Health Disparities
Race adjustment hides systemic racism: Real world example using lifetables Shabbar I Ranapurwala* Shabbar Ranapurwala Serita Coles Scott K. Proescholdbell Shana Geary Brian W. Pence
One of the best methods to calculate the societal burden of a public health problem is to examine the lost societal potential due to the problem, usually conceptualized as the years of potential life lost (YPLL). However, many studies use race-specific lifetables to calculate YPLL to adjust for varying life expectancies in racialized groups. We examined the implications of this race adjustment on YPLL due to suicide and homicide deaths among black and white residents of North Carolina (NC), where suicide and homicide death rates are similar to the US average. We used data from the North Carolina Violent Death Reporting System (NC-VDRS) from 2006-2019 to identify suicide and homicide deaths and used race-adjusted and -unadjusted life tables from the Centers for Disease Control and Prevention from 2006-2019 to calculate YPLL. From 2006-2019, there were 17,385 suicide deaths and 7,668 homicide deaths among black and white NC residents. Using race-unadjusted life tables, the YPLL from suicide deaths was 532,347.5 years (33.7 YPLL/death) for white NC residents and 68,293.4 years (43.1 YPLL/death) for black NC residents. However, when using race-adjusted life tables the total YPLL declined to 63,879.4 (40.3 YPLL/death) among black NC residents but remained almost identical for white NC residents at 532,383.1 (33.7 YPLL/death). With race adjustment, the YPLL/suicide death difference comparing black and white NC residents was 6.6 years (95% CI: 5.9, 7.4) relative to 9.9 years (8.7, 10.2) without race adjustment, with an overall underestimate of 4,414 YPLL for black NC residents. Similarly, the race adjusted YPLL/homicide death difference was 6.4 years (5.8, 7.1) relative to 9.5 years (8.8, 10.2) without race adjustment, an underestimate of 14,907 YPLL from homicides among black NC residents. The race-adjusted YPLL example shows how race adjustment masks and perpetuates systemic racism by hiding the magnitude of the problem and impacting resource allocation.
