Racial Disparities in Mortality in the District of Columbia from 2000 to 2020

Authors

• M Hashemian
• KM Conners
• TM Powell-Wiley
• R Rafi
• GH Santos
• JJ Shearer
• J Joo
• M Shiels
• VL Roger

Abstract

The District of Colombia (D.C.) has the largest gap in life expectancy between Black and White people among major U.S. cities. Data on cause-specific mortality, risk factors, and temporal trends are critical to target interventions. Using the CDC WONDER database, we calculated all-cause and cause-specific age-adjusted mortality rates per 100,000 persons for Non-Hispanic Black and Non-Hispanic White populations in D.C. and corresponding rate ratios from 2000 to 2020. Annual Percentage Change (APC) was examined with joinpoint regression. We examined the prevalence of risk factors (obesity, hypertension, diabetes, smoking, hypercholesterolemia) using the Behavioral Risk Factor Surveillance System from 2000 to 2020. Among 102,710 deaths that occurred in D.C. (80% Black), cardiovascular diseases (CVD, 35%) and cancer (24%) accounted for over half of the deaths. All-cause mortality declined between 2000 and 2012 (APC: -2.6%, 95% CI: -4.5, -1.9) but stagnated and even increased after 2018 (APC: 10.9%, 95% CI: 3.8, 15.1). CVD mortality declined between 2000 and 2011 and plateaued thereafter among Black individuals, contrasting with the monotonic decline among White individuals, resulting in magnification of disparities (APC for RR: 3, 95% CI:2.3, 3.7). Risk factors were all more prevalent among Black individuals compared to White individuals and disparities increased for smoking over time. In D.C., all-cause mortality is higher for Black than for White populations. While CVD and cancer mortality rates both declined, disparities worsened. CVD risk factors are more prevalent in Black populations. These data underscore the urgent need for precision public health interventions and provide insights into high-risk populations.

Scientific Focus Area: Epidemiology

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