Health disparities in the United States lead to high mortality rates and reduced life expectancy. African Americans in America face socioeconomic disadvantages which correlate with the social determinants of health and health needs, such as mortality and morbidity. Despite attempts to reduce the socioeconomic gap, African Americans still have poorer health outcomes than whites, which correlate to high mortality rates. African Americans living in impoverished urban areas are characterized by poverty, low educational attainments, reduced access to health care services, environmental pollution, violence, and lack of preventative health measures (Noonan et al., 2016). African-Americans are vulnerable to the risk of cardiovascular diseases, cancer, and unintentional injuries, which are the leading causes of mortality in America. This research paper explores the socioeconomic disadvantage faced by African-Americans to understand the causes and trends in African-American mortality rates over the past 20 years. The paper hypothesizes that African-Americans in the U.S. have high mortality rates due to socioeconomic disadvantage, affecting their ability to govern their health and adopt preventative measures.

Mortality in America

Introduction

Mortality rates are increasing among middle-aged and young African Americans. High mortality rates have been a focal point of interest in population research, spurring debate about the future of life expectancy in America. As medical science and technology innovations depict decreased mortality rates and enhanced life expectancy in the 20^th century, recent mortality rates indicate a different trend. While life expectancy at birth in 2019 was 78.8 years, life expectancy in 2020 was 77.0 years, a 1.8 years decrease (Arias et al., 2021). Mortality rates in America mirror existing disparities in socioeconomic factors, access to healthcare, quality of care, and geographical variations. Mortality rates among African Americans and Whites have reduced substantially over the past century. However, the mortality rates of African-Americans residing in impoverished urban areas compare unfavorably with whites.

Disparities in mortality rates result from differences in socioeconomic status and reduced access to social institutions needed to improve African Americans’ health. Mortality rates mirror a given population’s health status, and examining the trends in African-Americans living in urban areas mortality rates is critical to informing the distribution of resources and implementation of population-based interventions to improve health. Although the social justice policies focus on eliminating socioeconomic and health disparities, high mortality rates among African-Americans living in impoverished urban areas still exist due to socioeconomic disadvantage, which increases the risk of cardiovascular diseases, cancer, and unintentional injuries. This paper will explore the mortality trends of African-Americans living in urban, identify the causes and effects of mortality, and discuss the future of mortality in America. The paper will identify the socioeconomic disadvantage faced by African-Americans and the three leading causes of high mortality rates among African Americans.

                                                               Literature Review                                              

Mortality is significant because it reflects the variation in and causes of death. Literature about African-Americans living in urban areas in the U.S is well documented. Comparative studies indicate that the United States has low expectancy compared to other Organization for Economic Cooperation and Development (OECD) countries (Avendano and Kawachi 2014). Health disadvantage in America has led to increased mortality and morbidity rates. Although the U.S spends most of its gross domestic product (GDP) on healthcare, the country has high mortality rates and low life expectancy caused by various factors, including infant deaths, substance abuse, and obesity. The lack of a universal healthcare system in the U.S. hinders access to healthcare, a problem compounded by widening racial and socioeconomic inequalities and the rural-urban divide.

Mortality rates in the U.S. have increased since 2000, leading to over 400 000 excess deaths in 2017. Various studies indicate extra mortality rates since 2000 (Woolf et al., 2020). Increasing health inequities in the U.S account for about 74,402 excess deaths among black Americans per year from 2016 to 2018. Institutional and systemic racism in America disproportionately affects African Americans. Health disadvantage starts after a person’s birth and continues throughout their life course. The past 20 years have seen substantial gains in U.S. life expectancy. Life expectancy at birth in the U.S. continues to increase while mortality rates continue to decline. The number of years a person is expected to live in the U.S. in 2000 was about 77 years, while in 2002, it was 74.5 years for males and 79.9 years for females (Arias et al., 2021). Life expectancy in recent years has increased to 76 years for men and 81 years for women. Women in the U.S. have higher life expectancy than men. Arias et al.’s (2021) analysis indicate that the life expectancy disparity between men and women was 5.7 years in 2020 compared to 5.1 in 2019. Life expectancy also varies by race, whereby life expectancy for the Hispanic population decreased from 81.8 to 78.8 between 2019 and 2020 (Arias et al., 2021). Life expectancy for the non-Hispanic black population declined to 71.8 from 74.7, while the non-Hispanic white population decreased from 78.8 to 77.6 in the same period.

