, the reduction was driven by causes such as heart disease, diabetes, cancer, accidents (including unintentional injuries), and cerebrovascular diseases.
Disturbing Revival of Inequities
When the investigators looked at men and women, they found that for men from 2012 to 2019 and from 2016 to 2019 for women, there were “significant rises in mean annual excess AAMR,” which turned all previous gains on their head. However, significantly larger increases in specific causes of death such as accidents, heart disease, cerebrovascular disease and assault heralded the demise of this secular trend over several decades.
The situation was worsened by the emergence of the COVID-19 pandemic in 2020, where this disease contributed to 46.1% and 43.2% of increases in all-cause excess AAMR among women and men, respectively. This further magnifies the inequities of the Black community already wreaked by the pandemic.
Just in Time Expert Interventions and Equity
The results of this study suggest an urgent need to intervene to reverse these pervasive patterns of racial mortality disparities. As the authors write, “We face an imperative to understand how to recapture the gains and implement evidence-based interventions to advance health equity.”
It is imperative that access to care be level and that we work to address the systemic barriers and social determinants of health which contribute to these disparities. To halt the progress, targeted public health investments in tandem with improving access to quality healthcare and addressing root socioeconomic and structural drivers of inequities are necessary prerequisites for a return to the path towards real health equity. Addressing them will require a multi-faceted, multistakeholder approach to achieve health and well-being for all people of every race.
