Burden of liver cancer mortality by county, race, and ethnicity in the USA, 2000-19: a systematic analysis of health disparities.

Understanding how specific populations are affected by liver cancer is important for identifying priorities, policies, and interventions to mitigate health risks and reduce disparities. This study aims to provide comprehensive analysis of rates and trends in liver cancer mortality for different racial and ethnic populations in the USA nationally and at the county level from 2000 to 2019. We applied small-area estimation methods to death registration data from the US National Vital Statistics System and population data from the US National Center for Health Statistics to estimate liver cancer mortality rates by county, racial and ethnic population, and year (2000-19) in the USA. Race and ethnicity were categorised as non-Latino and non-Hispanic American Indian or Alaska Native (AIAN), non-Latino and non-Hispanic Asian or Pacific Islander (Asian), non-Latino and non-Hispanic Black (Black), Latino or Hispanic (Latino), and non-Latino and non-Hispanic White (White). Estimates were adjusted using published misclassification ratios to correct for inaccuracies in race or ethnicity as recorded on death certificates, and then age-standardised. Mortality rate estimates are presented for all county and racial and ethnic population combinations with a mean annual population greater than 1000. Nationally, the age-standardised liver cancer mortality rate increased between the years 2000 (4·2 deaths per 100 000 population [95% uncertainty interval 4·1-4·3]) and 2016 (6·0 per 100 000 [5·9-6·1]), followed by a stabilisation in rates from 2016 to 2019 (6·1 per 100 000 [6·0-6·2]). Similar trends were observed across the AIAN, Black, Latino, and White populations, whereas the Asian population showed an overall decrease across the 20-year study period. Qualitatively similar trends were observed in most counties; however, the mortality rate and the rate of change varied substantially across counties, both within and across racial and ethnic populations. For the 2016-19 period, mortality continued to increase at a substantial rate in some counties even while it stabilised nationally. Nationally, the White population had the lowest mortality rate in all years, while the racial and ethnic population with the highest rate changed from the Asian population in 2000 to the AIAN population in 2019. Racial and ethnic disparities were substantial: in 2019, mortality was highest in the AIAN population (10·5 deaths per 100 000 [9·1-12·0]), notably lower for the Asian (7·5 per 100 000 [7·1-7·9]), Black (7·6 per 100 000 [7·3-7·8]), and Latino (7·7 per 100 000 [7·5-8·0]) populations, and lowest for the White population (5·5 [5·4-5·6]). These racial and ethnic disparities in mortality were prevalent throughout the country: in 2019, mortality was higher in minoritised racial and ethnic populations than in the White population living in the same county in 408 (87·7%) of 465 counties with unmasked estimates for the AIAN population, 604 (90·6%) of 667 counties for the Asian population, 1207 (81·2%) of 1486 counties for the Black population, and 1073 (73·0%) of 1469 counties for the Latino population. Although the plateau in liver cancer mortality rates in recent years is encouraging, mortality remains too high in many locations throughout the USA, particularly for minoritised racial and ethnic populations. Addressing population-specific risk factors and differences in access to quality health care is essential for decreasing the burden and disparities in liver cancer mortality across racial and ethnic populations and locations. US National Institutes of Health (Intramural Research Program, National Institute on Minority Health and Health Disparities; National Heart, Lung, and Blood Institute; Intramural Research Program, National Cancer Institute; National Institute on Aging; National Institute of Arthritis and Musculoskeletal and Skin Diseases; Office of Disease Prevention; and Office of Behavioral and Social Sciences Research).

GBD US Health Disparities Collaborators 《The Lancet Regional Health》

Ten Americas: a systematic analysis of life expectancy disparities in the USA.

