Only 14 of 30 cities (46.7%) experienced improvements in overall mortality rates during the past decade. The racial inequities in rates for the US decreased between 20 (annual average percentage change, −0.51% 95% CI, −0.92% to −0.09% P =0.02). The US rate remained constant during the study period (average annual percentage change, −0.10% 95% CI, −0.34% to 0.14% P = .42). At the city level, this ranged from 6 excess Black deaths in El Paso to 3804 excess Black deaths every year in Chicago. The all-cause mortality rate among Black populations was 24% higher than among White populations nationally (rate ratio, 1.236 95% CI, 1.233 to 1.238), resulting in 74 402 excess Black deaths annually. In 2016 to 2018, all-cause mortality rates ranged from 537 per 100 000 population in San Francisco to 1342 per 100 000 in Las Vegas compared with the overall US rate of 759 per 100 000. Results The study included 26 295 827 death records. Main Outcomes and Measures Total population and race-specific age-standardized mortality rates using 3-year averages, mortality rate ratios between Black and White populations, excess Black deaths, and annual average percentage change in mortality rates and rate ratios. Data analysis was conducted from February to November 2020. Data were analyzed for the United States and the 30 most populous US cities. Changes from January 2009 to December 2018 were examined with joinpoint regression. Objectives To provide city-level data on all-cause mortality rates and racial inequities within cities and to determine whether these measures changed during the past decade.ĭesign, Setting, and Participants This cross-sectional study used mortality data from the National Vital Statistics System and American Community Survey population estimates to calculate city-level mortality rates for the non-Hispanic Black (Black) population, non-Hispanic White (White) population, and total population from January 2016 to December 2018. However, few or no all-cause mortality data are available at the local level to motivate and guide city-level actions for health equity within the country’s biggest cities. Importance To address elevated mortality rates and historically entrenched racial inequities in mortality rates, the United States needs targeted efforts at all levels of government. Shared Decision Making and Communication.
Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography.
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