Trends in Cause-Specific Mortality by Race and Hispanic Origin, 1999–2019

Notes

 1 The ICD-10 is available at https://icd.who.int/browse10/2019/en. The 11^th revision (ICD-11, available at https://www.who.int/standards/classifications/classification-of-diseases) was released after this research was conducted, but as of May 2024, the CDC WONDER database continues to use the ICD-10 classifications.

 2 Arias and others (2022) reported that “excess deaths due to COVID-19 and other causes in 2020 and 2021 led to an overall decline in life expectancy between 2019 and 2021 of 2.7 years for the total population, 3.1 years for males, and 2.3 years for females,” with the Hispanic and Black communities experiencing substantially higher declines. Holman and MacDonald (2022) provided an update of the 2020 cause-specific mortality experience in the United States. In addition, COVID mortality differentials by race have evolved over time and remain a subject of active research (Johnson and Keating 2022).

 3 Data for 1968–1978 are coded using ICD-8 and data for 1979–1998 are coded using ICD-9. The classification revisions differ enough to complicate direct comparison of cause-of-death data.

 4 For further details on age adjustment and the 2000 U.S. standard population, see https://www.cdc.gov/nchs/hus/sources-definitions/age-adjustment.htm.

 5 The CDC WONDER database provides the Census Bureau population estimates. Race bridging is a technique used to make the 31 race categories used in the 2000 and 2010 decennial censuses of the U.S. population compatible with the four race categories specified in the 1977 Office of Management and Budget standards (see https://www.cdc.gov/nchs/nvss/bridged_race.htm).

 6 Flagg and Anderson (2021) summarized the process.

 7 The racial categories and labels used in this article follow the 1977 Office of Management and Budget standards and are determined by the available data.

 8 As its name implies, the WNH category is an exception. Individuals who identify as White and Hispanic are included in the Hispanic group but not the WNH category.

 9 Whether referring to immigrants or the U.S.-born, the API group encompasses a widely heterogenous people who trace their origins to dozens of separate nations spanning East Asia, Southeast Asia, the Indian subcontinent, and the Pacific Islands, where several hundred languages and dialects are spoken.

10 As noted earlier, there is some small overlap among the non-WNH RE groups, which is ignored for the purposes of this discussion.

11 Population counts below a certain threshold are suppressed to prevent the possible identification of individuals.

12 Maryland is one of several states that recognizes independent cities as county-equivalent jurisdictions.

13 As Pacific Islanders, Native Hawaiians are included in the API group.

14 CDC deems crude death rates calculated from fewer than 20 deaths to be statistically unreliable.

15 The mortality experience of Hispanic individuals shows a great deal of heterogeneity by age, country of origin, and whether foreign-born, suggesting that the mortality advantage does not apply equally to all Hispanic subgroups. Instead, it is consistently stronger among foreign-born Hispanics and tends to be more pronounced at older ages (Fenelon, Chinn, and Anderson 2017).

16 The total count includes the comparatively low number of deaths among the AIAN population, and the total counts for the cause-of-death categories discussed later likewise include those in the AIAN population. However, as noted earlier, all other figures reported in this study exclude deaths among AIAN individuals (unless they also belong to at least one of this study's four RE groups).

17 In this article, “cancer” and “neoplasms” refer to malignant neoplasms, unless otherwise specified.

18 All-cause mortality rates at all ages improved for both males and females in every RE group from 1999 to 2019, with much of the mortality decline taking place by 2009. All-cause mortality rates at ages 25–64, on the other hand, rose after 2014 for all RE groups.

19 Queens County (NY), with more than 2.2 million residents and an age-adjusted mortality rate of 506.8, narrowly misses inclusion in the group.

20 County-level data are omitted to avoid statistical reliability problems associated with small sample sizes for certain RE groups in many counties.

21 The authors focused on the non-Hispanic Black population.

22 Swigris and others (2012) explored the differences by race and ethnicity.

23 During the COVID-19 pandemic, drug overdose deaths increased even more sharply, rising by 30 percent in 2020 and another 15 percent the following year (CDC 2022).

24 Such increases in apparent mortality rates may reflect factors besides a sudden steep rise in incidence. For example, epidemiological monitoring of certain diagnoses may become a priority, leading to the identification of cases that would previously have been classified under a different diagnosis. Nevertheless, even sharp increases in mortality for a given cause might be undercounted (Stokes and others 2020).

