lecture_9___mortalitydifferential_

lecture_9___mortalitydifferential_ - Who Lives Who Dies...

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September 29, 2008 Who Lives? Who Dies?
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Mortality differentials Who to target? What to target among the targeted group? Sex Race SES (income & education) Marital status Religion
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Sex Differentials
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Age-adjusted death rates, by sex
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Life Expectancy 2004
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Trends
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Sex differences in life expectancy
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Why do women have lower mortality? Biology? Environment? Approaches Prospective studies (link survey data to administrative records) Compare men and women in same environments (e.g., clergy) Results? Biology (e.g., immune function, fetal waste, animal studies, women are advantaged for every cause-of- death, except homocide) Environment (e.g., smoking – 25% of gender gap).
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Racial disparities
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Race differentials Higher cause-specific death rates for every cause
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Some Convergence over time!
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Genetics? Pathways of race to health are linked to the structure of society and to social experience — not to biology and genetics. Racial categories don’t capture much biologic distinctiveness, and they are unlikely to be a major explanation for heath disparities. Source: Williams (1996)
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Why? Environmental? What? Higher heart and cancer mortality (but why?) Low SES and poverty (big effect) Life style (e.g., smoking, exercise, obesity) Neighborhood conditions (why?)
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The facts Life expectancy for African-American men is 7.1 years less than for white men, 7.5 years less than for African-American women and 12.7 years less than for white women. African-American men die of heart disease at a rate of 244.7 per 100,000 — more than 2.5 times the rate for white women. Cerebrovascular disease is twice as likely to kill African-American men, at a rate of 50.5 per 100,000, as it is to kill white men or women. And 221.1 per 100,000 African-American men die of cancer — more than twice the rate for white women. African-American men die of complications from HIV/AIDS at a rate of 62.7 per 100,000, compared with 25.5 for Latino men, 19.1 for African-American women, 12.5 for white men, 5.9 for Latino women and 1.8 for white women.
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Black-white comparisons, age 40-64 (Elo & Drevenstedt)
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Race and health behaviors? African-American and Latino men are less likely than white men to see a doctor, even when they are in poor health. For non-elderly men, 46 percent of Latinos and 28 percent of African-Americans lack health insurance. Men of color are less likely than white men to have job-based insurance, and only 6 percent to 8 percent of Latino and African- American men have Medicaid. Regardless of insurance status, men of color are less likely to receive timely preventive services, and more likely to suffer the consequences of delayed attention, such as limb amputations and radical cancer surgery. The Institute of Medicine has found significant racial and ethnic disparities within the health care system.
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Black to white mortality
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