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Health care faulted in race mortality gap

Black men dying earlier than whites

WASHINGTON -- Middle-aged black men are dying at nearly twice the rate of white men of a similar age, reflecting lower incomes and poorer access to health care, a study says. But mortality among black infants is dropping.

While overall longevity for both blacks and whites has improved over the past 40 years, the gap between the races has narrowed little, former surgeon general David Satcher wrote in a paper published yesterday in the journal Health Affairs.

Satcher's paper was one of several in the journal, which is devoting most of its March/April issue to the topic of health care discrepancies between races.

Elimination of this racial gap would prevent an estimated 83,570 early deaths annually, Satcher wrote.

Some 10,472 of those deaths occurred among black men who were 45 to 54 in 2000, according to research based on a death rate of 1,060 per 100,000 black men in that age group compared with a rate of 503 for white men.

In 1960 the rates were 1,625 for black men and 932 for white men in that age group.

One reason for the differences is that gains in health care access generally have not included black men unless they were older or disabled, Satcher said. For example, when Medicare became law, the average black man did not live long enough to become eligible, he said.

Other factors include the relatively low incomes of black men compared with whites, a rise in gun-related deaths among blacks, their disproportionately high death rate from AIDS, and higher rates of heart disease and diabetes, Satcher said.

While a gap remains, there has been progress for infants, Satcher notes.

Deaths per 100,000 black males under 12 months old fell from 5,307 in 1960 to 1,653 in 2000, he found. Comparable figures for whites were 2,694 in 1960 and 656 in 2000.

For baby girls, the infant death rate fell from 4,162 in 1960 to 1,363 in 2000 for blacks and from 2,088 to 530 for whites.

Social factors, including neighborhood quality and residential segregation, contribute to the differences in health care, according to a separate paper by David R. Williams of the University of Michigan and Pamela Braboy Jackson of Indiana University.

Additional factors include education, income, and health practices such as diet, physical activity, and tobacco use, they report.

''Strikingly, the homicide rate of black males in the highest education category exceeds that of white males in the lowest education group," Jackson and Williams wrote.

In an accompanying paper, Senator Edward M. Kennedy, Democrat of Massachusetts, called on Congress and the Bush administration to act to improve health care for minorities.

''It boggles the mind that for a generation the United States, with all its wealth and leadership, has been the only industrialized country in the world that does not guarantee health care to all of its citizens," Kennedy wrote.

Senate majority leader Bill Frist, Republican of Tennessee, agreed that disparities in health care are unacceptable. But his approach to reform would differ from Kennedy's.

''The best way to eliminate health disparities is through improvements in the care we deliver to each patient," wrote Frist, who was a heart-lung surgeon before he was elected to Congress, in an accompanying paper.

The collection of studies echoes a report in 2002 from the Institute of Medicine that concluded that minorities receive lower quality health care than whites for serious conditions and routine services.

''Solving this national embarrassment will not be easy," read a foreword published in Health Affairs. It was signed by Rita Lavizzo-Mourey, president of the Robert Wood Johnson Foundation; William C. Richardson, president of the W.K. Kellogg Foundation; Robert K. Ross, president of the California Endowment; and John W. Rowe, chairman of the insurance company Aetna.

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