Nearly two decades ago, the Eight Americas study offered a novel lens for examining health inequities in the USA by partitioning the US population into eight groups based on geography, race, urbanicity, income per capita, and homicide rate. That study found gaps of 12·8 years for females and 15·4 years for males in life expectancy in 2001 across these eight groups. In this study, we aimed to update and expand the original Eight Americas study, examining trends in life expectancy from 2000 to 2021 for ten Americas (analogues to the original eight, plus two additional groups comprising the US Latino population), by year, sex, and age group. In this systematic analysis, we defined ten mutually exclusive and collectively exhaustive Americas comprising the entire US population, starting with all combinations of county and race and ethnicity, and assigning each to one of the ten Americas based on race and ethnicity and a variable combination of geographical location, metropolitan status, income, and Black-White residential segregation. We adjusted deaths from the National Vital Statistics System to account for misreporting of race and ethnicity on death certificates. We then tabulated deaths from the National Vital Statistics System and population estimates from the US Census Bureau and the National Center for Health Statistics from Jan 1, 2000, to Dec 31, 2021, by America, year, sex, and age, and calculated age-specific mortality rates in each of these strata. Finally, we constructed abridged life tables for each America, year, and sex, and extracted life expectancy at birth, partial life expectancy within five age groups (0-4, 5-24, 25-44, 45-64, and 65-84 years), and remaining life expectancy at age 85 years. We defined the ten Americas as: America 1-Asian individuals; America 2-Latino individuals in other counties; America 3-White (majority), Asian, and American Indian or Alaska Native (AIAN) individuals in other counties; America 4-White individuals in non-metropolitan and low-income Northlands; America 5-Latino individuals in the Southwest; America 6-Black individuals in other counties; America 7-Black individuals in highly segregated metropolitan areas; America 8-White individuals in low-income Appalachia and Lower Mississippi Valley; America 9-Black individuals in the non-metropolitan and low-income South; and America 10-AIAN individuals in the West. Large disparities in life expectancy between the Americas were apparent throughout the study period but grew more substantial over time, particularly during the first 2 years of the COVID-19 pandemic. In 2000, life expectancy ranged 12·6 years (95% uncertainty interval 12·2-13·1), from 70·5 years (70·3-70·7) for America 9 to 83·1 years (82·7-83·5) for America 1. The gap between Americas with the lowest and highest life expectancies increased to 13·9 years (12·6-15·2) in 2010, 15·8 years (14·4-17·1) in 2019, 18·9 years (17·7-20·2) in 2020, and 20·4 years (19·0-21·8) in 2021. The trends over time in life expectancy varied by America, leading to changes in the ordering of the Americas over this time period. America 10 was the only America to experience substantial declines in life expectancy from 2000 to 2019, and experienced the largest declines from 2019 to 2021. The three Black Americas (Americas 6, 7, and 9) all experienced relatively large increases in life expectancy before 2020, and thus all three had higher life expectancy than America 10 by 2006, despite starting at a lower level in 2000. By 2010, the increase in America 6 was sufficient to also overtake America 8, which had a relatively flat trend from 2000 to 2019. America 5 had relatively similar life expectancy to Americas 3 and 4 in 2000, but a faster rate of increase in life expectancy from 2000 to 2019, and thus higher life expectancy in 2019; however, America 5 experienced a much larger decline in 2020, reversing this advantage. In some cases, these trends varied substantially by sex and age group. There were also large differences in income and educational attainment among the ten Americas, but the patterns in these variables differed from each other and from the patterns in life expectancy in some notable ways. For example, America 3 had the highest income in most years, and the highest proportion of high-school graduates in all years, but was ranked fourth or fifth in life expectancy before 2020. Our analysis confirms the continued existence of different Americas within the USA. One's life expectancy varies dramatically depending on where one lives, the economic conditions in that location, and one's racial and ethnic identity. This gulf was large at the beginning of the century, only grew larger over the first two decades, and was dramatically exacerbated by the COVID-19 pandemic. These results underscore the vital need to reduce the massive inequity in longevity in the USA, as well as the benefits of detailed analyses of the interacting drivers of health disparities to fully understand the nature of the problem. Such analyses make targeted action possible-local planning and national prioritisation and resource allocation-to address the root causes of poor health for those most disadvantaged so that all Americans can live long, healthy lives, regardless of where they live and their race, ethnicity, or income. State of Washington, Bloomberg Philanthropies, Bill & Melinda Gates Foundation.

Dwyer-Lindgren L ，Baumann MM ，Li Z ，Kelly YO ，Schmidt C ，Searchinger C ，La Motte-Kerr W ，Bollyky TJ ，Mokdad AH ，Murray CJ ... -  《-》

Life expectancy by county and educational attainment in the USA, 2000-19: an observational analysis.

