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Minority Health

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Black race and low levels of education are associated with health disparities such as higher death rates

Blacks and people who have fewer years of education live about six fewer years than whites and people who are better educated. A few diseases in particular account for most of these socioeconomic and racial disparities, according to a study supported by the Agency for Healthcare Research and Quality (HS10858).

The researchers found that smoking-related diseases caused the most deaths among people with fewer years of education, while high blood pressure, HIV, diabetes, and trauma caused the most deaths among blacks. Targeting these diseases could help to reduce these and other health disparities, concludes Martin F. Shapiro, M.D., Ph.D., of the University of California at Los Angeles.

Dr. Shapiro and his colleagues used data from the National Health Interview Survey conducted from 1986 through 1994 to estimate cause-specific risks of death among a representative sample of the U.S. population, stratifying the population by educational level and race. People without a high school education lost 12.8 potential life-years per person compared with 3.6 years of potential life lost for high school graduates. Smoking-related heart disease and cancer contributed the most to the difference in potential life-years lost. Ischemic heart disease contributed 11.7 percent to the difference (with all cardiovascular diseases accounting for 35.3 percent). All cancers accounted for 26.5 percent, including 7.7 percent due to lung cancer. Other lung diseases and pneumonia contributed 10.1 percent of the total. Income-level disparities were similar.

Blacks and whites lost 7.0 and 5.2 potential life-years per person, respectively, as a result of deaths from any cause. Cardiovascular diseases accounted for one-third of this disparity, in large part because of hypertension (15 percent). HIV disease (11.2 percent) contributed almost as much as ischemic heart disease (5.5 percent), stroke (2.8 percent), and cancer (3.4 percent) combined, and trauma and diabetes accounted for 10.7 percent and 8.5 percent, respectively.

More details are in "Contribution of major diseases to disparities in mortality," by Mitchell D. Wong, M.D., Ph.D., Dr. Shapiro, W. John Boscardin, Ph.D., and Susan L. Ettner, Ph.D., in the November 14, 2002, New England Journal of Medicine 347(20), pp. 1585-1592.

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