The color of death: race, observed skin tone, and all-cause mortality in the United States

ABSTRACT

Objective: This paper examines how mortality covaries with observed skin tone among blacks and in relation to whites. Additionally, the study analyzes the extent to which social factors such as socioeconomic status affect this relationship.

Design: This study uses data from the 1982 General Social Survey (N = 1,689) data linked to the National Death Index until 2008. We use this data to examine the links between race, observed skin tone among blacks, and all-cause mortality. Piecewise exponential hazard modeling was used to estimate disparities in skin tone mortality among blacks, and relative to whites. The multivariate models control for age, education, gender, region, metropolitan statistical area, marital status, labor force status, and household income.

Results: Observed skin tone is a significant determinant of mortality among blacks and in relation to whites. Light skinned blacks had the lowest mortality hazards among blacks, while respondents with medium and dark brown skin experienced significantly higher mortality. The observed skin tone mortality disparities covaried with education; there are significant mortality disparities across observed skin tone groups among black respondents with high school or more education, and nonsignificant disparities among those with less education.

Conclusion: It is crucial to identify the social processes driving racial disparities in health and mortality. The findings reveal that the nuanced social experiences of blacks with different observed skin tones markedly change the experience of racial inequality. Research on the nuanced social processes and biological mechanisms that connect differences in observed skin tone to mortality outcomes promises to better illuminate the experience of racial inequality and policy mechanisms we can use to undermine it.

KEYWORDS:

• Race
• mortality
• health disparities
• skin tone

Acknowledgements

The authors thank Amelia Branigan, Eileen Crimmins, Bruce Foster and Ellis Monk for their comments, conversations and computational assistance on this manuscript.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1 Although skin tone and, more specifically, the use of skin tone in social interaction precedes respondent death, we cannot definitively establish the direction of covariance. Thus, we cautiously use the term covariance to highlight that our observations are the measured aspects of a complex recursive system, which we are unable to fully express mathematically.

2 Although we do not assess the extent that skin tone is a proxy for differential treatment, socioeconomic status and health outcomes in this paper, previous research discussed in the Introduction and Background highlights that skin tone is a significant correlate of these social and biological factors/characteristics.

3 These authors also measured skin tone using a reflectometer to produce a continuous measure of reflectance—and arbitrarily grouped respondents into skin tone tertiles using this scale. This methodological decision ignored the possibility of non-linearities in the relationship between skin tone and mortality, and may not reflect socially meaningful skin tone variation within the black population.

4 Importantly, all else equal, the skin tone of enslaved blacks working in agricultural settings would be darker than enslaved blacks working in privileged spaces. Status construction theory suggests that this relationship may have contributed to the status belief that light skin was indicative of higher status among blacks in early America (Ridgeway 1991). Thus, environmental factors may have partly contributed to the relationship between skin tone and status.

5 Gullickson (2005) subsequently examined cohort differences in the privileged social outcomes tied to skin tone using the National Survey of Black Americans. Although his results counter the conclusions of Hill (2000), his study/data has limited capacity to test the merits of time trends in the significance of skin tone. Specifically, Goldsmith, Hamilton, and Darity (2007) note that sample attrition, particularly that of light skinned blacks, was substantial—there were fewer than 15 blacks with light skin in the final wave of his sample.

6 In the GSS, interviewers only socially assigned the skin tone of black respondents. Specifically, interviewers assigned respondents into one of three racial groups: black, white and other. If the interviewer was unsure of respondent race, the interviewer asked the respondent to self-identify their racial group as black, white or other. After identifying respondent race, the interviewers assessed skin tone for all of the black survey respondents.

7 The GSS codes for skin tone rate ‘1’ as the darkest complexion group and ‘5’ as the lightest skin tone group. We reverse coded this variable such that ‘1’ was the lightest and ‘5’ was the darkest. We do this ease interpretation in our models which classify whites as having skin tone equal to 0. Thus, our descriptive and multivariate statistical tables present the categories: 0) white, 1) light brown, 2) medium brown, and 3) dark brown. (As mentioned in the text, we collapsed the two light brown and two dark brown categories due to sample size.)

8 The 1982 GSS does not contain adequate data on interviewer characteristics to include in our models. Existing research shows that interviewer characteristics can mask skin tone effects. Hill (2000), for example, shows that controlling for race of interviewer magnifies skin tone disparities in income using the Multi-City Study of Urban Inequality. This result suggests our skin tone effect may be an underestimate of the effect of socially assigned skin tone on mortality.

9 Six individuals did not provide information on age and were dropped from the analysis.

10 See Allison (1995) for a more complete discussion of piecewise exponential hazard models.

11 Importantly, mortality hazards vary across the life course and social groupings. The assumption of constant age-specific mortality hazards is a mechanism demographers employ to estimate mortality hazards in these groupings from discrete data.

12 Indeed, the unemployment statistics in this dataset do not follow the expected pattern between skin tone and SES. This finding may be a nuance of the sample or a deeper social form. Although this nuance is interesting, we are concerned with the relationships between this and many other factors with mortality. As a result, we control for unemployment and other factors in our model and refrain from discussing potential mechanisms driving this statistic.

13 We performed a separate test examining the significance of the difference in mortality hazards of skin tone groups 2 and 3. We found that the mortality experiences of medium brown blacks (group 2) were significantly worse than those of dark brown blacks (group 3) across all of the models in Table 3.

14 Due to sample size, we are unable to determine whether the baseline curvilinear mortality pattern is a function of immigrants among the dark skin tone group. There are only 4 respondents in the darkest skin tone category who are immigrants or children of immigrants—a number similar to those in our other skin tone groups. The uniform distribution of immigrants across skin tone groups suggests that dark skinned immigrants are not driving the lower mortality rates among the group, unless there is a distinct relationship between dark skin tone and better health among immigrants.

Additional information

Funding

This work was supported by National Institute on Aging [Grant Number P30 AG01528120, P30 AG017265, T32 AG000037].