Surveillance report by NCHS indicates that life expectancy based on Hispanic origin-race-sex groups decreased by 3.7 years for Hispanic males, 3.3 years for non-Hispanic black males, 2.4 years non-Hispanic black females, 2.0 years for Hispanic females, 1.3 years non-Hispanic white, and 1.1 years for non-Hispanic white females between 2019 and 2020 (Arias et al., 2021). The NCHS report further indicates racial and ethnic minority disparities in life expectancy increased in 2020. Blacks have had a lower life expectancy than whites. Research shows that black males residing in high-risk urban areas have 21 years lower life expectancy than other ethnic populations in America (Avendano and Kawachi, 2014). While these findings indicate increasing life expectancy for both sexes, the U.S. remains the country with the lowest life expectancy compared to other developed countries. Increasing mortality rates in the U.S. result from preventable deaths, infectious diseases, pregnancy complications, and infant and perinatal deaths.

However, in 2015, life expectancy decreased to 78.7 years from 78.9 years in 2014 and remained steady in 2016. Blacks’ mortality rate, especially for black men, has declined dramatically in the recent decades, with the mortality of black men aged 45-54 years reduced by approximately a third from 2000 to 2014 (Arias et al., 2021). Despite the progress the mortality, the U.S. still needs significant improvements to reduce mortality rates among vulnerable populations. Mortality rates for young African Americans have increased. Research indicates that African Americans have reduced access to healthcare, low-quality care for non-communicable diseases and overall preventive health. A recent report by the National Center for Health Statistics (NCHS) indicates that life expectancy at birth for African –Americans from 1990 to 2006  did not reduce the major leading causes of mortality despite a notable decline in age-adjusted mortality.

Research indicates excess mortality rates among African-Americans aged 15 to 64 years residing in impoverished urban areas in America. Ferdows et al. (2020) examined the historical trends of mortality rates disparities between White and Black adults in rural and urban settings from 1968 to 2016. From 1982 to 2010, Black adults living in urban areas had higher mortality rates than whites living in urban areas. The widening disparities in African-American’s and whites’ mortality imply increasing socioeconomic disadvantage among African-Americans.

African-American Socioeconomic disadvantage

The correlation between socioeconomic disadvantage in the health status of African-Americans and mortality is well documented. Social determinants include cultural patterns that influence and are influenced by blacks’ health status. Socioeconomic disadvantage disproportionately affects African-Americans’ health. Factors such as poverty, racism, water and sanitation, criminal justice, pollution, and housing predispose African-Americans to poor health and increased likelihood of high mortality rates. Research by Noonan et al. (2016) postulates that African Americans comprised about 13% of the U.S. population in 2014, and they have the poorest health compared to other ethnic groups. African-Americans’ poor health dates back to the slavery era, whereby they were transported in chains from African to European owners. The shipboard transport and treatment increased the deaths of African-Americans during the middle passage. 4.5% of the enslaved Africans died onshore, while one-third died in adjusting to America (Small, Allen, and Brown, 2017). Once settled in America as enslaved people, African-Americans lived in poor social and physical conditions that threatened their health, such as physical beatings and social and mental torture. African-Americans have been victims of systematic discrimination and oppression for decades, leading to more premature deaths. Despite the enactment of health reforms to improve blacks’ and ethnic minorities’ health, African-Americans still face health inequalities and are less involved in implementing policies and actions for eliminating health disparities in the U.S.

