decomposition of the us black/white inequality in life ... · decomposing black/white inequality...

Decomposition of the US Black/White inequality in life expectancy

Quantifying the impact of deaths of despair

Mathew Kiang, ScD@mathewkiangPostdoctoral Research FellowCenter for Population Health SciencesStanford University

Monica Alexander, PhD @monjalexanderAssistant Professor Department of Sociology Department of Statistical SciencesUniversity of Toronto

http://bit.ly/ser_2019

71

73

75

77

79

1999 2005 2011 2017

Year

s

Total

Life Expectancy in the US

• In 2017, US life expectancy declined for 3rd year in a row1

• Has not happened since 19182

1.Murphy, Xu, Kochanek, and Arias. 2018. “Mortality in the United States, 2017.” NCHS Data Brief. 2. Dyer. BMJ 2018. “US Life Expectancy Falls for Third Year in a Row.”

3. Case and Deaton. PNAS 2015. “Rising Morbidity and Mortality in Midlife Among White Non-Hispanic Americans in the 21st Century.”

Life Expectancy in the US

• In 2017, US life expectancy declined for 3rd year in a row1

• Has not happened since 19182

• Follows Case and Deaton 2015,3 which observed higher rates of deaths of despair in middle-age non-Hispanic Whites

1.Murphy, Xu, Kochanek, and Arias. 2018. “Mortality in the United States, 2017.” NCHS Data Brief. 2. Dyer. BMJ 2018. “US Life Expectancy Falls for Third Year in a Row.”

3. Case and Deaton. PNAS 2015. “Rising Morbidity and Mortality in Midlife Among White Non-Hispanic Americans in the 21st Century.”

71

73

75

77

79

1999 2005 2011 2017

Year

s

Non-Hispanic White Non-Hispanic Black Total

Non-Hispanic White

Non-Hispanic Black

1999 2005 2011 2017

0

20

40

60

80

0

20

40

60

80

Age c

atego

ry0-1 30 60 90+

Deaths per 100,000 population

Deaths of Despair

71

73

75

77

79

1999 2005 2011 2017

Year

s


• Alcohol-related liver disease, suicide, or drug overdose

Non-Hispanic White

Non-Hispanic Black

1999 2005 2011 2017

0

20

40

60

80

0

20

40

60

80

Age c

atego

ry0-1 30 60 90+


Deaths of Despair

71

73

75

77

79

1999 2005 2011 2017

Year

s



• 1999–2013, increases in 40-54 year old non-Hispanic White (NHW) population

Non-Hispanic White

Non-Hispanic Black

1999 2005 2011 2017

0

20

40

60

80

0

20

40

60

80

Age c

atego

ry0-1 30 60 90+


Deaths of Despair

71

73

75

77

79

1999 2005 2011 2017

Year

s



• 1999–2013, increases in 40-54 year old non-Hispanic White (NHW) population

• 2014–2017, affecting other ages and non-Hispanic Black (NHB) population

Non-Hispanic White

Non-Hispanic Black

1999 2005 2011 2017

0

20

40

60

80

0

20

40

60

80

Age c

atego

ry0-1 30 60 90+


Racial/Ethnic Health Inequalities

• But health inequalities aren’t new1 • And grow and shrink over time2,3

• Geographical variation yet spatially persistent4

1. Williams, and Sternthal. 2010. “Understanding Racial-Ethnic Disparities in Health: Sociological Contributions.” J Health Soc Behav 51 2. Krieger, Rehkopf, Chen, Waterman, Marcelli, and Kennedy. 2008. “The Fall and Rise of US Inequities in Premature Mortality: 1960–2002.” PLOS Med.3. Krieger, Kosheleva, Waterman, Chen, Beckfield, and Kiang. 2014. “50-Year Trends in US Socioeconomic Inequalities in Health: US-born Black and White Americans, 1959–2008.” IJE4. Cossman, Cossman, Jackson, and Cosby. 2003. “Mapping High or Low Mortality Places Across Time in the United States: A Research Note on a Health Visualization and Analysis Project.” Health Place

0

1

2

3

4

5

6

1999 2005 2011 2017

Whit

e - B

lack

71

73

75

77

79

1999 2005 2011 2017

Year

s


Quantify impact of deaths of despair

on Black/White inequalities

Data and Methods

• Restricted-access death and population data from the NCHS, 1999 to 2017 to create life tables

