The reduction of preventable deaths among minority populations in the United States is a national health objective for the year 2000 (1). One measure used to assess progress toward this objective is years of potential life lost before age 65 (YPLL-65), which measures the impact of deaths occurring in years preceding 65 years of age and emphasizes the effects of deaths among younger persons (2). This report compares trends in YPLL-65 among U.S. whites and blacks from 1979 through 1989.

To assess these trends, race- and sex-specific YPLL-65 rates for death from all causes were calculated for 1979 through 1988 and combined with recently available data on YPLL-65 in 1989 (3). The contributions of specific causes of death in 1979 and 1989 were analyzed among white and black males and females. Other racial/ethnic groups were not examined because of limitations in comparable census information.

From 1979 to 1989, the rate of YPLL-65 (per 1000 population) decreased for white males (from 76.3 to 65.3 [14.4%]) and white females (from 39.7 to 34.0 [14.4%]) (Figure 1). For blacks, the YPLL-65 rate decreased from 1979 through the mid-1980s, then began to increase. For black males, the rate decreased from 142.1 in 1979 to a low of 121.7 in 1984 and increased to 141.8 in 1989; for black females, the rate decreased from 79.2 in 1979 to a low of 68.9 in 1985 and increased to 74.3 in 1989 (Figure 1).

Among white males, unintentional injuries were the leading cause of YPLL-65 in both 1979 and 1989, followed by diseases of the heart, malignant neoplasms, and suicide; in 1989, human immunodeficiency virus (HIV) infection replaced homicide as the fifth leading cause of YPLL-65 (Table 1). In 1989, among black males, homicide replaced unintentional injury as the leading cause of YPLL-65, and HIV infection matched malignant neoplasms as the fourth leading cause of YPLL-65 (Table 1). Among white females, the relative ranking of four leading causes of YPLL-65 remained unchanged from 1979 to 1989: malignant neoplasm was the leading cause, followed by unintentional injuries, diseases of the heart, and suicide; in 1989, homicide replaced cerebrovascular diseases as the fifth leading cause of YPLL-65 (Table 1). Among black females, the relative ranking of the first four leading causes of YPLL-65 remained unchanged from 1979 to 1989; malignant neoplasm was the leading cause, followed by diseases of the heart, unintentional injuries, and homicide; in 1989, HIV-associated deaths replaced cerebrovascular disease as the fifth leading cause of YPLL-65.

In 1989, the YPLL-65 rate ratio for males compared with females was 1.9 both for whites and for blacks (Table 1). The YPLL-65 rate ratio for blacks compared with whites was 2.2 for both males and females in 1989; from 1979 to 1989, the rate ratio of YPLL-65 for blacks compared with whites increased by 10% among females and 16% among males.

Reported by: Applications Br, Div of Surveillance and Epidemiology, Epidemiology Program Office; Office of the Associate Director for Minority Health, Office of the Director, CDC.

Editorial Note

Editorial Note: This report indicates an increasing disparity in early death between whites and blacks in recent years. The greatest disparities in rates (as reflected by rate ratios) are for homicide, HIV infection, and cerebrovascular disease. These race- specific differences in rates and rank ordering of causes of YPLL-65 may reflect, in part, differences in socioeconomic status and health-care access and use (4,5).

YPLL-65 is a summary measure of premature mortality (i.e., deaths among persons aged less than 65 years) and contrasts with crude mortality statistics that are dominated by deaths among the elderly (2). Overall, white/black differences in YPLL-65 are consistent with other measures of death (e.g., life expectancy, crude mortality, and age-specific mortality) (6). With the exception of suicide, death rates (including YPLL-65) are higher for blacks than whites for the leading causes of death.

Although summary measures are used commonly for making general comparisons between groups, one limitation of summary measures is their potential to mask variation within populations. For example, while death rates are higher for blacks than whites in each age group less than 65 years, rate ratios vary substantially by age (6). Public health response to excess mortality may thus require analysis of age-specific rates for different conditions.

Several approaches have been outlined to reduce premature mortality among targeted populations. For example, CDC has recently developed a framework to assist communities in the design, implementation, and evaluation of programs to prevent youth violence; the framework includes approaches to restrict access to firearms and teach nonviolent conflict resolution.* HIV-prevention programs must address cultural and socioeconomic factors such as poverty, underemployment, and poor access to the health-care system; CDC supports community-based organizations in the operation of HIV-prevention programs (7), works with health departments, and funds local and national minority organizations involved in HIV-prevention programs. To lower risk from cerebrovascular disease in blacks, the National Institutes of Health has recommended steps to reduce hypertension and obesity (8). Finally, the Secretary's Task Force on Black and Minority Health has recommended that research and intervention programs be targeted to the specific needs and characteristics of minority communities (4).

References

1. Public Health Service. Healthy people 2000: national health promotion and disease prevention objectives -- full report, with commentary. Washington, DC: US Department of Health and Human Services, Public Health Service, 1991; DHHS publication no. (PHS)91-50212.

2. CDC. Premature mortality in the United States: public health issues in the use of years of potential life lost. MMWR 1986;35 (no.2S).

3. NCHS. Health, United States, 1991. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, 1992; publication no. (PHS)92-1232.

4. US Department of Health and Human Services. Report of the Secretary's Task Force on Black and Minority Health. Washington, DC: US Department of Health and Human Services, 1985.

5. American Medical Association Council on Ethical and Judicial Affairs. Black-white disparities in health care. JAMA 1990;263:2344-6.

6. NCHS. Advance report of final mortality statistics, 1989. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, 1992. (Monthly vital statistics report; vol 40, no. 8, suppl 2).

7. CDC. HIV/AIDS prevention: facts about HIV/AIDS and race/ethnicity. Atlanta: US Department of Health and Human Services, Public Health Service, 1992.

8. National Institutes of Health. Detection, evaluation, and treatment of high blood pressure. Bethesda, Maryland: US Department of Health and Human Services, Public Health Service, 1988; NIH publication no. 88-1088.

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