Racial and Ethnic Differences in the Health of Older Americans (1997) / Chapter Skim
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2 Racial and Ethnic Differences in Mortality at Older Ages
2 Racial and Ethnic Differences in Mortality at Older Ages
Pages 10-42
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VITAL STATISTICS AND CENSUS DATA African Americans and Whites Mortality estimates for whites and African Americans based on vital statistics and census data have consistently shown black death rates to exceed white rates until some age above the mid-seventies; at that point, black death rates have historically "crossed over" white rates and have declined relative to white rates thereafter. In Table 2-1 and Figures 2-1 and 2-2, we show estimates of agespecific death rates by 5-year age groups above age 45 for African Americans and whites (as well as for Asian/Pacific Islanders and Hispanics)
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ELO AND SAMUEL H PRESTON 11 TABLE 2-1 Death Rates Based on Vital Statistics and Census Data: Whites, African Americans, Asian/Pacific Islanders, and Hispanics, 1989 Death Rates (per 1,000)
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SOURCES: Based on data from National Center for Health Statistics, 1993; Hollman, 1993; 1989 NCHS Mortality Detailed Data Tape. Black White Hispanic Asian/Pacific Islander ~
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The first study to reveal serious inconsistencies in age reporting in vital statistics and census data was the 1960 Matched Records Study, which linked death certificates registered in May to August 1960 to the 1960 Census of Population (NCHS, 1968; Kitagawa and Hauser, 1973~. In only 44.7 percent of nonwhite male and 36.9 percent of nonwhite female matched cases was the same age reported in the two sources.
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Another potential problem with the use of vital statistics and census data is inconsistency of the reporting of race on death certificates and on the census records. Available evidence suggests that this is not an important issue for African Americans or whites.3 The 1960 Matched Records Study found, for example, that 98.2 percent of African Americans (all ages combined)
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Similar differences in Hispanic and white death rates at ages 45 and above are revealed by the mortality estimates, also based on vital statistics and census data, incorporated into the Census Bureau's population projections (Day, 1993~. The difference between Hispanic and white rates increases as age advances, with the ratios of Hispanic to white rates declining from 1.02 at ages 45 to 49 to 0.71 at ages 80 to 84 for males and from 0.88 at ages 45 to 49 to 0.72 at ages 80 to 84 for females (Bureau of the Census, unpublished tabulations)
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The only study that we know of that provides direct evidence about age reporting patterns among Hispanics in the United States is a study by Kestenbaum (1992) that linked 1987 death certificates from Texas and
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This study shows that for Hispanics, age reporting in the two sources was more consistent than for African Americans but less consistent than for nonHispanic whites. At death certificate ages 65 and above, ages agreed for 88.4 percent of Hispanic, 72.6 percent of African-American, and 94.6 percent of nonHispanic white decedents.
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In 1989, for example, information on Hispanic origin was missing on about 3 percent of the death certificates at ages 45 and above.6 In contrast, when the Hispanic-origin field is not filled out on a census form, the Census Bureau uses various imputation procedures to assign a value to the missing data. The only other linked data set that permits an investigation of the comparability of classifications is the Kitagawa-Hauser (1973)
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The main difficulty in estimating accurate levels of mortality from vital statistics and census data for Asian Americans and Pacific Islanders stems from problems in comparability of race reporting in the two sources. Although most studies that have examined the bias resulting from the lack of agreement in the denominator and numerator data for Asian Americans have focused on estimates of infant mortality (e.g., Frost and Shy, 1980; Yu, 1984; Wang et al., 1992)
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. We know of no studies that have examined consistency of age reporting in vital statistics and census data for Asian Americans and Pacific Islanders.
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based on death data from Massachusetts and Texas found, for example, that only 72.6 percent of African Americans whose age at death on the death certificate was 65 and over had the same age reported in the two sources; for the 85 and older age group, the percentage was even lower, 63.2 percent. Consistent with findings from previous studies, age reporting among non-Hispanic whites was much more compatible; ages agreed for 94.6 percent and 91.7 percent of non-Hispanic white decedents aged 65 and above and 85 and above, respectively.
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The superiority of age reporting in Social Security is supported by results from a three-way matching study linking a sample of death certificates for African Americans aged 65 and older in 1985 to records for those same individuals in U.S. censuses of 1900-1920 and to Social Security records (Preston et al., 1996~.
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Deaths of African Americans and women were less likely to be located in the NDI than those of whites and men. The main explanation given for this finding was Social Security number discrepancies in the NDI and in the identifying information of the decedent used in the match.
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In Kestenbaum's (1992) study of death certificate linkage with the SSA's Master Beneficiary Record File, only 2.3 percent of death certificates of persons aged 65 and older were missing a Social Security number or had an invalid number recorded.