• Line integral model of decomposition from Horiuchi, Wilmoth, and Pletcher. 2008. “A Decomposition Method Based on a Model of Continuous Change.” Demography 45 (4). doi:10.1353/dem.0.0033

f(p2)� f(p1) =nX

i=1

Z x(p2)

x(p1)

@f

@xi<latexit sha1_base64="mTil8Up1ixZ8fQufAiUH8mexKaQ=">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</latexit><latexit sha1_base64="mTil8Up1ixZ8fQufAiUH8mexKaQ=">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</latexit><latexit sha1_base64="mTil8Up1ixZ8fQufAiUH8mexKaQ=">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</latexit><latexit sha1_base64="mTil8Up1ixZ8fQufAiUH8mexKaQ=">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</latexit>

Data and Methods

Horiuchi, Wilmoth, and Pletcher. 2008. “A Decomposition Method Based on a Model of Continuous Change.” Demography 45 (4). doi:10.1353/dem.0.0033

f(p2)� f(p1) =nX

i=1

Z x(p2)

x(p1)

@f


0

1

2

3

4

5

6

1999 2005 2011 2017

Whit

e - B

lack

• Interested in decomposing the difference in life expectancy between two groups

Data and Methods


f(p2)� f(p1) =nX

i=1

Z x(p2)

x(p1)

@f


0

1

2

3

4

5

6

1999 2005 2011 2017

Whit

e - B

lack


• Express White LE and Black LE as a function f of n covariates denoted x = [x1, …, xn]

71

73

75

77

79

1999 2005 2011 2017

Year

s


Non-Hispanic White

Non-Hispanic Black

1999 2005 2011 2017

0

20

40

60

80

0

20

40

60

80

Age c

atego

ry

0-1 30 60 90+


Data and Methods


f(p2)� f(p1) =nX

i=1

Z x(p2)

x(p1)

@f


0

1

2

3

4

5

6

1999 2005 2011 2017

Whit

e - B

lack


• Express White LE and Black LE as a function f of n covariates denoted x = [x1, …, xn]

• Here, life expectancy (f) is a function of mortality rates by age (x1) and type of death (x2) 71

73

75

77

79

1999 2005 2011 2017

Year

s


Decomposing Black/White Inequality

• In 1999, NHW outlived NHB by ~6 years

• Negative values indicate NHB mortality rate is lower than NHW mortality rate in that age group

• NHW lower mortality in nearly every age group except 85+0.0

0.2

0.4

0.6

0-4

5-9

10-1

415

-19

20-2

425

-29

30-3

435

-39

40-4

445

-49

50-5

455

-59

60-6

465

-69

70-7

475

-79

80-8

485

+Age Group

Cont

ribut

ion to

Blac

k/Whit

e In

equa

lity (Y

ears

)

despair non_despair

1999 (5.91 years)


• In 1999, deaths of despair accounted for less than 1% of the Black/White inequality in life expectancy (-0.05 years)

• Non-despair, under-5 mortality was the single largest contributor at 12% (.72 years)

0.0

0.2

0.4

0.6

0-4

5-9

10-1

415

-19

20-2

425

-29

30-3

435

-39

40-4

445

-49

50-5

455

-59

60-6

465

-69

70-7

475

-79

80-8

485

+Age Group

Cont

ribut

ion to

Blac

k/Whit

e In

equa

lity (Y

ears

)

Non-despair Despair

1999 (5.91 years)

Two main results

(+ one bonus)

Convergence Mainly from Non-despair Deaths

• Majority of the lower inequality is due improvements in NHB 15-54 and 55+, non-despair mortality (5.17 to 3.18 years)

• Small contribution from 15-54 deaths of despair (albeit, growing: -0.04 to -0.49 years)

Non-despair Despair

1999 2005 2011 2017 1999 2005 2011 2017-0.5

0.0

0.5

1.0

1.5

2.0

2.5

Contr

ibutio

n to B

lack-W

hite D

iffere

nce (

Year

s) Age Group0-4

5-14

15-54

55+

We Need to Reduce Under-5 Deaths

• Under-5 inequality has not improved since 2010 (0.53 years)

