Black Americans: The Facts

Introduction

Blacks constitute 12% of the population of the United States and are the single largest minority group in the country. The health status of Blacks has been studied and compared regularly to that of the white population. The Black population is young (over 35% are under 18), unmarried (61.5% are not married), urban (81%) and predominantly female (52.7%). About half of Black families are maintained by a married couple, and over half of Black children are raised in single-parent homes. In 1984, the median family income for Blacks was 56% of that for whites. The proportion of Black Americans below the poverty level was nearly three times that of white Americans in 1984.

The life expectancy for Black males in 1983 was seven years less than for white males; Black females’ life expectancy was five years less than that for white females. In 1984, the death rate from all causes was 1.5 times higher among Blacks than whites. Infant mortality rates in 1983 were twice as high among Blacks as whites and maternal mortality rates were over three times as high. The leading cause of death for Black males from 15 to 44 years is homicide. The lifetime risk of becoming a homicide victim is 1 in 21 for Black males.

Improvement in health status of Blacks is apparent in cerebrovascular disease as a 48% decline in the stroke death rate was noted between 1970 and 1983. During the same period the heart disease death rate for Blacks declined 18%. Cigarette smoking declined 29% among Black males from 1965 to 1983, but remained stable for Black females.

The discrepancy between the mortality rates of Black and white Americans remains a major cause of concern for all Americans. Preventive strategies need to be targeted specifically for this high risk population.

Demographic Data

The U.S. population of Blacks in 1983 was 28.1 million, with females accounting for 52.7% of the total. The white population in 1983 totaled 199.6 million, with 51.2% being female.

In 1983, Blacks accounted for 15.1% of the U.S. population under age 15, whereas Blacks made up 8.2% of the population above age 64.

Under age 15, males constitute 50.5% of the Black population, however, over age 64 males make up 40.1% of the Black population, according to 1983 data.

In 1985, 44% of Black families were maintained by women alone, compared to 13% of white families.

In 1983, about one-third of Black women who maintained families had never been married. More than half of Black children in 1983 lived in one-parent homes.

A 1982 study found that 47.9% of first marriages among Black women ages 15-44 years had been dissolved (divorce, separation or widowhood) compared to 30.1% among white women.

Socioeconomic Data

Education and Employment

In 1983, 57% of all Blacks over 25 years of age and 79% of Blacks 25-34 years of age had completed high school. Among whites in 1983, 87% of those 25-34 years of age had completed high school.

In 1980, 8.4% of Blacks were college graduates. In 1983, 1.1 million Blacks (605,000 females and 497,000 males) were enrolled in college, double the number in 1970. Blacks represented 10% of the college population ages 18-34 years in 1983.

The percent of Black Americans in 1984 below the poverty level (33.8%) was nearly three times that of white Americans (11.5%).

The median family income in 1984 for Blacks was $15,430 compared to $27,690 for whites. Among married-couple families, the median income for Blacks was $23,420 compared to $30,000 for whites. Among female headed households without a husband, however, the median family income for Blacks was $8,650 compared to $15,130 for whites.

In 1984, the unemployment rate among Blacks (15.9%) was nearly 2.5 times that of whites (6.5%). More than 40% of Black teenagers in 1984 were looking for work.

In 1980, Blacks comprised 4.9% of all administrators, managers and executives; 7.1% of professionals; 8.4% of technicians; 10.0% of clerical and administrative support personnel; 17.6% of service personnel and 40.9% of private household personnel.

The occupational distribution of the Black population in 1980 was as follows: 27.6% operators, fabricators and laborers; 24.4% technical, sales and administrative support; 22.9% service; 13.2% managerial and professional specialty; 8.9% precision production, craft and repair; 2.0% farming, fishing and forestry.

The percentage of Blacks in medical schools has decreased from a high of 6.3% in 1974-75 to 5.5% in 1983-84.

Health Care Utilization

20% of Blacks compared to 13% of whites report having no usual source of medical care.

18% of Blacks have no medical insurance compared to 9% of whites.

A physician’s office is reported as the usual source of care by 48% of Blacks and 70% of whites.

In 1980, more than 25% of all visits to physicians made by Blacks occurred in hospital clinics or emergency rooms compared to 11% by whites.

In a 1983 National Health Interview Survey (NHIS), 54.0% of whites reported visiting a dentist within the previous 12 months compared to 37.7% of Blacks.

The 1983, NHIS showed that 73.0% of Blacks and 74.4% of whites had visited a doctor within the previous 12 months.

Morbidity

General Health

In a 1983 National Health Interview Survey, 42.4% of whites listed their health as excellent compared to 28.3% of Blacks. Whereas 9.5% of whites rated their health as fair or poor, 19.5% of Blacks rated their health as fair or poor.

