Life Expectancy Gap Due to Smoking, HIV, Diabetes

Blacks and the less educated in the United States have life expectancies about 6 years shorter than their white and better-educated counterparts, respectively. This week, a new report suggests that smoking-related diseases are largely to blame for cutting the life expectancy of people with lower levels of education. And high blood pressure, HIV, diabetes and homicide appear to be the greatest contributors to the discrepancy in death rates among blacks versus whites, according to a team of California researchers.

Dr. Mitchell D. Wong and his colleagues of the University of California-Los Angeles analyzed 1986-1994 data from the National Health Interview Survey and estimated death rates from various diseases, based on a life expectancy of 75 years. Overall, people without a high school education were at risk of dying an average nine years earlier than high school graduates, while blacks were at risk of dying almost two years earlier than their white counterparts. The investigators reported their findings in the article "Contribution of Major Diseases to Disparities in Mortality" in this week's issue of the New England Journal of Medicine (2002;347:1585-1592).

The diseases that most accounted for the educational disparity in death rates were heart disease, lung cancer, stroke, congestive heart failure, pneumonia and lung disease -- all smoking-related diseases. The discrepancy in death rates among blacks, in comparison to whites, was largely due to deaths from blood pressure (hypertension) -- which accounted for 15 percent of the disparity -- followed by deaths from HIV, diabetes and homicide.

The study did not investigate whether health insurance, access to care or related factors might explain the disparities in death rates, but the fact that smoking-related diseases accounted for the top six contributors to the educational disparity in life expectancy suggests "that interventions to prevent smoking could have an enormous impact," the authors wrote. While previous studies on racial health disparities have focused on heart attacks and cancer, the present findings "suggest that we need to pay more attention to hypertension, HIV and diabetes, as well as homicide," Wong said.

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