• Under-5 inequality has only modestly declined since 1999 (0.72 years)

• In every year, non-despair under-5 mortality is single largest contributor

Non-despair Despair

1999 2005 2011 2017 1999 2005 2011 2017-0.5

0.0

0.5

1.0

1.5

2.0

2.5

Contr

ibutio

n to B

lack-W

hite D

iffere

nce (

Year

s) Age Group0-4

5-14

15-54

55+

There is Substantial Geographic Variation

3.75 years 4.77 years -0.34 years

Pacific EN Central New England

0 20 40 60 80 0 20 40 60 80 0 20 40 60 80-1.5

-1.0

-0.5

0.0

0.5

Age Group

Con

tribu

tion

to B

lack

-Whi

te D

iffer

ence

(Yea

rs)

Non-despair Despair

~1% from Deaths of despair

Deaths of despair almost offset non-despair advantage

among NHW

Conclusion

Decomposition methods are useful and flexible —

nuanced view of inequalities.

0.0

0.2

0.4

0.60-

45-

910

-14

15-1

920

-24

25-2

930

-34

35-3

940

-44

45-4

950

-54

55-5

960

-64

65-6

970

-74

75-7

980

-84

85+

Age Group

Cont

ribut

ion to

Blac

k/Whit

e In

equa

lity (Y

ears

)

Non-despair Despair

1999 (5.91 years)Non-despair Despair

1999 2005 2011 2017 1999 2005 2011 2017-0.5

0.0

0.5

1.0

1.5

2.0

2.5

Contr

ibutio

n to B

lack-W

hite D

iffere

nce (

Year

s) Age Group0-4

5-14

15-54

55+



0 20 40 60 80 0 20 40 60 80 0 20 40 60 80-1.5

-1.0

-0.5

0.0

0.5

Age Group

Con

tribu

tion

to B

lack

-Whi

te D

iffer

ence

(Yea

rs)

Non-despair Despair

Geography cannot be ignored. Interventions

must be local.

We need to address under-5 mortality. Deaths of despair minor relative to under-5.

Thank you

Mathew Kiang, ScDT32 Postdoctoral Fellow@[email protected]

Center forPopulation Health Sciences

Support:NIMHD (DP2MD010478)NIDA (T32DA035165)PHS DataCore and SRCC for computational resources.

Slides available at: http://bit.ly/ser_2019

Decomposition methods are useful and flexible —

nuanced view of inequalities.

0.0

0.2

0.4

0.60-

45-

910

-14

15-1

920

-24

25-2

930

-34

35-3

940

-44

45-4

950

-54

55-5

960

-64

65-6

970

-74

75-7

980

-84

85+

Age Group

Cont

ribut

ion to

Blac

k/Whit

e In

equa

lity (Y

ears

)

Non-despair Despair

1999 (5.91 years)Non-despair Despair

1999 2005 2011 2017 1999 2005 2011 2017-0.5

0.0

0.5

1.0

1.5

2.0

2.5

Contr

ibutio

n to B

lack-W

hite D

iffere

nce (

Year

s) Age Group0-4

5-14

15-54

55+



0 20 40 60 80 0 20 40 60 80 0 20 40 60 80-1.5

-1.0

-0.5

0.0

0.5

Age Group

Con

tribu

tion

to B

lack

-Whi

te D

iffer

ence

(Yea

rs)

Non-despair Despair

Geography cannot be ignored. Interventions

must be local.

We need to address under-5 mortality. Deaths of despair minor relative to under-5.

Additional slides

Pacific Mountain WN Central WS Central EN Central ES Central Mid-Atlantic S Atlantic New England

'99 '05 '11 '17 '99 '05 '11 '17 '99 '05 '11 '17 '99 '05 '11 '17 '99 '05 '11 '17 '99 '05 '11 '17 '99 '05 '11 '17 '99 '05 '11 '17 '99 '05 '11 '17

72.5

75.0

77.5

80.0Year

s


Life Expectancy by Division

Contributions by DivisionPacific Mountain WN Central WS Central EN Central ES Central Mid-Atlantic S Atlantic New England

Non-despairDespair

'99 '05 '11 '17 '99 '05 '11 '17 '99 '05 '11 '17 '99 '05 '11 '17 '99 '05 '11 '17 '99 '05 '11 '17 '99 '05 '11 '17 '99 '05 '11 '17 '99 '05 '11 '17

