Related Experiment Videos
Excess mortality in Harlem
1Department of Surgery, Columbia University, New York, NY.
Insights
Inner-city communities, particularly Harlem, face extremely high mortality rates, especially for those under 65. These elevated death rates from conditions like cardiovascular disease and homicide demand urgent attention and resources.
Area of Science:
- Public Health
- Epidemiology
- Urban Health Disparities
Background:
- National mortality rates mask significant disparities in inner-city communities.
- Central Harlem, a predominantly Black and impoverished area, experiences disproportionately high mortality.
Purpose of the Study:
- To examine mortality rates in New York City's Central Harlem health district.
- To identify causes and demographic patterns of excess mortality in this urban community.
Main Methods:
- Utilized 1980 census data and death certificates from 1979-1981.
- Calculated age-adjusted mortality rates and standardized mortality ratios (SMRs) compared to the white population.
- Conducted survival analysis to compare life expectancy.
Main Results:
- Harlem's all-cause mortality rate was the highest in NYC, exceeding U.S. white and Black averages.
- Excess mortality was concentrated in individuals under 65, with SMRs for males and females significantly elevated.
- Leading causes of excess deaths included cardiovascular disease, cirrhosis, homicide, and neoplasms.
- Black men in Harlem had a lower probability of reaching age 65 than men in Bangladesh.
- 54 NYC health areas had mortality rates at least double the expected, predominantly Black or Hispanic.
Conclusions:
- Central Harlem exhibits exceptionally high mortality rates, particularly among younger populations.
- These findings highlight severe health inequities in inner-city, predominantly Black communities.
- Urgent, targeted interventions are necessary for these high-mortality urban areas, akin to disaster relief.
Abstract:
In recent decades mortality rates have declined for both white and nonwhite Americans, but national averages obscure the extremely high mortality rates in many inner-city communities. Using data from the 1980 census and from death certificates in 1979, 1980, and 1981, we examined mortality rates in New York City's Central Harlem health district, where 96 percent of the inhabitants are black and 41 percent live below the poverty line. For Harlem, the age-adjusted rate of mortality from all causes was the highest in New York City, more than double that of U.S. whites and 50 percent higher than that of U.S. blacks. Almost all the excess mortality was among those less than 65 years old. With rates for the white population as the basis for comparison, the standardized (adjusted for age) mortality ratios (SMRs) for deaths under the age of 65 in Harlem were 2.91 for male residents and 2.70 for female residents. The highest ratios were for women 25 to 34 years old (SMR, 6.13) and men 35 to 44 years old (SMR, 5.98). The chief causes of this excess mortality were cardiovascular disease (23.5 percent of the excess deaths; SMR, 2.23), cirrhosis (17.9 percent; SMR, 10.5), homicide (14.9 percent; SMR, 14.2), and neoplasms (12.6 percent; SMR, 1.77). Survival analysis showed that black men in Harlem were less likely to reach the age of 65 than men in Bangladesh. Of the 353 health areas in New York, 54 (with a total population of 650,000) had mortality rates for persons under 65 years old that were at lest twice the expected rate. All but one of these areas of high mortality were predominantly black or Hispanic. We conclude that Harlem and probably other inner-city areas with largely black populations have extremely high mortality rates that justify special consideration analogous to that given to natural-disaster areas.