Excess Mortality and Years of Potential Life Lost Among Black People in the US from 1999 to 2020

Abstract

ABSTRACTImportanceAmid efforts in the United States to promote health equity, there is a need to assess progress in reducing excess deaths and years of potential life lost (YPLL) among Black people compared with White people.ObjectiveTo evaluate trends in excess mortality and YPLL among Black people compared with White people.DesignSerial cross-sectional.SettingNational data from the Centers for Disease Control and Prevention, 1999-2020ParticipantsNon-Hispanic White and non-Hispanic Black peopleExposuresRace as documented in the death certificates.Main outcomes and measuresExcess age-adjusted all-cause and disease-specific mortality rate (per 100,000 individuals) and YPLL among Black people compared with White people.ResultsFrom 1999 to 2020, the total number of excess deaths was 658,356 and 1,154,108 among Black females and males, representing 34,938,070 and 47,005,048 excess YPLL among Black females and males. The excess deaths and YPLL were largest among infants and non-elderly adults. Heart disease had the most excess deaths. From 1999, the age-adjusted excess mortality rate declined at an annual average of -9.0 (95% CI: -10.0, -8.0; P<0.001) until 2015 among Black women and at an annual average of -16.3 (95% CI: -20.9, -11.6; P<0.001) until 2012 among Black men, followed by no significant change until 2019 in either group. From 2019 to 2020, excess deaths increased from 90.4 to 192 per 100,000 Black women and from 209.8 to 395 per 100,000 Black men, reaching rates approximating those of 1999. The trends in rates of excess YPLL followed a similar pattern.Conclusions and relevanceOver a recent 22-year period, Black people in the US lost more than 80 million years of life when compared with White people. After a period of progress, improvements stalled, and most gains were eliminated in 2020.KEY POINTSQuestionHow many excess deaths and years of potential life lost (YPLL) for Black people, compared with White people, occurred in the United States from 1999 through 2020?FindingsBased on Centers for Disease Control and Prevention data, excess deaths and YPLL persisted throughout the period, with initial progress followed by little improvement, and then worsening in 2020 to about 1999 levels. Black people had 1.8 million excess deaths and over 80 million YPLL over the study period.MeaningAfter initial progress, excess mortality and YPLL among Black people stagnated and then worsened, indicating a need for new approaches.