25 In addition, the rates for API females increased by a factor of more than 20, from 0.04 in 1999 to 0.85 in 2019.

26 Although breast cancer among males is uncommon, death rates in that subcategory also are higher in the Black population than in the other RE groups.

References

Angrist, Josh. 2002. “How Do Sex Ratios Affect Marriage and Labor Markets? Evidence from America's Second Generation.” The Quarterly Journal of Economics 117(3): 997–1038.

Arias, Elizabeth, William S. Schauman, Karl Eschbach, Paul D. Sorlie, and Eric Backlund. 2008. “The Validity of Race and Hispanic Origin Reporting on Death Certificates in the United States.” Vital Health Statistics Series 2, No. 148. Hyattsville, MD: CDC, NCHS. https://www.cdc.gov/nchs/data/series/sr_02/sr02_148.pdf.

Arias, Elizabeth, Betzaida Tejada-Vera, Kenneth D. Kochanek, and Farida B. Ahmad. 2022. “Provisional Life Expectancy Estimates for 2021.” Vital Statistics Rapid Release No. 23. Hyattsville, MD: CDC, NCHS. https://stacks.cdc.gov/view/cdc/118999.

Ashok, Sowmiya. 2016. “The Rise of the American 'Others.'” The Atlantic, August 27. https://www.theatlantic.com/politics/archive/2016/08/the-rise-of-the-others/497690/.

Bor, Jacob, Gregory H. Cohen, and Sandro Galea. 2017. “Population Health in an Era of Rising Income Inequality: USA, 1980–2015.” The Lancet 389(10777): 1475–1490.

Budiman, Abby. 2020. “Key Findings About U.S. Immigrants.” Washington, DC: Pew Research Center Short Read. https://www.pewresearch.org/fact-tank/2020/08/20/key-findings-about-u-s-immigrants/.

Budiman, Abby, and Neil G. Ruiz. 2021. “Key Facts About Asian Americans, a Diverse and Growing Population.” Washington, DC: Pew Research Center Short Read. https://www.pewresearch.org/fact-tank/2021/04/29/key-facts-about-asian-americans/.

Budiman, Abby, Christine Tamir, Lauren Mora, and Luis Noe-Bustamante. 2020. “Facts on U.S. Immigrants, 2018.” Pew Research Center Report. https://www.pewresearch.org/hispanic/2020/08/20/facts-on-u-s-immigrants/.

Carrion, Andres F., Ravi Ghanta, Olveen Carrasquillo, and Paul Martin. 2011. “Chronic Liver Disease in the Hispanic Population of the United States.” Clinical Gastroenterology and Hepatology 9(10): 834–841.

Case, Anne, and Angus Deaton. 2020. Deaths of Despair and the Future of Capitalism. Princeton, NJ: Princeton University Press.

CDC. See Centers for Disease Control and Prevention.

Census Bureau. 2022. “Research to Improve Data on Race and Ethnicity.” https://www.census.gov/about/our-research/race-ethnicity.html.

Centers for Disease Control and Prevention. 2010. “The 2009 H1N1 Epidemic: Summary Highlights, April 2009–April 2010.” https://www.cdc.gov/h1n1flu/cdcresponse.htm.

———. 2017. “Increase in Hepatitis C Infections Linked to Worsening Opioid Crisis.” NCHHSTP News Release. Atlanta, GA: CDC, National Center for HIV, Viral Hepatitis, STD, and TB Prevention. https://www.cdc.gov/nchhstp/newsroom/2017/hepatitis-c-and-opioid-injection-press-release.html.

———. 2022. “U.S. Overdose Deaths in 2021 Increased Half as Much as in 2020—But Are Still Up 15%.” https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2022/202205.htm.

Chang, Ellen T., Theresa H. M. Keegan, Scarlett L. Gomez, Gem M. Le, Christina A. Clarke, Samuel K. S. So, and Sally L. Glaser. 2007. “The Burden of Liver Cancer in Asians and Pacific Islanders in the Greater San Francisco Bay Area, 1990 through 2004.” Cancer 109(10): 2100–2108. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2777532/.