Educational disparities in life expectancy in the USA have been documented nationally but have not been comprehensively explored at the county level. Such geographical granularity is necessary for determining how these disparities vary across the country, thus highlighting the populations that could benefit most from increased access to educational support. We aim to estimate life expectancy at age 25 years for US counties from 2000 to 2019 for four educational attainment populations: less than high school, high-school graduate (including certificate of high school equivalency or other alternative credentials), some college (including associate degrees and incomplete college), and college graduate (including graduate and professional degrees). In this observational analysis, we estimated age-specific mortality by educational attainment, county, sex, age, and year using validated small-area estimation models, and then used standard life table techniques to estimate life expectancy at age 25 years using deaths data from the US National Vital Statistics System and population data from the 2000 decennial census, American Community Survey, and National Center for Health Statistics between Jan 1, 2000, and Dec 31, 2019. Estimates were adjusted for misclassification of educational attainment on death certificates and format changes to how education is captured on death certificates. We masked (ie, did not display) estimates for counties and educational attainment populations with a mean annual population of less than 1000. Nationally, in all years there was a clear educational gradient in life expectancy at age 25 years where those with higher levels of education had higher life expectancy: individuals who had completed a college degree had higher life expectancy compared with those who had completed some college education (by 0·3 to 2·0 years over the study period), those who had completed some college had higher life expectancy than the high-school graduate population (by 4·1 to 4·9 years over the study period), and those who had graduated high school had higher life expectancy than those with less than a high-school education (by 3·4 to 5·1 years over the study period). From 2000 to 2019, life expectancy increased by 2·5 years (95% uncertainty interval 2·4 to 2·6) for the college graduate population, 0·7 years (0·6 to 0·8) for the population who had completed some college, and 0·3 years (0·3 to 0·4) for the high-school graduate population; there was no net change for those with less than a high-school education (0·0 years [-0·1 to 0·1]). In every educational attainment population, life expectancy increased by more from 2000 to 2010, with diminishing gains or even declines from 2010 to 2019. Life expectancy varied at the county level; eg, in 2019, the IQR for the population with less than a high-school education was 67·4 to 72·1 years, whereas for the college graduate population it was 82·3 to 84·6 years among counties with unmasked estimates. The college graduate population had higher life expectancy than those who had completed some college in 1937 (81·1%) of 2389 counties (47·1% statistically significant), which in turn had higher life expectancy than the high-school graduate population in 2726 (97·7%) of 2791 counties (87·0% statistically significant), which in turn had higher life expectancy than the population with less than a high-school education in 2356 (95·9%) of 2456 counties (91·6%). Over the study period, the gap in life expectancy between the college graduate population and those with less than a high-school education grew in 2594 (84·8%) of 3060 counties. Educational disparities in life expectancy are large, widespread, and increasing, both nationally and in most counties throughout the USA. Further research is needed to determine how both more equitable access to higher education and efforts to mitigate barriers to good health facing people with lower levels of education might result in better health and longer lives. Intramural Research Program, National Institute on Minority Health and Health Disparities; National Heart, Lung, and Blood Institute; Intramural Research Program, National Cancer Institute; National Institute on Aging; National Institute of Arthritis and Musculoskeletal and Skin Diseases; Office of Disease Prevention; and Office of Behavioral and Social Sciences Research, US National Institutes of Health.

Global Burden of Disease US Health Disparities Collaborators 《-》

Disparities in wellbeing in the USA by race and ethnicity, age, sex, and location, 2008-21: an analysis using the Human Development Index.

