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

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Title: Race adjustment hides and perpetuates systemic racism: real-world example using life tables.
Authors: Ranapurwala SI; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States.; Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States., Coles SA; Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States.; Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States., Proescholdbell SK; Injury and Violence Prevention Branch, Division of Public Health, Department of Health and Human Services, Raleigh, NC 27609, United States., Geary S; Injury and Violence Prevention Branch, Division of Public Health, Department of Health and Human Services, Raleigh, NC 27609, United States., Pence BW; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States.; Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States.
Source: American journal of epidemiology [Am J Epidemiol] 2025 Aug 05; Vol. 194 (8), pp. 2194-2199.
Publication Type: Journal Article; Research Support, N.I.H., Extramural
Language: English
Journal Info: Publisher: Oxford University Press Country of Publication: United States NLM ID: 7910653 Publication Model: Print Cited Medium: Internet ISSN: 1476-6256 (Electronic) Linking ISSN: 00029262 NLM ISO Abbreviation: Am J Epidemiol Subsets: MEDLINE
Imprint Name(s): Publication: Cary, NC : Oxford University Press
Original Publication: Baltimore, School of Hygiene and Public Health of Johns Hopkins Univ.
MeSH Terms: Black or African American*/statistics & numerical data , Homicide*/statistics & numerical data , Homicide*/ethnology , Life Expectancy*/ethnology , Suicide*/statistics & numerical data , Suicide*/ethnology , Systemic Racism*/statistics & numerical data , White*/statistics & numerical data , Life Tables*, North Carolina/epidemiology ; White People/statistics & numerical data ; Adolescent ; Adult ; Aged ; Child ; Female ; Humans ; Male ; Middle Aged ; Young Adult
Abstract: 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.
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Grant Information: R01 CE003579 United States CE NCIPC CDC HHS; R01 MH124752 United States MH NIMH NIH HHS; R01CE003579 United States ACL ACL HHS
Contributed Indexing: Keywords: life expectancy; race adjustment; racism
Entry Date(s): Date Created: 20241119 Date Completed: 20250825 Latest Revision: 20260629
Update Code: 20260629
PubMed Central ID: PMC12624515
DOI: 10.1093/aje/kwae435
PMID: 39562149
Database: MEDLINE
Description
ISSN:1476-6256
DOI:10.1093/aje/kwae435