A socioeconomic approach to African-Americans’ mortality explains the factors such as health inequalities, access to healthcare, and the primary needs of the population that lead to variations in mortality. Health inequalities correlate with health needs such as mortality and exposure to health risks. At the core of U.S. health disparities is racism which correlates with poor housing, unemployment, low income, and reduced access to healthcare services. Systemic racism subjects African-Americans to low-quality living standards, inadequate healthy foods, easy access to drugs, high crime rates, environmental education, and poor education. Noonan et al. (2016) found that social and ecological stressors increase the likelihood of psychopathology and morbidity. Stressful events reduce African-Americans’ ability to prioritize their health or cope with social and environmental factors that influence their health. African-Americans have a history of lagging behind their white peers in educational attainment. In 2014, 72.5% of blacks graduated from high school, and 18.6% earned a bachelor’s degree compared to 87.2% non-Hispanic whites’ high school graduates and 32.5% of Whites with a bachelor’s degree (Noonan et al., 2016). Low educational attainments correlate with high black unemployment rates of 8.8%, higher than 4.3% unemployment for whites. Research shows that African-Americans are the poorest ethnic group in America, with the lowest median household income (Noonan et al., 2016). In 2014, African Americans had a $35,398 median income compared to a $74,297 Asian median income (Noonan et al., 2016). High poverty rates among blacks increase their risk of poor health outcomes and mortality. African-Americans are at a higher risk of cardiovascular diseases, diabetes, high blood pressure, low birth weight, and obesity than whites.

African-Americans’ physical environment, such as air quality, weather, and other artificial factors, influence their health. Blacks live in low-quality housing and are disproportionately affected by housing-related diseases such as asthma. African-Americans also live in segregated housing with a high probability of developing cardiovascular diseases. Poor neighborhoods expose African Americans to high crime rates and delinquency. African-Americans have high homicide rates and are less likely to engage in physical activity. Violence is prevalent in black communities and leads to premature deaths. The continued disparity in exposure to violence among African-Americans and whites increases the differences in gunshot deaths. Research by Noonan et al. (2016) shows that in 2014, 57% of Blacks died from firearm homicides which were the main causes of mortality among African-Americans men aged 15 to 34 years. These neighborhoods also have poor infrastructure, and transportation is a major problem limiting access to healthcare services. African-Americans have reduced access to preventive care, leading to many preventable deaths.

Reduced access to markets and food stores that sell healthy food expose blacks to food poisoning. African-Americans live in food deserts, with few supermarkets and low-quality and less fresh foods. This problem is compounded by easy access to alcohol outlets in African-American communities. Unhealthy lifestyles and alcohol consumption increase the risk of obesity and diabetes in black communities. Blacks also live in areas with low air quality and high chances of air pollution. Research shows that African-Americans live close to toxic waste sites with few to no air quality monitoring sites. Environmental pollution negatively impacts their health, increasing the likelihood of hospitalization, childhood cancer, congenital abnormalities, and pregnancy complications, major causes of high mortality rates in America.

The socioeconomic disadvantage faced by African-Americans correlates with the high infant and maternal mortality rates. Novoa and Taylor (201) indicate that African American mothers have high infant mortality rates, about four times higher than non-Hispanic whites mothers. African-American infants die at a higher rate than non-Hispanic infants. Research highlights that racial discrimination plays a vital role in African American infant and maternal mortality rate. Poverty and low socioeconomic status of African American women increase their risk of maternal and infant mortality (Novoa and Taylor, 2018). African American mothers have reduced access to prenatal care, and those who access it are offered low-quality, which increases pregnancy complications and infant deaths.