Cardiovascular and Cerebrovascular Diseases

Preliminary analysis of electrocardiographic (ECG) data from NHANES I and NHANES II indicates that the prevalence of myocardial infarction (MI) was similar in Black and white men ages 45-64 years. Among older men however, whites had a higher prevalence of MI-associated ECG changes than Blacks.

Two population studies in the 1960s found the prevalence of coronary heart disease to be more than twice as high among white males as in Black males while the rates among Black and white women were similar.

Among persons 35 years and older in Charleston, SC in 1960-61, the prevalence of coronary heart disease (per 1,000 subjects) was 75.8 for white males compared to 32.7 for Black males, and was 26.6 for both Black and white females.

In a 14 year follow-up study in Charleston, SC, the incidence of ischemic heart disease was higher among white males (188.4 cases per 1,000 population) than Black males (131.7), but was higher among Black females (161.0) than white females (113.8).

The National Health Interview Survey (HIS) of 1982 showed that the reported prevalence of heart disease among whites ages 45-64 years was 14.1% as compared to 12.4% among Blacks. For those 65 and older the reported prevalence of heart disease was 26.9% among whites and 16.2% among Blacks.

The reported prevalence of cerebrovascular disease among Blacks (6.6%) was higher than among whites (5.6%) in the 1982 HIS study.

Cancer

[Incidence rates for cancers from specific primary sites are listed with cancer mortality rates in the Mortality section of this chapter.]

Age-adjusted incidence rates for cancer from all sites in 1983 were highest among Black males (505.9 per 100,000 population) followed by white males (402.0) then white females (311.4) and Black females (303.6).

The three most common cancers among Black men are prostate cancer (126.9 cases per 100,000 population), lung and bronchus cancer (125.3 per 100,000) and colorectal cancer (58.7 per 100,000).

The three most common cancers among Black women are breast cancer (81.8 cases per 100,000 population), colorectal cancer (46.6 per 100,000) and lung and bronchus cancer (33.9 per 100,000).

Diabetes

According to 1979-81 National Health Interview Surveys (NHIS), the prevalence rate of diagnosed diabetes among Black males (25.4 per 1,000 population) was 16% higher than among white males (21.9) and the rate among Black females (38.2) was 50% higher than that of white females (25.6).

The 1982 HIS showed that among persons 65 years and older the prevalence of diabetes among Blacks (164.5 per 1,000 population) was twice that of whites (82.1 per 1,000).

Blacks in the U.S. appear to have a greater risk of diabetic complications than do whites. The incidence of diabetic end-stage renal disease among Blacks (40 per million population) was nearly three times the rate among whites (14 per million) in 1980.

Reproductive Health

The birth rate for women ages 15 to 17 was almost three times as high among Blacks (70.1 births per 1,000 women) as among whites (24.8 births per 1,000 women).

In 1983, 25% of births to Black women were to teenagers compared to 12% of white births.

In 1982, 39% of births to Black women in the five years preceding the interview were unwanted or mistimed compared to 28% for white women.

The percent of Black women ages 15-44 using any contraception at first intercourse was 33.6% in 1982 compared to 46.6% of white women.

In 1982, 58.9% of first births to Black women occurred prior to marriage compared to 11.4% for white women.

In 1983, the fertility rate among Black women (81.7 births per 1,000 women ages 15-44) was 31% higher than the rate among white women (62.4).

Infant Health

In 1983, 38.5% of Black mothers failed to receive any prenatal care in the first trimester compared to 20.6% of white mothers.

In 1983, the percent of Black infants born preterm (17.4%) was more than twice that of white infants (8.0%).

The percent of infants born of low birthweight (below 2500 grams) was more than twice as high among Blacks (12.4%) as whites (5.6%) in 1982.

About 40% of both Black and white preterm infants are of low birth-weight, yet 6% of Black births at term or later are of low birthweight compared to 2.6% of comparable white births.

In 1980-81, 12.1% of Black babies were breastfed for three months or more compared to 35.8% of white babies.

Mortality

Life Expectancy and Mortality Rates for Leading Causes of Death

In 1983, the life expectancy for Blacks was 65 years for men and 74 years for women compared to 72 and 79 years for white men and women respectively.

According to provisional figures for 1984, the age-adjusted death rates for all causes among Blacks and whites were as follows:

White 525.6 Black 773.7
Males 694.6 Males 1016.1
Females 391.4 Females 586.2

(Rates are deaths from all causes per 100,000 population.)

Between 1979 and 1981, an average of 227,000 Blacks died each year including 139,000 Blacks under age 70. About 59,000 (or 42.3%) of these deaths among Blacks under age 70 would not have occurred had Blacks experienced the same age-sex death rates as whites.

