By David A. Kindig, MD, PhD
We regularly scan eleven journals for new studies of particular population health relevance (the list of journals is at the end of this post). Two articles in June caught our eye:
Trends in the Black-White Life Expectancy Gap, 2003-2008 (Harper S, Rushani D, Kaufman J. JAMA. 2012;307(21):2257-2259).
The gap in life expectancy between non-Hispanic white and non-Hispanic blacks has continued to be one of the greatest lingering disparities of public health in the modern era. However, this brief report in JAMA asserts that this gap may be beginning to close. The authors have found that between 2003 and 2008 the life expectancy gap has been reduced from 6.5 to 5.4 years for men and 4.6 to 3.7 years for women. This reduction is significant, as a reduction of this magnitude has not been observed since the early 1990s, with the authors concluding “these racial inequalities among men and women in 2008 are the lowest ever recorded in the United States.” Authors attribute the narrowing gap among both men and women to declines in heart disease and HIV mortality rates, as well as a recent increase in poisoning mortality that has affected middle-aged white men more than any other group. This example illustrates that disparity rates are ratios that can be improved by worsening health among advantaged groups as well as improved health among disadvantaged groups. Overall, these results are remarkably hopeful and need to be followed in future years for clues about how such trends can be sustained.
We often report population health outcomes as mortality rates or life expectancy, as in the article above, since such data are widely available. However, non-mortality outcomes are also very important, and make up half of the health outcome rank in the County Health Rankings. The term health related quality of life (HRQoL) is a term used to generally describe such non-mortality or morbidity outcomes. Using one of the most sophisticated HRQoL measures (the HUI-3 in the National Population Health Survey), the authors traced social health gradients over time in a representative sample of Canadians. They report that HRQL is lower for Canadian men and women of lower education and income levels compared with those with a high education and increased affluence. This social gradient in HRQL is evident in early adulthood and continues through mid and later life, but age-related declines in quality of life do not appear to be vastly different across the social spectrum in Canada. The authors comment that “this may suggest that policies such as universal health insurance and comparatively generous old age benefits have helped to reduce the disparities in life circumstances as Canadians age”…and that “socio-economic disadvantage in early life may encompass a wide variety of both material (e.g., poverty and poor nutrition, poor quality housing) and psychosocial (e.g., stressful life events, shame from stigma, social isolation) exposures that collectively limit life chances and set up health-related quality of life deficits in early life that are never overcome at older ages.”
We call this paper to your attention not only for the significance of its conclusions but for creative use of a non-mortality measure in a longitudinal study.
I want to acknowledge the assistance of Erik Bakken, BA for his assistance in scanning the literature and drafting this post.
Journals we follow:
American Journal of Preventive Medicine
American Journal of Public Health
Annual Review of Public Health
Health Affairs
Journal of the American Medical Association (JAMA)
Journal of Epidemiology and Community Health
Journal of Health and Social Behavior
Milbank Quarterly
New England Journal of Medicine
Preventing Chronic Disease
Social Science and Medicine
David A. Kindig, MD, PhD is Emeritus Professor of Population Health Sciences and Emeritus Vice-Chancellor for Health Sciences at the University of Wisconsin School of Medicine and Public Health. Follow him on twitter: @DAKindig.
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