Ciccarone, Daniel. 2019. “The Triple Wave Epidemic: Supply and Demand Drivers of the U.S. Opioid Overdose Crisis.” International Journal of Drug Policy 71: 183–188.

Culp, MaryBeth B., and Natasha Buchanan Lunsford. 2019. “Melanoma Among Non-Hispanic Black Americans.” Preventing Chronic Disease 16(E79). https://doi.org/10.5888/pcd16.180640.

Ellington, Taylor D., S. Jane Henley, Virginia Senkomago, Mary Elizabeth O'Neill, Reda J. Wilson, Simple Singh, Cheryll C. Thomas, Manxia Wu, and Lisa C. Richardson. 2020. “Trends in Incidence of Cancers of the Oral Cavity and Pharynx—United States 2007–2016.” Morbidity and Mortality Weekly Report 69(15): 433–438. http://dx.doi.org/10.15585/mmwr.mm6915a1.

Ely, Danielle M., and Anne K. Driscoll. 2020. “Infant Mortality in the United States, 2018: Data from the Period Linked Birth/Infant Death File.” National Vital Statistics Reports 69(7): 1–17. https://www.cdc.gov/nchs/data/nvsr/nvsr69/NVSR-69-7-508.pdf.

Fenelon, Andrew, Juanita J. Chinn, and Robert N. Anderson. 2017. “A Comprehensive Analysis of the Mortality Experience of Hispanic Subgroups in the United States: Variation by Age, Country of Origin, and Nativity.” SSM Population Health 3: 245–254. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5769052/.

Flagg, Lee Ann, and Robert N. Anderson. 2021. “Unsuitable Underlying Causes of Death for Assessing the Quality of Cause-of-Death Reporting.” National Vital Statistics Reports 69(14). https://www.cdc.gov/nchs/data/nvsr/nvsr69/nvsr69-14-508.pdf.

GBD 2015 Maternal Mortality Collaborators. 2016. “Global, Regional, and National Levels of Maternal Mortality, 1990–2015: A Systematic Analysis for the Global Burden of Disease Study 2015.” The Lancet 388(10053): 1775–1812. https://doi.org/10.1016/S0140-6736(16)31470-2.

Hartholt, Klaas A., Robin Lee, Elizabeth R. Burns, and Ed F. van Beeck. 2019. “Mortality from Falls Among US Adults Aged 75 Years or Older, 2000–2016.” Journal of the American Medical Association 321(21): 2131–2133.

Holman, Jerome, and Cynthia S. MacDonald. 2022. U.S. Population Mortality Observations—Updated with 2020 Experience. Society of Actuaries. https://www.soa.org/resources/research-reports/2022/us-population-mortality/.

Hoyert, Donna L. 2021. “Maternal Mortality Rates in the United States, 2019.” NCHS Health E-Stats. https://doi.org/10.15620/cdc:103855.

Hsu, Ling-I, Farren Briggs, Xiaorong Shao, Catherine Metayer, Joseph L. Wiemels, Anand P. Chokkalingam, and Lisa F. Barcellos. 2016. “Pathway Analysis of Genome-Wide Association Study in Childhood Leukemia Among Hispanics.” Cancer Epidemiology, Biomarkers & Prevention (25)5: 815–822. https://cebp.aacrjournals.org/content/25/5/815.

Johnson, Akilah, and Dan Keating. 2022. “Whites Now More Likely to Die from Covid than Blacks: Why the Pandemic Shifted.” The Washington Post, October 19. https://www.washingtonpost.com/health/2022/10/19/covid-deaths-us-race/.

Kim, Hyun-Seok, Laura Rotundo, Ju Dong Yang, Donghee Kim, Neil Kothari, Mirela Feurdean, Constance Ruhl, and Aynur Unalp-Arida. 2017. “Racial/Ethnic Disparities in the Prevalence and Awareness of Hepatitis B Virus Infection and Immunity in the United States.” Journal of Viral Hepatitis 24(11): 1052–1066.

Livingston, Gretchen. 2019. “Hispanic Women No Longer Account for the Majority of Immigrant Births in the U.S.” Pew Research Center Short Read. https://www.pewresearch.org/fact-tank/2019/08/08/hispanic-women-no-longer-account-for-the-majority-of-immigrant-births-in-the-u-s/.

