Georgia blacks make strong gains in premature death rates; rural white females losing ground

As we’ve noted in various previous posts, Georgia’s premature death rate (known formally as Years of Potential Life Lost before age 75, or YPLL 75) has been improving fairly steadily over the 20 years that the state’s Department of Public Health (DPH) has been compiling pertinent data.[1]  Between 1994 and 2013, the state’s YPLL 75 rate improved from 9,195.6 to 7,104.7, a gain of 19.4 percent.  The national median, as reported the Robert W. Johnson Foundation in its latest County Health Rankings, was 7,681, so Georgia is doing a little better than the nation as a whole.

But, as we’ve noted in past posts, Georgia’s improvement has been far from even; we’ve focused in particular on regional differences and the dramatic gap in YPLL 75 performance between Metro Atlanta and the rest of the state.  Until now, however, we haven’t looked at racial or gender comparisons, and that produces a couple of interesting headlines.  One is that the vast majority of gains in premature death rates between 1994 and 2013 have been made in the black population.  The other is that rural white females are losing ground. 

In some respects, the stronger gains by blacks aren’t a huge surprise.  Black YPLL 75 rates in Georgia have historically been so bad – and so much worse than the white rates – that they arguably had nowhere to go but up.  Still, the contrast in change is striking.

Over the 20-year period, white YPLL 75 rates improved just 5.9 percent while the black rate improved 33.5 percent.  In the process, the gap in the premature death rate between blacks and whites was cut from 76.9 percent to 26.5 percent, as the chart below illustrates.

But that’s only part of the story.  While rural white males improved a very meager two percent in their YPLL 75 rates over the 20-year period, rural white females suffered a stunning 20 percent decline.

In some respects, this squares with national data that began to emerge several years ago.  In September 2012, The New York Times reported on the trend, focusing on a then newly-published study published in Health Affairs.

From the Times:  “The steepest declines were for white women without a high school diploma, who lost five years of life between 1990 and 2008, said S. Jay Olshansky, a public health professor at the University of Illinois at Chicago and the lead investigator on the study, published last month in Health Affairs. By 2008, life expectancy for black women without a high school diploma had surpassed that of white women of the same education level, the study found.” [2]

Rural black males and females in Georgia have yet to catch their white counterparts, but they are closing the gap.  YPLL 75 rates among rural blacks (male and female) have, again, historically been significantly worse than for their white rural counterparts – but the white rates have generally been mediocre at best.  Between 1994 and 2013, rural black females cut the premature death gap with rural white females nearly in half; while rural white females suffered a 20 percent drop in their YPLL 75 rates, rural black females posted an 8.4 percent improvement.

Rural black males have done even better versus their white counterparts.  As noted above, rural white males managed to improve a mere two percent over the 20-year period, but rural black males improved their numbers 31.5 percent.  In the process, they closed the gap with rural white males dramatically, as this chart shows:

Further, the decline in the white YPLL 75 rate hasn’t been confined to one area of the state.  Over the 20-year period, white YPLL 75 rates declined in 91 of the state’s 159 counties; black rates declined in only 31 counties.  The white decline also hasn’t been entirely rural.  Among the major urban counties that had worse YPLL 75 rates in 2013 than in 1994 were Chatham, Dougherty, Fayette, Floyd, Lowndes and Richmond.

This is obviously a bit of a good news/bad news story.  The deterioration in YPLL 75 rates among rural white females is as troubling as the gains among all blacks are encouraging.  The obvious question in all this is why?  What’s happening here to cause black premature death rates to improve pretty dramatically while white rates are static and decliining?

The Health Affairs study referenced in the Times report (above) ties the drop in life expectancy among whites to lower education levels – specifically, the lack of even a high school degree – and there’s no doubt something to that.  Here in Georgia, as we’ll report in a future post, the gap in educational attainment between urban and rural areas generally (and Metro Atlanta and the rest of the state specifically) has been widening for years.

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The table below shows the YPLL 75 rates for the demographic groups discussed in this post for 1994 and 2013, the change, and the percentage change.

YPLL 75 Rates for Select Demographic Groups: 1994 & 2013

 With YPLL 75 rates, the lower the number, the better.  Negative numbers in the Change and %Change columns indicate improvement.

(NOTE: As we were finalizing this post, Atlanta Journal-Constitution columnist Jay Bookman came out Wednesday, November 4, with a column based on a national study that arrived at similar findings and observations.)

[1] Unless otherwise indicated, all the data referred to in this post was pulled from the DPH’s OASIS database, which can be found at https://oasis.state.ga.us/.

[2] The Health Affairs study covered in The New York Times story was based on life expectancy calculations, while the premature death (YPLL 75) data compiled and made available through the Georgia Department of Public Health’s OASIS database provides hard historical data.  The two approaches measure the same thing – namely, how long people in a given population live – but they are different calculations.  We have been unable to find Georgia-specific (let alone county-specific) life expectancy data that matches the utility of the state’s YPLL 75 data.