The Human Development Index (HDI)-a composite metric encompassing a population's life expectancy, education, and income-is used widely for assessing and comparing human development and wellbeing at the country level, but does not account for within-country inequality. In this study of the USA, we aimed to adapt the HDI framework to measure the HDI at an individual level to examine disparities in the distribution of wellbeing by race and ethnicity, sex, age, and geographical location. We used individual-level data on adults aged 25 years and older from the 2008-21 American Community Survey (ACS) Public Use Microdata Sample. We extracted information on race and ethnicity, age, sex, location (Public Use Microdata Areas), educational attainment, and household income and size. We merged these data with estimated life tables by race and ethnicity, sex, age, location (county), and year, generated using Bayesian small-area estimation models applied to death certificate data from the National Vital Statistics System. For each individual in the ACS, we used these combined data to estimate years of education, household consumption, and expected lifespan; converted each of these three features into an index using a percentile score; and calculated the HDI as the geometric mean of these three indices. Finally, we grouped individuals into yearly HDI deciles. Years of education, household consumption, and expected lifespan-and thus the HDI-varied considerably among adults in the USA during the 2008-21 period. For most race and ethnicity and sex groups, the mean HDI increased gradually from 2008 to 2019, then declined in 2020 due to declines in expected lifespan, although there were systematic differences in the distribution of the HDI by race and ethnicity and sex. In the lowest HDI decile, there was over-representation (ie, >10% of the total population of a given race and ethnicity and sex group) of American Indian and Alaska Native (AIAN) males (50% [SE 0·2] in decile, mean annual population in decile 0·37 million [SE 0·002]), Black males (40% [<0·1], 4·67 million [0·006]), AIAN females (23% [0·1], 0·19 million [0·001]), Latino males (21% [<0·1], 3·27 million [0·006]), Black females (14% [<0·1], 1·86 million [0·004]), and Latina females (13% [<0·1], 2·07 million [0·006]). Given differences in total population size, however, White males were the largest population group in the lowest decile (27% [<0·1] of the lowest decile, 5·87 million [0·012]), followed by Black males (22% [<0·1]) and Latino males (15% [<0·1]). There were notable differences in these patterns by age group: for example, for the 25-44 years age group, the lowest HDI decile had even greater over-representation of AIAN males (66% [0·2] in decile, 0·22 million [0·001]) and Black males (46% [<0·1], 2·52 million [0·005]) than the 85 years and older age group (22% [1·1], <0·01 million [<0·001]; and 20% [0·3], 0·03 million [<0·001]). By contrast, the lowest decile had an under-representation of Asian females (2% [<0·1], 0·06 million [<0·001]) in the 25-44 years age group, but an over-representation in the 85 years and older age group (25% [0·3], 0·03 million [<0·001]). The lowest HDI decile for the 25-44 years age group was primarily male (76% [<0·1], 6·44 million [0·009]) whereas for age 85 years and older it was predominantly female (71% [0·1], 0·42 million [0·002]). In the highest HDI decile, shifts in the composition of the population by age were particularly large for White males, who made up 5% (0·1; 0·39 million [0·001]) of this decile in the 25-44 years age group, but 49% (0·2; 0·29 million [0·001]) in the 85 years and older age group. From 2012 to 2021, the proportion of the population living in the lowest HDI decile varied substantially by location, and a disproportionately high share of the population living in locations in much of the southern half of the USA, Appalachia, and Rust Belt states were in the lowest HDI decile. Substantial disparities in wellbeing exist within the USA and are heavily influenced by race and ethnicity (due to racism), sex, age, and geographical location. These disparities are not immutable, but improvement is not a given, and gains can be fleeting in the face of a crisis such as the COVID-19 pandemic. Sustained action to ensure that everyone has meaningful access to a high-quality education, the means to earn a sufficient income, and the opportunity to live a long and healthy life is needed to reduce these disparities and should focus on the populations and locations that are worst off. State of Washington and National Institute on Minority Health and Health Disparities.

Dwyer-Lindgren L ，Kendrick P ，Baumann MM ，Li Z ，Schmidt C ，Sylte DO ，Daoud F ，La Motte-Kerr W ，Aldridge RW ，Bisignano C ，Hay SI ，Mokdad AH ，Murray CJL ... -  《-》

Homicide Rates Across County, Race, Ethnicity, Age, and Sex in the US: A Global Burden of Disease Study.

GBD US Health Disparities Collaborators ，Strassle PD ，Kendrick P ，Baumann MM ，Kelly YO ，Li Z ，Schmidt C ，Sylte DO ，Compton K ，Bertolacci GJ ，La Motte-Kerr W ，Daoud F ，Naghavi M ，Rodriquez EJ ，Mensah GA ，Murray CJL ，Mokdad AH ，Dwyer-Lindgren L ，Pérez-Stable EJ ... -  《-》