Black-White mortality differences in the United States: Part Two

 

In yesterday's post, I wrote about certain causes-of-death that had the largest contrast between Black mortality and White mortality. The reasoning for using that approach was because the differences should be easier to find than for causes-of-death that had smaller differences.

In today's post, I was going to was about the big three causes of death in absolute numbers while still searching for the differences but ran into a few snarls. For one thing, in ABSOLUTE terms, heart attacks, cancer and strokes have a lower death-rate among Blacks than among Whites. The key words are buried in the header of the image at the top of the page "...age adjusted...". We all die of something and healthy people die from body-parts wearing out (dementia, heart attacks and so-on).

The numbers in ABSOLUTE terms (2015-2019 time period chosen):

• Diseases of the Heart: 173/100k vs 216/100k per year for Blacks vs Whites
• Cancer: 154/100k vs 199/100K
• Cerebrovascular Diseases: 42/100k vs 47/100k   Source
  

The picture changes considerably if we look at a single slice-in-time. I chose the "slice" from 45-to-54 years of age because those are peak earning years and there are often children still at home.

• Diseases of the Heart: 134/100k vs 72/100k per year for Blacks vs Whites
• Cancer: 114/100k vs 93/100K
• Cerebrovascular Diseases: 25/100k vs 10/100k

One small, mathematical note: The 100k in the divisor refers to the number of people in that ten-year slice-of-time and not to the total population of all age groups. You cannot simply add-up the death-rates when they are age-stratified.

Access to Primary Care Providers

One of the "contrasts" in the last set of numbers is that the ratio between cancer death-rates is not as pronounced as the B:W ratios for heart disease and strokes.

One plausible hypothesis is that Blacks can get healthcare but they cannot get it quickly. That is, Heart and Cerebrovascular disease are fast-moving and require quicker responses than Cancer.

Detroit, 640k people, 143 square miles and 17 Primary Care outlets according to Google.

Livonia, Michigan, 95k people, 36 square miles and 12 "dots" for Primary Care outlets.

One of my frequent commenters TSgt-Joe used to be a Social Worker in Detroit and in a different post he commented about the difficulty in getting clients to medical appointments. It was not uncommon for a pregnant woman to travel two-hours by bus or ride-share to her appointment. A lot of appointments don't get made when it is that hard to get there.

Another consideration about Heart Attacks and Strokes is that some kinds of elevated-risk can be identified during routine checkups: Inflammation markers like CRP, high blood pressure, lipid-profile, blood-sugar levels, atrial fibrillation and so on.

Why so few Primary Care Providers in the Inner City?

Income tax: Residents pay 2.4% in income tax and non-residents pay 1.2% in Detroit. Other legacy cities also levy income taxes.

Throttled Income: Inner cities have a disproportionate share of Medicaid payments. Medicaid reimbursements are often below the cost-to-provide. PCP in the suburbs have more patients with private insurance to soften the revenue hit.

Crime: Detroit has a violent crime rate of approximately 2000/100k per year

Roads: The roads are not well maintained and eat BMWs for lunch. One doctor who I know personally purchased a used Crown Vic in dark blue to be his daily ride to a hospital on the northern fringe of Detroit.

Few amenities: Restaurants? Barber shops? Retail shops? Maybe a few...but not an enjoyable stroll to-and-from away.

Aging facilities and other infrastructure: Not as nice to work in.

Facilities consolidated into massive outlets: Large, fortress-like facilities lack the collegial atmosphere of smaller, more accessible outlets. People don't like working in a place where they have to walk a quarter-mile through a parking lot or parking ramp and pass through two levels of security.

The one thing that could be changed tomorrow would be to remove the income tax on Doctors, Nurse-Practioners, Physician's Assistants, Pharmacists and Registered Nurses.

Another thing that could happen tomorrow would be to investigate and prosecute perps who commit violent crimes that victimize people working in the  Primary Care fields more vigorously. That would send a message: Do not mug people in certain parking lots or parking ramps. Do not mug people within a block of a PCP outlet or rob drugstores.

Major roads servicing Primary Care outlets could be fixed over a six-month time-horizon.

The other issues fall under the heading of "Culture" and would be slower to address.

Bonus images

SIDS plus Accidental Suffocation death-rates per 100k, 1999-2020

Recommended vax for children 1999. You can click on the images to enlarge them.

Recommended vax children 2018.

Incidentally, all US vaccines have been free of thiomersal (mercury) since March, 2001