Excess Mortality and Years of Potential Life Lost Among the Black Population in the US, 1999-2020.

Importance: Amid efforts in the US to promote health equity, there is a need to assess recent progress in reducing excess deaths and years of potential life lost among the Black population compared with the White population. Objective: To evaluate trends in excess mortality and years of potential life lost among the Black population compared with the White population. Design, setting, and participants: Serial cross-sectional study using US national data from the Centers for Disease Control and Prevention from 1999 through 2020. We included data from non-Hispanic White and non-Hispanic Black populations across all age groups. Exposures: Race as documented in the death certificates. Main outcomes and measures: Excess age-adjusted all-cause mortality, cause-specific mortality, age-specific mortality, and years of potential life lost rates (per 100 000 individuals) among the Black population compared with the White population. Results: From 1999 to 2011, the age-adjusted excess mortality rate declined from 404 to 211 excess deaths per 100 000 individuals among Black males (P for trend <.001). However, the rate plateaued from 2011 through 2019 (P for trend = .98) and increased in 2020 to 395-rates not seen since 2000. Among Black females, the rate declined from 224 excess deaths per 100 000 individuals in 1999 to 87 in 2015 (P for trend <.001). There was no significant change between 2016 and 2019 (P for trend = .71) and in 2020 rates increased to 192-levels not seen since 2005. The trends in rates of excess years of potential life lost followed a similar pattern. From 1999 to 2020, the disproportionately higher mortality rates in Black males and females resulted in 997 623 and 628 464 excess deaths, respectively, representing a loss of more than 80 million years of life. Heart disease had the highest excess mortality rates, and the excess years of potential life lost rates were largest among infants and middle-aged adults. Conclusions and relevance: Over a recent 22-year period, the Black population in the US experienced more than 1.63 million excess deaths and more than 80 million excess years of life lost when compared with the White population. After a period of progress in reducing disparities, improvements stalled, and differences between the Black population and the White population worsened in 2020.

Factors Affecting SARS-CoV-2 Vaccination Intent and Decision Making Among African American, Native American, and Hispanic Participants in a Qualitative Study.

Limited studies are available on how decisions and perceptions on SARS-CoV-2 vaccination have changed since the start of vaccination availability. We performed a qualitative study to identify factors critical to SARS-CoV-2 vaccination decision making and how perspectives evolved among African American/Black, Native American, and Hispanic communities disproportionately affected by COVID-19 and social and economic disadvantage. We conducted 16 virtual meetings, with 232 participants in wave 1 meetings (December 2020) and with 206 returning participants in wave 2 meetings (January and February 2021). Wave 1 vaccine concerns in all communities included information needs, vaccine safety, and speed of vaccine development. Lack of trust in government and the pharmaceutical industry was influential, particularly among African American/Black and Native American participants. Participants showed more willingness to get vaccinated at wave 2 than at wave 1, indicating that many of their information needs had been addressed. Hesitancy remained greater among African American/Black and Native American participants than among Hispanic participants. Participants in all groups indicated that conversations tailored to their community and with those most trustworthy to them would be helpful. To overcome vaccine hesitancy, we propose a model of fully considered SARS-CoV-2 vaccine decision making, whereby public health departments supply information, align with community values and recognize lived experiences, offer support for decision making, and make vaccination easy and convenient.

Community-based Strategies to Engage Pastors Can Help Address Vaccine Hesitancy and Health Disparities in Black Communities.

In an era of Freddie Gray and Black Lives Matter, a long history of structural racism, combined with disproportionate rates of COVID-19, the African American community has seen a lot of reasons to demand social justice, equal treatment and immediate access to solutions to health disparities. Despite the promise of COVID-19 vaccines, the community is highly distrustful of the vaccine and institutions given a history of mistreatment and many other current concerns. Trusted messengers such as Black pastors are crucial to protecting the community that faces a disproportionate amount of disease. We present a framework to build trust and acceptance including understanding history and context; listening and empathy; engaging pastors as trusted messengers; creating partnerships with shared responsibility and power; and co-creation of solutions with faith leaders and their community, governments and institutions to create sustainable, long-term change. Efforts to support vaccine acceptance must be customized to the variety of needs and realities of the African American community, not just the topic of concern to the institution. Evaluations are needed to help ensure the community is engaged and feeling heard. Pastors and other religious leaders can work with government and institutions to bring information, facilitate discussion, build trust and develop measurable improvement efforts. Although acceptance of COVID-19 vaccines may not be achieved overnight, the process of focusing on issues that are important to the community is an important step in laying the foundation for both COVID-19 vaccines and future interventions.

The centers for medicare & medicaid services diabetes health disparities reduction program.

The Centers for Medicare & Medicaid Services has implemented 3 prevention interventions programs to bring diabetes self-management education to vulnerable populations via Medicare's Quality Improvement Organizations. The programs and the lessons derived from a Federal initiative geared to closing the health disparities gap are described.