Race adjustment hides and perpetuates systemic racism: real-world example using life tables

Extant research shows that race adjustment in epidemiologic analyses could lead to masking of systemic racism. In this study, we compare race-adjusted and -unadjusted years of life lost (YLL), a measure of societal burden, to understand the impact of race adjustment in YLL estimation. We used North Carolina (NC) Violent Death Reporting System data from 2006-2019 linked to 2006-2019 race-adjusted and -unadjusted life tables from the Centers for Disease Control and Prevention by calendar year and age at death. We calculated total YLL and YLL per death from suicide and homicide deaths for non-Hispanic Black and non-Hispanic White NC residents using both the race-adjusted and -unadjusted life tables. We found that YLL and YLL/death from suicide and homicide deaths for non-Hispanic White individuals were almost identical regardless of race adjustment. However, race-adjusted life tables vastly underestimated total YLL and YLL per death for non-Hispanic Black NC residents. Overall, race adjustment resulted in an underestimation of 14 907 YLL from homicide deaths (3.1 fewer YLL/death) and 4414 YLL from suicide deaths (2.8 YLL/death) for Black NC residents. Our study shows that the baked-in underestimation of YLL for non-Hispanic Black Americans when using race-adjusted life tables hides racialized health disparity and perpetuates inequity. This article is part of a Special Collection on Methods in Social Epidemiology.