文章基本信息

标题：The Longevity Gap Between Black and White Men in the United States at the Beginning and End of the 20th Century
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作者：Frank A. Sloan ; Padmaja Ayyagari ; Martin Salm 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2010
卷号：100
期号：2
页码：357-363
DOI：10.2105/AJPH.2008.158188
语种：English
出版社：American Public Health Association
摘要：Objectives. We sought to assess whether the disparity in mortality rates between Black and White men decreased from the beginning to the end of the 20th century. Methods. We used Cox proportional hazard models for mortality to estimate differences in longevity between Black and White Civil War veterans from 1900 to 1914 (using data from a pension program) and a later cohort of male participants (using data from the 1992 to 2006 Health and Retirement Study). In sensitivity analysis, we compared relative survival of veterans for alternative baseline years through 1914. Results. In our survival analysis, the Black–White male difference in mortality, both unadjusted and adjusted for other influences, did not decrease from the beginning to the end of the 20th century. A 17% difference in Black–White mortality remained for the later cohort even after we controlled for other influences. Although we could control for fewer other influences on longevity, the Black–White differences in mortality for the earlier cohort was 18%. Conclusions. In spite of overall improvements in longevity, a major difference in Black–White male mortality persists. Substantial improvements in health and longevity occurred during the 20th century.^{1 – 4} Nevertheless, disparities in health and health care in the US population between Black and White races persist.^{5 , 6} In the past 20 years there was an initial increase in the Black–White mortality differential followed by a slight convergence in the 1990s.^{7 , 8} Although short-term fluctuations in differentials are to be expected, a more meaningful indicator of progress in eliminating disparities is evidence of narrowing differentials over the longer term. We hypothesized that, in view of the substantial growth in spending on personal health care services and implementation of large-scale public health insurance programs, Black–White mortality differences would have decreased over the century. We used data from a major data collection effort spanning the late 19th and early 20th centuries, which converted paper records on health and longevity to data in machine-readable form on US males, both Black and White.^{9 – 12} We used these data in combination with more recent data on comparably aged men to compare Black–White differences in longevity between the early and late 20th century.