-1

0

1

2

3

-1

0

1

2

3

Cont

ribut

ion to

Blac

k-W

hite

Diffe

renc

e (Y

ears

)

Data and Methods

• We can find the solution using numerical integration (i.e., calculating small steps between observations)

• This assumes a smooth continuous function (i.e., differentiable but not necessarily monotonic)

• While deaths are discrete events at the individual level, death rates at the population level are (generally) smooth

f(p2)� f(p1) =nX

i=1

Z x(p2)

x(p1)

@f


Data and Methods

• We performed numerical integration in R 3.6.0 using 20 integration steps as outlined in Horiuchi, Wilmoth, and Pletcher. 2008. “A Decomposition Method Based on a Model of Continuous Change.” Demography 45 (4)

f(p2)� f(p1) =nX

i=1

Z x(p2)

x(p1)

@f


Data and Methods

• Used simulation to estimate uncertainty intervals

• Assume deaths are Poisson distributed and use observed age- and death-type-specific mortality rates as the mean of the distribution

• Create a simulated life table • Estimate the quantity of interest • Repeat 1,000 times and report 2.5th

and 97.5th percentiles

f(p2)� f(p1) =nX

i=1

Z x(p2)

x(p1)

@f



• In 1999, NHW outlived NHB by ~6 years

• Negative values indicate NHB mortality rate is lower than NHW mortality rate in that age group

• NHW lower mortality in nearly every age group except 85+*0.0

0.2

0.4

0.6

0-4

5-9

10-1

415

-19

20-2

425

-29

30-3

435

-39

40-4

445

-49

50-5

455

-59

60-6

465

-69

70-7

475

-79

80-8

485

+Age Group

Cont

ribut

ion to

Blac

k/Whit

e In

equa

lity (Y

ears

)

despair non_despair

1999 (5.91 years)

*Not clear this is real. See: Nam 1995 in Social Biology (doi: 10.1080/19485565.1995.998889)


• By 2017, Black/White inequality dropped to 3.24 years

-0.50

-0.25

0.00

0.25

0.50

0-4

5-9

10-1

415

-19

20-2

425

-29

30-3

435

-39

40-4

445

-49

50-5

455

-59

60-6

465

-69

70-7

475

-79

80-8

485

+Age Group

Cont

ribut

ion to

Blac

k/Whit

e In

equa

lity (Y

ears

)

Non-despair Despair

2017 (3.24 years)



• 17% of gap is due to deaths of despair (-0.54 years)

-0.50

-0.25

0.00

0.25

0.50

0-4

5-9

10-1

415

-19

20-2

425

-29

30-3

435

-39

40-4

445

-49

50-5

455

-59

60-6

465

-69

70-7

475

-79

80-8

485

+Age Group

Cont

ribut

ion to

Blac

k/Whit

e In

equa

lity (Y

ears

)

Non-despair Despair

2017 (3.24 years)



• 17% of gap is due to deaths of despair (-0.54 years)

• Non-despair, under-5 mortality still the largest contributor 17% (0.55 years)

-0.50

-0.25

0.00

0.25

0.50

0-4

5-9

10-1

415

-19

20-2

425

-29

30-3

435

-39

40-4

445

-49

50-5

455

-59

60-6

465

-69

70-7

475

-79

80-8

485

+Age Group

Cont

ribut

ion to

Blac

k/Whit

e In

equa

lity (Y

ears

)

Non-despair Despair

2017 (3.24 years)

There is substantial geographic variation



0 20 40 60 80 0 20 40 60 80 0 20 40 60 80-1.5

-1.0

-0.5

0.0

0.5

Age Group

Con

tribu

tion

to B

lack

-Whi

te D

iffer

ence

(Yea

rs)

Non-despair DespairKiang, Basu, Chen, Alexander. Assessment of Changes in the Geographical Distribution of

Opioid-Related Mortality Across the United States by Opioid Type, 1999-2016. JAMA Network Open. doi:10.1001/jamanetworkopen.2019.0040

Increasing synthetic opioid mortality

decomposition of the us black/white inequality in life ... · decomposing black/white inequality...

Documents