Transcript for Vital Signs African American Health

OPERATOR: Hello and thank you for standing by. At this time, all participants will be on a listen only mode until the question and answer session of today’s conference. At that time, if you would like to ask a question over the phone lines, please press star 1 on your phone and record your name at the prompt. This call is being recorded. If you have any objections, please disconnect at this time. I would now like to turn the call over to your host, Kathy Harben. Thank you and you may begin.

KATHY HARBEN: Thank you Victor and thank you all for joining us today for the release of an anew CDC Vital Signs. This one is on African American or black health. We will use the term blacks during this telebriefing. I need to let you know about a factual correction that just came to our attention. This is related to the crossover effect in people ages 65 and older. You’ll hear more about this correction from one of our speakers a bit later. And we’re working to get you the corrected language as quickly as possible. We’re joined today by Dr. Leandris Liburd. She is director of CDC’s Office of Minority Health and Health Equity. We’re also joined by Dr. Timothy Cunningham. He is a senior epidemiologist in CDC’s Division of Population Health. I’ll turn the call over now to Dr. Liburd.

LEANDRIS LIBURD: Good afternoon. Thank you to everyone for joining today’s call. CDC works 24/7 to protect the health, safety, and security of all Americans. One of the ways we do this is by identifying health threats and what can be done to address them. This Vital Signs report describes improvements in health among blacks over the past 17 years. It also discusses improvements in health disparities between blacks and whites. In areas where disparities still exist. Lastly, this report highlights health risk factors for blacks and opportunities to improve their health outcomes. We want to acknowledge that blacks are a diverse group. They come from different regions and countries of origin and have varied educational and professional achievements, wealth, and life experiences. We have some good news here today. Our analysis of data from the U.S. Census, the National Vital Statistics System and from CDC’s Behavioral Risk Factor Surveillance System, shows that death rates for blacks have declined substantially in the past 17 years. From 1999 to 2015, the overall death rate for blacks decreased by 25 percent. CDC sees this is as a move in the right direction. Although we recognize that there are still gaps in that achievement, we particularly are seeing declines in three leading causes of death among blacks: heart disease, cancer, and HIV. We will share some data about that in a minute. The disparity in deaths between black and white populations is closing. For these 17 years for all causes of death and all ages, the disparity in deaths went down by more than half. Even so, critical disparities remain. Young blacks who are in their 20s, 30s and 40s are living with or dying of diseases that are typically seen in people of older age, including chronic diseases. The risk factors for those diseases are often silent and are not often diagnosed or treated during these early years. There’s still a lot of work to do. Before we get into the details of our study, it’s important to reiterate that when you look at all causes of death combined, death rates for blacks are decreasing across all age groups. Most disparities between blacks and whites and leading causes of death are decreasing due largely to improvements in the health of the black population overall. However, we need to continue raising awareness among blacks from an early age to encourage healthy behaviors that will have lifelong impact. My colleague Dr. Cunningham will next talk about the analysis of the data and the findings.

TIMOTHY CUNNINGHAM: I want to make several main points. First, death rates among blacks from the key leading causes of death have decreased. For example, in 50 to 64-year-olds, deaths from heart disease decreased by 32 percent and cancer deaths by 27 percent. Death rates from HIV among blacks went down about 80 percent in 18 to 49-year-olds. These declines are coming during their peak years of productivity. Second, some death rates are declining faster among blacks than whites leading to smaller disparities. For example, in 1999, the overall disparity in deaths between blacks and whites in death rates was 33 percent. In 2015, it had dropped to 16 percent for all causes of death for all ages. Third, while death rates are highest in blacks 65 and older, these deaths decrease substantially between 1999 and 2015. For heart disease, which is the leading cause of death, deaths in blacks 65 years and older have declined by 43 percent and deaths in whites 65 years and older have declined by 38 percent. For cancer, the second highest cause of death, deaths in blacks have decreased by nearly 29 percent and deaths in whites have decreased by 20 percent. We saw a crossover effect in people 65 years and older starting in 2011. I want to clarify again, this is age specific data and not age adjusted. That is to say that in 1999, blacks had a 10 percent higher death rate from all causes than whites and in 2015, blacks had a lower death rate of 3 percent than whites. My fourth point concerns HIV. Blacks have had a two third reduction in death rates from this disease in the past 17 years. Whites have also seen a similar drop in rates, but blacks between 18 to 49 years old are still 7 to 9 times as likely to die from HIV as whites of the same age. My fifth point concerns deaths from homicide. This is a topic of active discussion and great concern for many Americans. My purpose here is to describe to you what happened with homicide death rates between 1999 and 2015. Homicide is the seventh highest cause of death among blacks and has not decreased to any major extent during these 17 years and in any age-group other than blacks 65 years and older. In fact, during these 17 years, in any age-group other than 65 years and older, it’s gone up. In blacks 18 to 34 years old, it remains the number one cause of death and blacks 35 to 49 years old, it is the number three cause of death after heart disease and cancer. Across all age groups, homicide among blacks has 2 1/2 times the death rate as HIV and 3 1/2 times the death rate as suicide. Finally, of great concern is that blacks in their 20s, 30s, and 40s are dying of diseases such as heart disease and diabetes. Which are typically seen in whites at older ages. This phenomenon has been described as weathering, meaning that the black population may be exposed to socioeconomic influences such as poverty and other environmental factors that can result in illness and death and earlier age than whites. We can take several steps to change this. I’ll now turn this back to Dr. Liburd to talk about what we can do.

