In recent decades the US black population has experienced substantial gains in life expectancy, now approaching the life expectancy of the white population. Between 1995 and 2014, the increase in black life expectancy at birth was more than double the white increase: a gain of 6.0 years from 69.6 years to 75.6 years for black people compared with a gain of 2.5 years from 76.5 years to 79.0 for white people.1 The difference in the percent per annum rate of increase was also more than double: 0.44 for black people, 0.17 for white people.
Male life expectancy increased more rapidly than female life expectancy in both races. From 1995 through 2014, life expectancy at birth increased from 65.7 years to 72.5 years among black men, from 73.3 years to 76.7 years among white men, from 73.9 years to 78.4 years among black women, and from 79.6 years to 81.4 years among white women1; thus, black men had the largest gains of the 4 race-sex groups, with a rate of increase of 0.52% per annum. Also noteworthy is that between 1990 and 2011, the bottom half of the black survivor distribution gained appreciably more than the top half: 0.65% per annum vs 0.24%. The bottom half, a gain of 8 years of life expectancy, and the top have had a gain of 4 years. In 1990 for black individuals, life expectancy for the top half of the survivor distribution was 30.3 years more than the lower half (84.3 vs 54.0 years); in 2011, the gap was reduced to 26.8 years (88.7 vs 61.9 years).1
In a study of changes in black-white differences in life expectancy from 1999 to 2013, Kochanek et al2 found that the gap in life expectancy closed by 2.3 years, from 5.9 to 3.6 years. The authors reported that greater decreases in cardiovascular disease mortality for blacks accounted for 0.37 years of the total decrease in the gap, cancer accounted for 0.32 years, human immunodeficiency virus (HIV) disease for 0.31 years, unintentional injuries for 0.28 years, and perinatal conditions for 0.14 years. Thus, gains in just 5 causes accounted for almost 60% of the decrease in the black-white life expectancy gap. A study by Firebaugh et al3 shifted the emphasis to black-white changes in age of death rather than cause of death. Their study combined all causes of death into just 4 major categories. Because there is an interaction between cause and age, cause of death might have been found to have more influence and age less of an influence if the study had divided cause of death into many more discrete categories.
The potential for further closing the gap in life expectancy between blacks and whites has changed significantly since the 1990s. The death rate for HIV disease has declined so substantially that even elimination of the large racial differential could not have a major effect on the existing life expectancy gap for all causes. Much the same could apply for deaths from perinatal conditions and, to a lesser extent, even to deaths from cardiovascular disease. Although cardiovascular disease is still a major cause of death, the average age of death from this cause has increased appreciably for both sexes, thus reducing the potential for further gains in life expectancy. For instance, in 2014, more than half the deaths from cardiovascular disease in white and black women occurred after age 85 years. Among white men, the median age of death from cardiovascular diseases was 78 years; for black men, it was 68 years.
To make a significant contribution to reducing the current gap between black and white life expectancy, a cause must have substantial number of deaths and a significantly higher age-adjusted death rate for blacks than for whites. Eleven causes of death meet those 2 criteria (Table). For example, diabetes mellitus ranks high on both counts, with a black age-adjusted death rate almost double the white death rate (37.3 vs 19.3 per 100 000 in 2014 and more total deaths, 13 435 among blacks and 59 741 among whites in 2014) than most of the other causes on the list. With a goal of reducing the 17% differential in black-white all-cause deaths, it appears that progress in just a few causes probably will not be enough; progress in many causes will be required.
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