Background Mortality from all causes is higher for persons withfewer years of education and for blacks, but it is unknown whichdiseases contribute most to these disparities.
Methods We estimated cause-specific risks of death from datafrom the National Health Interview Survey conducted from 1986through 1994 and from linked vital statistics. Using these riskestimates, we calculated potential years of life lost and potentialgains in life expectancy related to specific causes, with stratificationaccording to education level and race.
Results Persons without a high-school education lost 12.8 potentiallife-years per person in the population, as compared with 3.6for persons who graduated from high school (ratio, 3.5; P<0.001).Ischemic heart disease contributed most (11.7 percent) to thedifference according to education in potential life-years lost(with all cardiovascular diseases accounting for 35.3 percent).All cancers accounted for 26.5 percent, including 7.7 percentdue to lung cancer; other lung diseases and pneumonia contributed10.1 percent of the total, whereas human immunodeficiency virus(HIV) disease accounted for none of the difference accordingto education. The pattern of disparities according to levelof income was similar to that according to level of education.Blacks and whites lost 7.0 and 5.2 potential life-years perperson, respectively, as a result of deaths from any cause (ratio,1.35; P<0.001). Cardiovascular diseases accounted for onethird of this disparity, in large part because of hypertension(15.0 percent); HIV disease (11.2 percent) contributed almostas much as ischemic heart disease (5.5 percent), stroke (2.8percent), and cancer (3.4 percent) combined; trauma and diabetesmellitus accounted for 10.7 percent and 8.5 percent, respectively.
Conclusions Although many conditions contribute to socioeconomicand racial disparities in potential life-years lost, a few conditionsaccount for most of these disparities — smoking-relateddiseases in the case of mortality among persons with fewer yearsof education, and hypertension, HIV, diabetes mellitus, andtrauma in the case of mortality among black persons. These findingshave important implications for targeting efforts to reduceexisting disparities in mortality rates.
Source Information
From the Division of General Internal Medicine and Health Services Research (M.D.W., M.F.S., S.L.E.) and the School of Public Health, Departments of Health Services (M.F.S., S.L.E.) and Biostatistics (W.J.B.), University of California at Los Angeles, Los Angeles.
Address reprint requests to Dr. Wong at the University of California at Los Angeles, Division of General Internal Medicine and Health Services Research, 911 Broxton Plaza, Los Angeles, CA 90095-1736, or at miwong{at}mednet.ucla.edu.
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