The leading cause of excess death among Black males under age 45 in 1979-81 was homicide. More than six times as many deaths from homicide occurred to Black males under age 45 than would have been expected from the rate observed in the white population.

The leading cause of excess deaths among Black males and females under age 70 in 1979-81 was cardiovascular disease (both heart disease and stroke). There were a total of 18,181 more than would have occurred had Blacks experienced the same death rates as whites.

The relative risk of death from all causes for Blacks under age 45 is nearly double that for comparable whites.

The conditions for which the relative risks of death are highest for Black (compared to white) males and females under age 45 are:

Males Females
Tuberculosis 17.4 15.6
Hypertension 10.2 13.4
Homicide 6.6 4.3
Anemias 6.0 5.2

Cancer

Age-adjusted mortality rates for cancer from all sites in 1983 were highest among Black males (300.5 deaths per 100,000 population) followed by white males (211.7), Black females (158.5) and white females (135.4).

The leading causes of cancer deaths among Black males in 1983 were lung and bronchus cancer (97.3 deaths per 100,000 population), prostate cancer (46.1 per 100,000) and colorectal cancer (25.8 per 100,000).

The leading causes of cancer deaths among Black females in 1983 were breast cancer (27.8 deaths per 100,000 population), lung and bronchus cancer (24.8 per 100,000) and colorectal cancer (202 per 100,000).

Diabetes

The provisional age-adjusted mortality rate for diabetes in 1984 for Blacks (19.7 deaths per 100,000) was more than double the rate for whites (8.9). The diabetes mortality rate among Black women (21.1) was 2.5 times the rate for white women (8.6), while the rate for Black men (17.7) was 1.9 times the rate for white men (9.2).

Accidental Death, Homicide and Suicide

In 1983, age-adjusted death rates from motor vehicle accidents were slightly lower among Black males (26.4 deaths per 100,000 population) and females (7.5) as compared to white males (27.8) and females (10.3).

The age-adjusted death rates in 1983 for accidents and adverse effects (including poisoning, drowning, burns, suffocation, electrocution and others), other than motor vehicle accidents, were about 40% higher among Black males (39.8 deaths per 100,000 population) and females (14.3) as compared to white males (24.0) and females (8.0).

Homicide is the leading cause of death for Black males ages 15 to 44 years.

In 1983, Blacks accounted for 43% of homicide victims, yet represented just 11.5% of the population.

The lifetime risk of becoming a homicide victim is 1 in 21 for Black males and 1 in 104 for Black females as compared to 1 in 131 for white males and 1 in 369 for white females.

In 1983, the death rate from homicide and legal intervention for Black males ages 25-34 years (102.0 per 100,000) was nearly seven times the rate for white males (14.9 per 100,000). The comparable rate for Black females (19.9 per 100,000) was nearly five times the rate for white females (4.1 per 100,000).

The age-adjusted death rate for all ages from homicide and legal intervention in 1983 was 53.8 (deaths per 100,000) for Black males, 11.2 for Black females, 8.4 for white males and 2.8 for white females.

In 1983, age-adjusted death rates from suicide among Black males (10.5 deaths per 100,000 population) and females (2.1) were about half the comparable rates among white males (19.3) and females (5.6).

Infant Mortality

Provisional 1984 data show that the Black infant (younger than 1 year old) mortality rate (20.3 deaths per 1,000 population) was more than twice the white infant mortality rate (9.1).

In 1983, the postneonatal (age 28 days to 1 year) mortality rate for Black infants increased from 6.6 (deaths per 1,000 live births) to 6.8, whereas the rate among white infants remained 3.3.

In 1983, the ratio of the infant mortality rate for Black infants to that for white infants for the leading causes of death were: disorders of short gestation and low birthweight (3.4); pneumonia and influenza (3.0); newborn affected by maternal complications of pregnancy (2.1); sudden infant death syndrome (2.1); accidents and adverse effects (2.0); intrauterine hypoxia and birth asphyxia (1.9); respiratory distress syndrome (1.7); perinatal infections (1.7); and complications of the placenta, cord and membranes (1.7). The smallest race ratio was for congenital anomalies (1.02).

Maternal Mortality

In 1983, the maternal mortality rate for Black women (18.3 deaths per 100,000 live births) was more than three times the rate for white women (5.9).

Risk Factor Prevalence

Obesity

A 1976-80 National Health and Nutrition Examination Survey (NHANES II) found that 49.5% of Black women ages 25-74 years were overweight compared to 27.5% of white women of the same age. In addition, 30.9% of Black men and 26.7% of white men were considered overweight. [Overweight was defined as body mass greater than or equal to 27.3 kilograms/meter2 which is the limit of the 85th percentile for persons 20-29 years.]

Smoking

Cigarette smoking is more prevalent among both Black males (42.6%) and Black females (32.5%) than white males (34.7%) and white females (29.8%). (Current smokers defined as a person who has smoked at least 100 cigarettes and who currently smokes, even occasionally.)

