Longevity gap lessens for blacks

Gains credited mainly to decline in homicides, better HIV treatment

March 20, 2007|By Dennis O'Brien | Dennis O'Brien,SUN REPORTER

Whites still live longer than blacks, but the gap is shrinking, mainly because death rates are dropping for causes that have historically hit African-American communities particularly hard, HIV and homicide, researchers announced yesterday.

Average life expectancy among blacks rose from 69.2 in 1993 to 72.7 in 2003, while for whites it rose from 76.3 to 78 years, according to a study of mortality statistics released yesterday by The Journal of the American Medical Association.

That reduced the difference to 5.3 years, a historic low that is almost two years less than the gap recorded 10 years earlier, researchers at McGill University in Montreal determined.

Black life expectancy rose in part because of a reduction in homicides and better therapies for those with HIV, said Sam Harper, a McGill epidemiologist who was the lead author. In addition, heart disease rates for black women dropped, he said.

Nevertheless, Harper said, heart disease appears to be the main reason for the continuing gap between blacks and whites.

Writing in the journal, the authors say that narrowing the gap further will require concerted efforts to address all of the problems with an emphasis on heart disease.

"This suggests the need to place a lot more emphasis on cardiovascular disease as the major determinant in this gap," Harper said in an interview.

Not everyone agrees with the conclusions.

"This doesn't let violence off the hook. Violence remains a major public health problem in Baltimore," said Dr. Joshua M. Sharfstein, Baltimore's commissioner of health. He said there has been "definite progress" in reducing the life expectancy gap but that it hasn't been nearly enough.

"I don't think the attitude should be that it's just heart disease," he said.

Health experts say the findings echo the conclusions reached in previous reports and are unlikely to lead to significant changes in health care policies.

Dr. Carlessia A. Hussein, director of the Office of Minority Health and Health Disparities at the Maryland Department of Health and Mental Hygiene, said blacks and whites in Maryland have been experiencing the same life expectancy trends. Between 2001 and 2005, life expectancy rose from 72.2 to 74.3 for blacks and from 78 to 79.1 for whites.

"I think what they found is pretty much what we have going on here as well," Hussein said.

"It doesn't surprise me. I'm glad to see it," said Dr. Myung H. Park, a cardiologist at University of Maryland Medical Center who is director of the pulmonary hypertension program. "I'd say since the 1990s, there is a definite improvement in terms of public awareness, patient awareness and physician awareness, in terms of heart disease."

Some are skeptical

Some experts were skeptical of any reported decline in heart disease rates among black women.

"In my view, [black] women are getting more diabetes, the obesity problem is more, and the metabolic syndrome that is a major cause of heart disease is rampant among black women," said Dr. Elijah Saunders, a cardiologist at the University of Maryland School of Medicine who has devoted his career to researching hypertension among African-Americans.

Last year, a Harvard study found that Baltimore, which has a predominantly African-American population and high rates of HIV and drug addiction, had one of the lowest average life expectancies in the nation. City residents could expect to live 68.6 years on average, according to the study, compared with 81.3 years in affluent Montgomery County.

In that study, researchers blamed low life expectancies in urban centers on chronic health problems such as cardiovascular and lung diseases, diabetes, HIV and the effects of smoking among those ages 15 to 59.

"We've simply done a good job at these two ends of life stages, the very young and the very old, the beginning and the end. But there are still problems in the middle," said Majid Ezzati, a co-author of the earlier study and an associate professor of international health at the Harvard School of Public Health.

Harper of McGill credited improved survival of those with HIV to the development and widespread use of antiretroviral therapy drugs.

Kathy Bennett, who is HIV-positive, was sent home by her physician expecting to die any day about five years ago. Because she also had hepitatis C, her liver was rejecting the medications being used at the time. "Basically, there was nothing left they could do," said Bennett, 48, who is African-American.

New HIV medications

A few days later, her doctor told her about a new series of medications, the antiretroviral therapy drugs, and they have been keeping her alive ever since. She is a treatment coach for HIV patients at the University of Maryland School of Medicine's Institute of Human Virology.

Many times, patients assigned to her want to quit taking the medications because side effects include fatigue, vomiting, nausea and joint pain. But those effects subside after a few weeks, she said.

"Basically, I just tell them what I went through, and I tell them, `Whatever you do, just don't stop taking it,'" she said.

Bennett doesn't know how she was infected. At one point after her diagnosis, she contemplated suicide. Not anymore.

"I think I'll live to see maybe another 48 years, or even more," she said.

dennis.obrien@baltsun.com

Sun reporters Jonathan Bor and Chris Emery contributed to this article.

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