Widening Black/White mortality differentials among US children during the 1980s.

ABSTRACT

OBJECTIVES: With the exception of infants, mortality rate differentials among Black and White children have received very little attention. We address four empirical questions 1) Did the Black/White childhood mortality disparity grow between 1980 and 1990? 2) What causes of death account for Black/White disparities in childhood mortality and temporal changes in the size of this disparity? 3) Do economic disparities between Black and White families account for Black/White childhood mortality differentials in 1980 or 1990? 4) Do growing economic disparities between Black and White families explain any growth in childhood mortality differentials? METHODS: Childhood mortality patterns and causes of excess deaths in Black children are examined in the nation overall and in three major metropolitan areas-Chicago, Detroit, and New York-using a dataset combining death certificate and Census data. Logistic regression analyses utilize Census socioeconomic information to identify the relationship between mortality risk and local area income in the metro areas. RESULTS: Black children's relative mortality disadvantage grew more severe during the 1980s, with startling growth in Black/White disparities seen in many age- and sex-specific metro populations. While White children generally experienced marked mortality declines, Black children's rates fell more slowly or actually increased, most dramatically among adolescent boys in Detroit and Chicago. Excess deaths among younger Black children were most often fire-related, while homicide was the predominant cause at older ages. Regression analyses confirmed that areal income was significantly and strongly related to child mortality at both time points in all study areas. However, the deterioration in areal income for Black children relative to Whites from 1980 to 1990 did not explain their worsening mortality rates over the time period. CONCLUSIONS: Black children are increasingly suffering excess deaths relative to White children. We find that Black children's mortality disadvantage is largely accounted for by areal economic disadvantage; however, expanding death rate disparities over time represented more than simply growth in income differentials. Our results suggest that other adverse exposures also have increasingly served to compromise Black children's life chances during the 1980s.