US racial-ethnic mortality gap adjusted for population structure
Pifarré i Arolas, Héctor (University of Wisconsin)
Acosta, Enrique (Max Planck Institute for Demographic Research)
Dudel, Christian (Max Planck Institute for Demographic Research)
Mhairi Hale, Jo (Max Planck Institute for Demographic Research)
Myrskylä, Mikko (Max Planck Institute for Demographic Research)

Data:	2023
Resum:	Standard measures, such as life expectancy or years of life lost, are based on synthetic populations and do not account for the real underlying populations experiencing the inequalities. Methods: We analyze US mortality disparities comparing Asian Americans, Blacks, Hispanics, and Native Americans/Alaska Natives to Whites using 2019 CDC and NCHS data, using a novel approach that estimates the mortality gap, adjusted for population structure by accounting for real-population exposures. This measure is tailored for analyses where age structures are fundamental, not merely a confounder. We highlight the magnitude of inequalities by comparing the population structure-adjusted mortality gap against standard metrics' estimates of loss of life due to leading causes. Results: Based on the population structure-adjusted mortality gap, Black and Native American mortality disadvantage exceeds mortality from circulatory diseases. The disadvantage is 72% among Blacks (men: 47%, women: 98%) and 65% among Native Americans (men: 45%, women: 92%), larger than life expectancy measured disadvantage. In contrast, estimated advantages for Asian Americans are over three times (men: 176%, women: 283%) and, for Hispanics, two times (men: 123%; women: 190%) larger than those based on life expectancy. Conclusions Mortality inequalities based on standard metrics' synthetic populations can differ markedly from estimates of the population structure-adjusted mortality gap. We demonstrate that standard metrics underestimate racial-ethnic disparities through disregarding actual population age structures. Exposure-corrected measures of inequality may better inform health policies around allocation of scarce resources.
Nota:	Altres ajuts: The Social Sciences and Humanities Research Council (Canada) - Postdoctoral grant No. 756-2019-0768 ; The Fonds de recherche du Québec - Société et culture - Postdoctoral grant No.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Age structure ; Mortality ; Exposure ; Racial disparities
Publicat a:	Epidemiology, Vol. 34 Núm. 3 (May 2023) , p. 402-410, ISSN 1531-5487

DOI: 10.1097/EDE.0000000000001595
PMID: 36863061

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