Cost of Being Black in America: 1.6 Million Extra Deaths Over Two Decades
Over the past two decades, premature deaths have cost Black Americans over 80 million more lost years of life, compared with white Americans, a new study finds.
The study is the latest to highlight the nation's longstanding racial disparities in health and life expectancy.
And while the problem is well known, the new findings frame it in a striking light, experts said.
"This is a staggering number," said senior researcher Dr. Harlan Krumholz, a professor at Yale School of Medicine in New Haven, Conn.
Between 1999 and 2020, his team found, Black Americans suffered more than 1.6 million excess deaths, relative to their white counterparts. Over the first half or so of that period, the disparity did narrow gradually — but then the progress stopped.
"There was a promising trend, though it didn't improve as fast as you'd want to see," Krumholz said. "And then it just stalled out."
That was the case, at least, until the pandemic, which took an outsized toll on Black American lives. In 2020, Krumholz said, even the modest progress of the previous 20 years was erased.
All told, the study found, Black Americans lost more than 80 million potential years of life, compared with white Americans. Older adults were among those most affected, but so were infants: Black babies had more than double the death rate of white infants — what Krumholz called a tragic disparity.
"We're living in a society where one group is experiencing a staggering loss, and it's due to social inequities," he said.
For the study, the researchers used data from the U.S. Centers for Disease Control and Prevention to compare age-adjusted death rates for non-Hispanic Black and non-Hispanic white Americans between 1999 and 2020.
Over that period, Black Americans persistently suffered excess deaths, though there was an improvement between 1999 and 2011 — from just over 400 more deaths per 100,000 people, to 211 more deaths per 100,000, relative to white Americans.
But then the progress halted from 2011 to 2019, followed by the reversal in the pandemic's first year.
It's not clear what drove the initial improvement, Krumholz said, but whatever it was, it was short-lived.
As for the causes of the excess deaths among Black Americans, heart disease and cancer were the top culprits, Krumholz said. In 2020, though, COVID-19 was the leading cause of excess deaths among Black men; among women, COVID-19 was second only to heart disease.
The way the study framed the problem — years of life lost — helps convey "the depth and breadth" of the nation's death rate disparity, said Laudan Aron, a senior fellow at the Urban Institute's Health Policy Center, in Washington D.C.
She said it shines a particular light on the deaths of younger people, which take a heavy toll on families and communities.
That, Aron noted, is the piece that often gets lost in the data — the trauma that untimely and unexpected deaths leave in their aftermath.
"They have profound ripple effects," she said.
Unequal access to high-quality health care is part of the problem, but only part, both Krumholz and Aron said. Black Americans' shorter lives are connected to deeply rooted social barriers — in everything from housing and education to taxes, good jobs and the opportunity to build wealth to the criminal justice system.
"This [disparity] is a reflection of policy choices," Aron said. "We can make different choices and have better outcomes."
Dr. Laurie Zephyrin is senior vice president of advancing health equity at the nonprofit Commonwealth Fund, in New York City.
She said the new findings "provide an important framing in terms of what we're losing as a society."
Excess deaths, Zephyrin noted, are those that could probably have been prevented. Those losses rob families of loved ones, she said, and they also cost communities and the wider society.
"This doesn't just harm a few of us. It harms all of us," Zephyrin said. "And it will take all of us to remedy this."
With so many social factors feeding the nation's health disparities, the task of addressing them may seem daunting. But Zephyrin also saw hope in the fact that those social inequities are getting more attention.
"We are seeing more recognition of the structural impacts [on people's health], rather than just blaming individuals," she said.
The findings were published May 16 in the Journal of the American Medical Association.
The Commonwealth Fund has more on advancing health equity.
SOURCES: Harlan Krumholz, MD, professor, medicine (cardiology), director, Center for Outcomes Research and Evaluation, Yale School of Medicine, Yale New Haven Hospital, New Haven, Conn.; Laudan Aron, MA, senior fellow, Health Policy Center, Urban Institute, Washington, D.C.; Laurie Zephyrin, MD, MPH, MBA, senior vice president, advancing health equity, The Commonwealth Fund, New York City; Journal of the American Medical Association, May 16, 2023