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ELO AND SAMUEL H PRESTON 25 TABLE 2-2 Coefficients of Equations Predicting the Log Odds of Dying in a 5-Year Period: Males Aged 45 to 89, 1979-1985, National Longitudinal Mortality Surveya Characteristic Model 1 Model la Model 2 Model 3b Age 0.0926 0.0927 0.0956 0.0826 (0.001)
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Asian/Pacific Islander -0.6754 Foreign born (0.219) Asian/Pacific Islander -0.4559 Birthplace unknown (0.356)
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. Table 2-4 and Figures 2-3 and 2-4 present the age-specific death rates by 5 TABLE 2-4 Predicted Death Rates: Whites, African Americans, Asian/ Pacific Islanders, and Hispanics, National Longitudinal Mortality Survey, 1979-1985 Death Rates (per 1,000)
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-1.5 -2.0 -2.5 (a ~ -3.0 s -3.5 If -4.0 o -4.5 -5.5 -- - Black White - Hispanic Asian/Pacific Islander -6.0 ~1 1 1 1 45-49 50-54 55-59 60-64 65-69 -~ 70-74 75-79 80-84 85-89 Age FIGURE 2-4 Death rates, white, African-American, Asian/Pacific Islander, and Hispanic males, ages 45 to 89, 1979-1985. SOURCE: Based on data from the National Longitudinal Mortality Survey.
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The coefficients for African Americans in Model 1 for both sexes in NLMS are large and highly significant. As age advances, however, the racial gap in white and black death rates begins to narrow as is indicated by the significant and negative interaction terms between age and being African American (Tables 2-2 and 2-3, Model 2~.
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The findings for the native-born Asian Americans and Pacific Islanders further imply that their mortality is also lower than that of non-Hispanic whites, although the small number of deaths makes the results unstable and reaches significance only for males. The results from the NLMS indicate that mortality estimates based on vital statistics and census data seem to exaggerate the relative mortality advantages of Asian/Pacific Islander males and females in comparison with white Americans.
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Even so, the NLMS results continue to suggest that Asian/Pacific Islanders in the United States have extremely low mortality in comparison with whites and African Americans. Suhnational Studies A number of studies have used data from small-scale, subnational data collection efforts, in addition to national data, to examine black-white mortality differentials at older ages.
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African-American death rates exceed white rates at younger ages, with the two rates slowly converging as age advances until, at the oldest ages, African-American death rates fall below those of whites. We have suggested that inconsistencies in age reporting in vital statistics and census data could account for this pattern when dual data sources are used for mortality estimates.
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ELO AND SAMUEL H PRESTON 33 To investigate the effect of age misstatement on African-American mortality at older ages, the authors have matched a sample of 5,262 death certificates of African Americans dying at ages 60 and above in 1985 or 1980 to records from U.S.
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(1996) study is the most painstaking attempt to establish corrected ages at death for older African Americans, and it is the only study that fails to reveal a crossover between white and black death rates.
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Asian/Pacific Cause of DeathWhitesBlacksIslandersHispanics Males All causes2,0303,0391,1581,484 Diseases of the heart726969373485 Cerebrovascular diseases991949984 Malignant neoplasms565870335352 Females All causes1,2231,776714892 Diseases of the heart376597205271 Cerebrovascular diseases841488163 Malignant neoplasms380457215238 SOURCE: Compiled from NCHS, 1994: Tables 32-35. The excess mortality of African Americans from heart disease and stroke also reflects differences in the distribution of other risk factors between blacks and whites.
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Cancer accounted for an additional 18 percent (Often et al., 1990:Table 2~. In an analysis of all-cause mortality, the above six risk factors accounted for 31 percent of the excess mortality of African Americans at ages 35 to 54 and all of the much smaller black excess at ages 55 to 77.
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Age reporting inconsistencies in vital statistics and census data and age misreporting in death statistics, both of which are more pronounced for African Americans than whites, seriously bias comparisons of age-specific death rates based on dual data sources and on extinct generation estimates. Differences in age reporting accuracy at the baseline interview in linked data files could also produce the observed mortality patterns.
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death records because some of these individuals may have died abroad. Inconsistencies in the reporting of race in vital statistics and census data also bias mortality estimates downward for both Hispanics and AsianlPacific Islanders.
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Hill, and T.P. Cheney 1996 Consistency of age reporting on death certificates and Social Security records among elderly African Americans.
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Stallard 1981 Methods for evaluating heterogeneity of aging processes in human populations using vital statistics data: Explaining the black/white mortality crossover by a model of mortality selection. Human Biology 53:47-67.
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Bradshaw 1988 The status of death certificates for Hispanic population of the Southwest. Social Science Quarterly 69:722-736.
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Rogot, and N.J. Johnson 1992 Validity of demographic characteristics on the death certificate.
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