In April 2021, Rochelle P. Walensky, then director of the Centers for Disease Control and Prevention, declared racism to be a serious public health threat. A new study published in the September 23 Lancet identifies the disease categories most illustrative of racial and ethnic differences in U.S. mortality, as well as the influence of where one lives.

Using deidentified death records from the U.S. National Vital Statistics System and population estimates from the National Center for Health Statistics, researchers tracked annual U.S. mortality rates from 2000 to 2019 by age, cause of death, county of residence, and racial and ethnic group. The five racial and ethnic groups included were non-Latino and non-Hispanic American Indian or Alaska Native (AIAN), non-Latino and non-Hispanic Asian or Pacific Islander (Asian), non-Latino and non-Hispanic Black (Black), Latino or Hispanic (Latino), and non-Latino and non-Hispanic White (White). There were 19 groups of causes of death, based on metrics used in the international Global Burden of Disease study.

Previous studies have found generally higher mortality rates among Black and AIAN populations and generally lower mortality rates among Asian and Latino populations compared to White populations. The current study confirmed this breakdown, with Black and AIAN populations having the highest overall mortality rates. For all five racial and ethnic groups, cardiovascular disease and cancers were the first and second leading causes of death, and diabetes and kidney disease were among the top five causes of death.

In comparisons of mortality from each of the 19 causes of death, the Asian population had the lowest mortality for every cause of death except respiratory disease, tuberculosis, and maternal/neonatal disorders. Latino mortality rates were lower than those of the other racial and ethnic groups (except Asian) across all causes except for HIV/AIDS and sexually transmitted infections and diabetes and kidney diseases.

Black and AIAN populations had the highest mortality rates overall and for nearly every cause of death. Compared with the other racial and ethnic groups, AIAN populations had particularly high mortality rates for digestive diseases and substance use disorders, and Black populations had particularly high mortality rates for HIV/AIDS and sexually transmitted infections, and for maternal/neonatal disorders.

The researchers acknowledged previous studies positing that high mortality rates for Black and AIAN populations reflect the effects of residential segregation, mass incarceration, chronic stress, systemic racism, and discrimination in health care. But they noted that their study also found significant variation in mortality rates and causes by geographic region. For example, deaths from maternal and neonatal disorders were especially high in the southeastern states and particularly so for Black populations. The researchers recommended better collection of county-level and disease-specific racial and ethnic mortality data in order to craft appropriate local interventions to improve health and longevity.-Betsy Todd, MPH, RN