Patterns of mortality disparities by race/ethnicity and area poverty level across places: The equity gap

The relationship between social and health inequity can be shown in a compelling and simple manner. Health departments monitoring disparities in populations by race/ethnicity and income often rely on geocoding death records and linking them to census tract income or poverty levels, since individual death records lack income data. We explain methods and report such analysis for the San Francisco Bay Area, California, Los Angeles, Philadelphia, Cleveland, Minneapolis, and Colorado. Places show consistent patterns—mortality for African Americans and Whites is higher for each level of neighborhood poverty than for Hispanics and Asians; mortality for African Americans and Whites shows stronger gradients by neighborhood poverty than for Hispanics and Asians; and the gap between mortality rates for African Americans and Whites compared to Hispanics and Asians increases with neighborhood poverty level. We also observed a gradient in mortality rate by neighborhood poverty level in Kaiser Permanente Northern California, which covers 30% of the Bay Area population. We discuss key implications of these results for population health epidemiology and public health practice. These include the importance of reporting distributions of population by ethnicity and neighborhood poverty to convey the population burden of mortality disparities by ethnicity and income, and the need to better understand how different factors might result in the observed disparities by ethnicity, neighborhood poverty, and specific combinations of ethnicity and neighborhood poverty.