Smoking as much as 25 cigarettes or more per day is about three times more common among white smokers than among Black smokers. Whereas 36.3% of white male smokers and 21.7% of white female smokers smoked 25 cigarettes or more per day, 11.6% of Blacks male smokers and 5.3% of Black female smokers smoked that much.

Alcohol

Surveys of drinking patterns reveal few differences between Blacks and the general population. A 1979 national survey found that a higher proportion of Black males and females (30% and 49%, respectively) classified themselves as abstainers than did white males and females (25% and 39%, respectively).

Death from cirrhosis of the liver is 1.7 times more common among Blacks than whites. In 1983, the age-adjusted death rate for chronic liver disease and cirrhosis was 22.8 (deaths per 100,000) for Black males, 10.8 for Black females, 13.4 for white males, and 6.0 for white females.

Cholesterol

Elevated serum cholesterol levels were found more commonly among Black males (23.4%) than white males (20.1%), but were about equally prevalent among Black women (22.3%) and white women (23.4%). (Cholesterol levels were considered elevated if above 220 milligrams/deciliter (mg/dl) for ages 20-29; 240 mg/dl for ages 30-39; 260 mg/dl for ages 40 or above.)

High Blood Pressure

In the 1976-80 NHANES II study of adults 18-74 years of age, high blood pressure (higher than 140/90 mm Hg) was more common in Blacks (38.2%) than whites (28.8%). The difference was more noticeable between Black women (38.6%) and white women (25.3%) than between Black men (37.9%) and white men (32.6%).

In the HANES II study, the prevalence of moderate high blood pressure (diastolic pressure of 105-114 mm Hg) was twice as common among Blacks (3.1%) as whites (1.5%) ages 18-74 years. The prevalence of severe high blood pressure (diastolic pressure of 115 mm Hg or above) was nearly three times as common among Blacks (1.4%) as whites (0.5%).

Significant Trends

Socioeconomic Status

The proportion of Black families maintained by married couples has declined from 68% in 1970 to 53% in 1983.

From 1980 to 1984, the percent of Black persons below the poverty level increased 4% from 32.5% to 33.8%, and remained about three times the percent of whites below the poverty level (11.5%).

From 1980 to 1984, the median family income for Blacks decreased 3.4% from $15,980 to $15,430 while the median family income for whites increased 0.3% from $27,610 to $27,690.

From 1974 to 1984, the Black unemployment rate increased 51% from 10.5% to 15.9%, while the white unemployment rate increased 30% from 5.0% to 6.5%.

Cardiovascular and Cerebrovascular Diseases

From 1970 to 1983, age-adjusted death rates for diseases of the heart decreased 25.8% for white males, 18.0% for Black males, 24.5% for white females and 23.9% for Black females.

From 1970 to 1983, age-adjusted cerebrovascular disease death rates decreased 48% for both Blacks and whites.

Cancer

From 1974 to 1983, the incidence of cancer from all sites increased 18.4% for Black males and 3.9% for Black females compared to increases of 7.8% for white males and 0.7% for white females.

Among Black males from 1974 to 1983, the incidence of cancer of the oral cavity and pharynx increased by 42.2%, the largest increase for any cancer site.

Among Black females from 1974 to 1983, the cancers that showed the highest increases in incidence were non-Hodgkin’s lymphoma (89.9% increase) and lung and bronchus cancer (54.3% increase).

From 1974 to 1983, cancer mortality rates for all sites increased 14.1% for Black males and 8.1% for Black females compared to increases of 3.9% and 4.2% for white males and females.

Cancer of the lung and bronchus resulted in the largest increase in mortality among all Blacks from 1974 to 1983. A 64.4% increase in morality from cancer of the lung and bronchus among Black females and a 23.8% increase among Black males occurred from 1974 to 1983.

Diabetes

From 1963 to 1979-81, the prevalence of diabetes increased 175% in Blacks and 106% in whites.

Homicide

From 1980 through 1983, death rates from homicide and legal intervention declined more for Black males (25.2% decline) and Black females (18.2% decline) than for white males (22.9% decline) and white females (12.5% decline).

Infant Health

Infant mortality rates declined about 4.5% per year in the 1970s for both Blacks and whites. From 1980 to 1983, the average annual rate of decline in infant mortality has slowed to about 3.0% for whites and 2.6% for Blacks.

Risk Factors

From 1960-1962 to 1976-1980, the percent of Blacks who were overweight increased 14% from 35.9% to 41.1%. During that time period the percent of overweight whites increased 3% to 27.2%.

From 1965 to 1983, cigarette smoking declined 29% among Black males to 42.6% but remained unchanged among Black females at 32.5%.

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