posted 11/20/02
People without a high school education were at risk of dying
an average 9 years earlier than high school graduates, while blacks were at risk
of dying almost 2 years earlier than their white counterparts.
Diabetes, hypertension, HIV infection, and homicide appear to be
the greatest contributors to the discrepancy in mortality between blacks and
whites in the US, according to a team of California researchers.
Smoking-related diseases are largely to blame for
why people with lower levels of education have shorter life expectancies, they
report in the November 14th issue of The New England Journal of Medicine.
Dr. Mitchell D. Wong, lead author from the
University of California at Los Angeles said, "The study has important
implications for redirecting public health efforts and the allocation of future
research funding.”
"Previous studies have found that African
Americans and those less educated have worse health outcomes for a diverse array
of diseases, thus, it has been difficult to know where to focus our public
health resources," he explained.
Dr. Wong and his colleagues investigated the
diseases that most contribute to educational and racial disparities in mortality
by analyzing data from the 1986 to 1994 National Health Interview Survey. The
authors estimated mortality from various diseases, based on a life expectancy of
75 years.
Overall, people without a high school education
were at risk of dying an average 9 years earlier than high school graduates,
while blacks were at risk of dying almost 2 years earlier than their white
counterparts, the investigators state. These findings remained true when the
researchers adjusted for potentially confounding factors, such as age and
gender.
The diseases that most accounted for the
educational disparity in mortality were ischemic heart disease, lung cancer,
stroke, congestive heart failure, pneumonia and lung disease--all
smoking-related diseases.
In fact, eliminating heart disease--which
accounted for nearly 12% of the potential years of life lost--would lead to a
nearly 10-month gain in life expectancy, the authors note. Similarly,
eliminating lung disease--the second greatest contributor to the educational
disparity--would add about 6 months to the life expectancy of less educated
individuals.
The discrepancy in mortality among blacks, in
comparison to whites, was largely due to deaths from hypertension--which
accounted for 15% of the disparity, followed by deaths from HIV infection,
diabetes and homicide.
Eliminating hypertension would lead to an almost
3-month gain in life expectancy among blacks, and getting rid of HIV-related
deaths would lead to a roughly 2-month gain in life expectancy, the report
indicates.
While the study did not investigate whether
factors such as health insurance and access to care might explain the
disparities in death rates, the fact that smoking-related diseases accounted for
the top six contributors to the educational disparity in life expectancy
suggests "that interventions to prevent smoking could have an enormous impact,"
the authors write.
"In addition, we know that African Americans are more likely to get hypertension, HIV and diabetes and also tend to have more severe disease," Dr. Wong said. "Thus, it is important to find out what the impact would be of improved screening, prevention and treatment of these diseases on racial disparities in life expectancy."
Source: Diabetes In Control.Com: N Engl J Med
2002;347:1585-1592.
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