Similarly, Noonan et al. (2016) indicate that in 2002, 75% of African-American women compared to 89% of white women accessed prenatal care. 2008 witnessed a similar trend where only 59.1% of black American women gave birth to live babies and had received prenatal care compared to 72.2% of white women (Noonan et al., 2016). In 2019, the infant mortality rate for black women was the highest at 10.62%, and the most increased neonatal mortality was 6.85% (Ely and Driscoll, 2021). Along with reduced access to prenatal care, African women are less likely to receive pregnancy education. Disparities in maternal health correlate with increases in infant mortality among African American women.

Leading Causes of African-American Mortality

Research identifies that the major causes of high African American mortality are cardiovascular diseases (CVD), cancer, and unintentional injuries.

Cardiovascular Diseases

Major types of cardiovascular diseases include stroke and coronary heart diseases. African Americans have 20% high rates for heart diseases and 40% for stroke, translating to high age-adjusted mortality rates for CVD (Mensah, 2018). Disproportional access to CVD healthcare faced by African-Americans increases CVD-related mortality. African Americans are vulnerable to CVD risk factors such as diabetes, obesity, and hypertension, increasing the risk of developing CVD. Adverse health behaviors such as reduced physical activity, poor diet, inadequate sleep, and untreated sleep disorders increase the CVD burden among African Americans living in impoverished urban areas. Mensah (2018) concluded that African Americans have a 64% prevalence of hypertension, 62% obesity, 39% hypercholesterolemia, and 23% diabetes. Research shows that African Americans develop coronary heart disease (CHD) earlier than whites and are prone to multiple risk factors. In 2010, African Americans had a 6.5% CHD prevalence, higher than 5.8% in whites (Carnethon et al., 2017). African Americans are affected mainly by CHD, with a 5.9% prevalence compared to 40% in white women. High prevalence of CHD among the African-American population increase CHD-related mortality. African Americans are at increased risk of stroke mortality due to the high prevalence of stroke risk factors such as diabetes, low educational attainment, and hypertension. Carnethon et al. (2017) indicate that African Americans have 4.5% higher stroke mortality rates than whites.

Cancer

Cancer research indicates that African Americans are at a higher risk of dying from cancer. Cancer statistics for African Americans in 2019 suggest that black persons have a disproportionate share of the cancer burden with high mortality rates and low survival rates (DeSantis et al., 2019). The primary factor associated with increased cancer deaths is low socioeconomic status among African Americans. Lack of insurance coverage among black communities delays cancer diagnosis and treatment. The most prevalent types of cancer in African Americans are prostate cancer in men and breast cancer in females. In 2019, about 38,840 black men and 36,190 women died from cancer.

Unintentional Injuries

Unintentional injuries are the third leading cause of African American mortality, especially among individuals below 45 years of age. Drug overdose primarily increased alcohol consumption among African Americans, which has led to increased injury mortality. Analysis of data from the National Vital Statistics System indicates that drug overdose deaths increased from 7.5 in 199 to 12.2 in 2015 among non-Hispanic black persons (Hedegaard, Minino, and Warner, 2019). The risk factors for high mortality associated with unintentional injuries include high rates of gun ownership, low social and economic status, living in high crime neighborhoods, and easy access to drugs and alcohol.

The literature review in this paper signifies that socioeconomic disparities in the USA disproportionately affect African Americans living in urban areas, leading to reduced life expectancy and high mortality rates. Systemic and institutionalized racism is a major factor rendering black Americans the least healthy population group. Racism affects the social determinants of health by subjecting blacks to poverty, unemployment, environmental pollution, low education, and violence, leading to poor health outcomes. The social disadvantage faced by African Americans predisposes them to cardiovascular diseases, cancer, and unintentional injuries, which are the leading causes of high mortality rates in America.

Research Question and Hypothesis

Research Question

How has mortality in America changed over the past 20 years, and what will it look like in the near future? What are the leading causes of mortality, and how does it affect different groups in America?

Hypothesis

This research hypothesizes that if African Americans have the highest mortality rates in America, then there is a need to address health disparities to ensure equal distribution of and access to health resources and improve African Americans’ health in the long run.