Racial/Ethnic Differences in Early-Life Mortality in the United States

Abstract

U.S. early-life (ages 1–24) deaths are tragic, far too common, and largely preventable. Yet demographers have focused scant attention on U.S. early-life mortality patterns, particularly as they vary across racial and ethnic groups. We employed the restricted-use 1999–2011 National Health Interview Survey–Linked Mortality Files and hazard models to examine racial/ethnic differences in early-life mortality. Our results reveal that these disparities are large, strongly related to differences in parental socioeconomic status, and expressed through different causes of death. Compared to non-Hispanic whites, non-Hispanic blacks experience 60 percent and Mexican Americans 32 percent higher risk of death over the follow-up period, with demographic controls. Our finding that Mexican Americans experience higher early-life mortality risk than non-Hispanic whites differs from much of the literature on adult mortality. We also show that these racial/ethnic differences attenuate with controls for family structure and especially with measures of socioeconomic status. For example, higher mortality risk among Mexican Americans than among non-Hispanic whites is no longer significant once we controlled for mother’s education or family income. Our results strongly suggest that eliminating socioeconomic gaps across groups is the key to enhanced survival for children and adolescents in racial/ethnic minority groups.

Acknowledgments

We thank the National Center for Health Statistics (NCHS) for collecting the data and making the restricted-use linked files available to researchers through Research Data Centers (RDCs), Juhee Woo for computing assistance, Pat Barnes for creating the restricted-use linked files and expertly assisting us in analyzing the data and navigating the NCHS and RDC protocols, Bert Grinder and Gale Boyd for supporting our analyses at the RTI RDC, Nancy Mann for editing a previous version of this manuscript, and an anonymous reviewer for helpful suggestions and comments. This manuscript also benefitted from insights and discussion from Patrick Krueger and members of the Early Life Mortality project. NCHS reviewed the manuscript and had no disclosure concerns. The content of this article is the sole responsibility of the authors and does not necessarily represent the official views of NIH, NICHD, or NCHS. Previous versions of this article were presented at the Southern Demographic Association annual meeting in San Antonio, Texas, October 14–16, 2015, and the Population Association of America annual meeting in Washington, DC, March 31–April 2, 2016.

Funding

We thank the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD grant R01HD082106 and F32 HD 085599) for research support and the NICHD-funded University of Colorado Population Center (Award Number P2CHD066613) and the NICHD-funded Carolina Population Center (Award Number P2CHD050924) for administrative and computing support.

Notes

1. We use the term Hispanic to refer to Mexican Americans, Cuban Americans, Puerto Rican Americans, and Other Hispanics. Much research examines Hispanics without disaggregating by country of origin. When data permitted, we separately examined Mexican Americans and Other Hispanics.

2. Mortality risk differs by sex at these ages, however, and we examined sex-stratified models. Because of the smaller number of deaths in these stratified models, standard errors were larger. But the estimates were generally similar, though Other Hispanic females (but not males) showed reduced mortality risk compared to their non-Hispanic counterparts, and other than two-parent family structure was associated with higher mortality among males (but not females).

3. Because Cox models adjust for no deaths within specific age groups, suicide mortality results are identical for analyses based on the full range of early-life ages and on analyses restricted to ages 10 and above (when our dataset reports deaths due to suicide). For consistency, all cause-specific models include the full range of early-life ages.

4. Auxiliary models that omitted health insurance and homeownership and that omitted family structure produced marginally significant HRs for non-Hispanic blacks, with a 23 percent increased risk of death compared to non-Hispanic whites. Other effects remained similar.

5. We tested but did not find a significant interaction between age and race/ethnicity in discrete-time models. We also disaggregated our results by age group to determine whether different age patterns would emerge. We found no discernable patterns, although specific age variations might be obscured because of small cell sizes.

Additional information

Funding

We thank the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD grant R01HD082106 and F32 HD 085599) for research support and the NICHD-funded University of Colorado Population Center (Award Number P2CHD066613) and the NICHD-funded Carolina Population Center (Award Number P2CHD050924) for administrative and computing support.