Mortality rates between Black, white Americans narrow — except in case of infants

Americans are living longer than ever. And the disparity in overall mortality rates between Black and white Americans has narrowed since the 1950s. Among infants, however, the gap has widened, with Black infants dying at twice the rate of white infants, a new study reports.

A team of researchers, including Associate Professor Soroush Saghafian, founder and director of the Public Impact Analytics Science Lab at Harvard, collected and analyzed data across the U.S. from 1950 to 2019 to determine how mortality rates and disparities have changed over time.

In general, life expectancy has improved for both Black Americans (from 60.5 years in the 1950s to 76 years in the 2010s, a 20.4 percent increase) and white Americans (from 69 years in the 1950s to 79.3 years in the 2010s, a 13 percent rise), according to the new research. The racial gap has also improved, though Black adults still have an 18 percent higher mortality rate.

The picture for Black infants is far bleaker. While mortality rates for both Black and white infants have improved, the disparity between races has worsened. The mortality rate for Black infants was 92 percent higher than for white infants in the 1950s. Today the difference is 115 percent. Medical conditions during pregnancy were the leading cause of excess death in the 2010s.

In this edited conversation, Saghafian explains where these disparities have persisted and what needs to happen to address them.

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Life expectancy has been improving for 70 years, and yet the difference between mortality in Black and white infants has actually gotten worse. What’s happened since the 1950s?

There is a public understanding that healthcare has improved over time in the U.S., and that life expectancy and other healthcare metrics are improving. This study is showing that, while all that is true, there have been gaps between different races, specifically between Black and white Americans.

When focusing on adults, we see that, fortunately, things have improved. But in the case of Black infants, they are now dying twice as often as white infants. That’s just a huge number. And the fact that it has worsened since the 1950s is of great concern. Public policy and public health authorities should have put their utmost priority on at least improving such gaps. I mean, the ideal is to make measures like this equal between different races. But at least you can improve things.

What accounts for the disparity in infant rates?

We did look at the causes of death, and it turns out that, for infants, the main reasons for excess mortalities are medical. There is, unfortunately, a large amount of healthcare inequality, and it’s multidimensional. There’s access to care, but also quality of care. There’s a large set of factors that cause these disparities.

However, the goal of this particular study was not to study the reasons, but to point out the important differences. The hope is that it can inform other studies to get to the reasons, and to inform policymakers about what they should do. Our work raises the critical question of why, over seven decades post-World War II, we still haven’t figured out a solution for this enormous problem.

Several shorter-span studies have also found mortality rate disparities between races. What does this study tell us that the others didn’t?

This is, to the best of my knowledge, the first time that the whole data over seven decades — the entire postwar era — has been collected and analyzed. When you look at shorter periods, you might not get the full picture.

Looking at a more extended period, we can think more carefully about all the claims that say, “Look, healthcare is improving” — which, to be clear, is mostly true. We are still seeing that, by and large, healthcare is improving for both Black and white Americans in most dimensions.

The problem is the comparisons. For instance, are things getting better for Black people compared to white people? When we look at measures like excess infant and childhood mortality among Black Americans during this whole seven-decade period, it becomes clear that not only have things not improved, but they have gotten worse. However, if you looked at, say, only three decades, instead of seven, you might not be able to see this full picture.

Your results showed that 5 million excess deaths of Black Americans could’ve been avoided over the past 70 years. Now that the disparities have been laid out, what needs to happen next?

As I mentioned, we didn’t go into the details of the causes, and I think that needs a lot more attention from both researchers and public policy and public health authorities. At the same time, our findings raise important questions for both researchers and authorities.

This is like a red alarm. Our findings are saying: Look, we could have saved 5 million Black Americans if they had the same things as white Americans have. This, in turn, raises an important question: What should the priorities for public policy and public health officials be now and in the next few decades?