Despite unprecedented mortality declines during the 20th century, black-white disparities in all cause and cause-specific mortality continue to be substantial in the United States. Explanations offered for these disparities include black-white differences in income, education and wealth, racial discrimination, and disparities in access to health care, including differential treatment in the health care system. Despite the vast literature on black-white differences in health and mortality there is little consensus regarding how best to reduce them. This project proposes new ways to analyze black-white mortality disparities in the U.S. between 1980 and 2005 by investigating the contribution of causes of death considered avoidable by (1) high-quality and timely medical care and (2) policy/behavior interventions. Although the study of avoidable mortality (AM) originated in the U.S., it has been applied mainly in other countries as an indicator of health system performance and thus its role in explaining B-W mortality disparities in the U.S. is not known. We will estimate the contribution of various categories of AM and non-AM to black-white differences in life expectancy at birth and to changes therein between 1980 and 2005;investigate the effect of state-level policies, health system and socioeconomic characteristics on state-level variation and black-white differences in various categories of AM and non-AM between 1980 and 2005;and examine effects of individual-level socio-demographic characteristics and health behaviors on black-white differences in various categories of AM and non-AM from 1986 to 2002. The strengths of the study include the use of multiple data sources (vital statistics and census data;state- level policies, health resources, and socio-demographic characteristics;and National Health Interview Survey- Multiple Cause of Death data) and methods (demographic, econometric). The analyses will complement prior individual- and disease-oriented studies of black-white disparities in the leading causes of death by estimating the impact of causes grouped by the main means of reducing them (e.g. medical care, public policy, behavior).

Public Health Relevance

The elimination of race/ethnic health disparities is one of the public health priorities in the United States. The proposed project contributes to this goal by improving our understanding of black-white disparities in mortality due to causes of death that are avoidable by good quality medical care and amenable by policy /behavior interventions. The results will aid in monitoring health inequalities and help guide public investments to areas of greatest need.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Exploratory/Developmental Grants (R21)
Project #
Application #
Study Section
Special Emphasis Panel (ZRG1-HOP-B (90))
Program Officer
Bures, Regina M
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
University of Pennsylvania
Schools of Arts and Sciences
United States
Zip Code
Macinko, James; Silver, Diana; Bae, Jin Yung (2015) Age, period, and cohort effects in motor vehicle mortality in the United States, 1980-2010: the role of sex, alcohol involvement, and position in vehicle. J Safety Res 52:47-57
Elo, Irma T; Beltrán-Sánchez, Hiram; Macinko, James (2014) The Contribution of Health Care and Other Interventions to Black-White Disparities in Life Expectancy, 1980-2007. Popul Res Policy Rev 33:97-126
Silver, D; Macinko, J; Bae, J Y et al. (2013) Variation in U.S. traffic safety policy environments and motor vehicle fatalities 1980-2010. Public Health 127:1117-25
Ho, Jessica Y; Elo, Irma T (2013) The contribution of smoking to black-white differences in U.S. mortality. Demography 50:545-68