Moslimani, Mohamad, and Luis Noe-Bustamante. 2023. “Facts on Latinos in the U.S.” Pew Research Center Fact Sheet. https://www.pewresearch.org/hispanic/fact-sheet/latinos-in-the-us-fact-sheet/.

Neel, James V. 1997. “Are Genetic Factors Involved in Racial and Ethnic Differences in Late-Life Health?” In Racial and Ethnic Differences in the Health of Older Americans, edited by Linda G. Martin and Beth J. Soldo (210–232). Washington, DC: National Academies Press. https://www.ncbi.nlm.nih.gov/books/NBK109845/.

Preston, Samuel H., and Haidong Wang. 2006. “Sex Mortality Differences in the United States: The Role of Cohort Smoking Patterns.” Demography 43(4): 631–646. https://doi.org/10.1353/dem.2006.0037.

Remund, Adrien, Carlo G. Camarda, and Tim Riffe. 2018. “A Cause-of-Death Decomposition of Young Adult Excess Mortality.” Demography 55(3): 957–978. https://doi.org/10.1007/s13524-018-0680-9.

Shaver, Amy L., Collin M. Clark, Mary Hejna, Steven Feuerstein, Robert G. Wahler Jr., and David M. Jacobs. 2021. “Trends in Fall-Related Mortality and Fall Risk Increasing Drugs Among Older Individuals in the United States, 1999–2017.” Pharmacoepidemiology and Drug Safety 30(8): 1049–1056. https://doi.org/10.1002/pds.5201.

Stokes, Andrew C., Jordan Weiss, Dielle J. Lundberg, Wubin Xie, Jung Ki Kim, Samuel H. Preston, and Eileen M. Crimmins. 2020. “Estimates of the Association of Dementia with US Mortality Levels Using Linked Survey and Mortality Records.” Journal of the American Medical Association Neurology 77(12): 1543–1550. https://doi.org/10.1001/jamaneurol.2020.2831.

Substance Abuse and Mental Health Services Administration. 2020. The Opioid Crisis and the Black/African American Population: An Urgent Issue. Publication No. PEP20-05-02-001. Rockville, MD: SAMHSA, Office of Behavioral Health Equity. https://store.samhsa.gov/product/opioid-crisis-and-blackafrican-american-population-urgent-issue/pep20-05-02-001.

Swigris, Jeffrey J., Amy L. Olson, Tristan J. Huie, Evans R. Fernandez-Perez, Joshua Solomon, David Sprunger, and Kevin K. Brown. 2012. “Ethnic and Racial Differences in the Presence of Idiopathic Pulmonary Fibrosis at Death.” Respiratory Medicine 106(4): 588–593. https://doi.org/10.1016/j.rmed.2012.01.002.

Tamir, Christine. 2022. “Key Findings About Black Immigrants in the U.S.” Washington, DC: Pew Research Center Short Read. https://www.pewresearch.org/short-reads/2022/01/27/key-findings-about-black-immigrants-in-the-u-s/.

Viña, Jose, and Ana Lloret. 2010. “Why Women Have More Alzheimer's Disease Than Men: Gender and Mitochondrial Toxicity of Amyloid-β Peptide.” Journal of Alzheimer's Disease 20(S2): S527–S533. https://doi.org/10.3233/jad-2010-100501.

Wolf, Jennifer Moriatis, Lisa Cannada, Ann E. Van Heest, Mary I. O'Connor, and Amy L. Ladd. 2015. “Male and Female Differences in Musculoskeletal Disease.” Journal of the American Academy of Orthopaedic Surgeons 23(6): 339–347. https://doi.org/10.5435/jaaos-d-14-00020.

Woolf, Steven H., and Heidi Schoomaker. 2019. “Life Expectancy and Mortality Rates in the United States, 1959–2017.” Journal of the American Medical Association 322(20): 1996–2016. https://doi.org/10.1001/jama.2019.16932.

Wooten, G. F., L. J. Currie, V. E. Bovbjerg, J. K. Lee, and J. Patrie. 2004. “Are Men at Greater Risk for Parkinson's Disease than Women?” Journal of Neurology, Neurosurgery and Psychiatry 75(4): 637–639.