LEANDRIS LIBURD: Thank you, Dr. Cunningham. This Vital Signs report on black health highlights gains and ongoing challenges in our work to achieve health equity. The data also supports there has been considerable success using targeted actions to reduce largely preventable health disparities. We know there is more work to be done to continue work and in communities at highest risk, to improve the health of all and create opportunities for all Americans to attain their best health possible. There are proven action that’s many groups can take. For example, public health professionals can work across all sectors such as the faith and community organizations, education, business, transportation, and housing sectors, to create social and economic conditions that promote health starting in childhood. And then also link people to doctors, nurses, or community health centers to encourage regular and follow up medical visits. Community organizations can train community health workers in underserved communities to educate and link people to free or low-cost services. Transportation and housing, all of which we know impacts health. Health care providers can work with communities and health care professional organizations to eliminate cultural barriers to care and address social and economic conditions that may put some patients at higher risk than others for having a health problem. Today’s Vital Signs shows that progress has been made in narrowing the gap in deaths among blacks and whites over the past 17 years. We’ve seen striking decreases in deaths among blacks overall, including from heart disease, cancer, and HIV. To continue to reduce the disparities, we must collaborate with organizations across all sectors, promote healthy behavior starting in early ages, and together we must create opportunities and the environment to make it easy for people to make decisions that protect their health. The bottom line is we are cautiously optimistic. However, stark disparities persist. This analysis shows that our investments and prevention efforts over the past 17 years are starting to pay off and we must maintain our momentum until all health gaps are closed. This vVital Signs is a renewed call to action in addressing health disparities and promoting health as early in life and effectively as possible, so that all Americans have equal opportunities to obtain the best health possible. Thank you.

KATHY HARBEN: Thank you, Dr.s Liburd and Cunningham. Victor, I believe we’re now ready for questions.

OPERATOR: Absolutely. We will now begin a question and answer session. To ask a question over the phone lines, please press star 1. Make sure your phone is unmuted and record your name at the prompt. To withdraw your questions, press star 2. One moment, please, for incoming questions. Our first question comes from Joel Achenbach from the Washington Post. Your line is now open.

JOEL ACHENBACH/WASHINGTON POST: Yes, thank you. It’s Joel Achenbach with the Post. Thank you for holding this teleconference. On the trend, the 17-year trend, were most of the gains, the improvements seen earlier in that period rather than later? Just looking at your graphs, it looks to me like the narrowing of the gap, for example, was more dramatic earlier in the period and that in recent years there’s more of a flattening out of that trend. Can you address that?

TIMOTHY CUNNINGHAM: Yes. The gap, what we see is the gap starting after 2011 there is a crossover whereby we’re experiencing lower, mortality in that age five and older population.

JOEL ACHENBACH/WASHINGTON POST: Okay. Let me clarify my question. Looking at — I’ll call up the report. I guess I’m wondering is this trend consistent across 17 years? Or — since roughly 2008 and 2009 and 2010 has there been a change in the trend? In other words, if you started the whole thing just starting at 2008, would you see the same kind of dramatic closing of the gap?

TIMOTHY CUNNINGHAM: No. The trend is not linear.

JOEL ACHENBACH/WASHINGTON POST: Okay. Can you expand on that? The reason I ask – just eyeballing it, it looks like the gap was more dramatically closed in the earlier part of the period.

TIMOTHY CUNNINGHAM: There are a number of factors that can explain the narrowing of the gap. We didn’t exactly look at what is driving the gap. But what we do know from other studies that have documented changes in mortality and changes in life expectancy over time, is that they are often associated with improvements in health care access. Such as screening for chronic diseases, regular follow up visits and taking medication regularly. But what we do see is that the major diseases that account for the majority of the decline are leading causes of death, such as heart disease.

JOEL ACHENBACH/WASHINGTON POST: Thank you.

OPERATOR: Our next question comes from Mike Stobbe with The Associated Press. Your line is open.

MIKE STOBBE/ASSOCIATED PRESS: Thank you. Hi. Thank you for taking my call. At the outset of the call it was discussed that there was a correction. Could you be moreclear about what the correction is?

TIMOTHY CUNNINGHAM: Yes. There will be wording changes and we’ll be able to get that to you. But to be specific, the crossover happens after 2010 rather than in 2010. This is in regards to the age-specific data for adults who are 65 years and older. We need to correct the text that says age adjusted and it should say age specific.

MIKE STOBBE/ASSOCIATED PRESS: So you’re offering crude rates not age adjusted rates. Is that correct?

TIMOTHY CUNNINGHAM: They’re age-specific rates that are presented in figure one and in table one there are age-adjusted rates and also age-specific rates.

MIKE STOBBE/ASSOCIATED PRESS: I’m sorry. I’m not clear on your response. So are these age-adjusted — the crossover that you’re describing for people 65 and older, is that based on age-adjusted or a reflection mainly of the proportion of whites who are in the 65 and older population, so we would expect to see higher white death rates in that population?

TIMOTHY CUNNINGHAM: So the crossover effect has been documented for several decades. We don’t necessarily know the exact age point at which it occurs from the way that we perform this analysis. But from the age-specific data for those who are 65 years and older, we see the crossover in the mortality rate starting after 2010. We will be more than happy to follow up with you directly with any questions that you have regarding age-specific and age adjustment.

KATHY HARBEN: Thanks. Next question, please.

OPERATOR: Once again if, you’d like to ask a question over the phone lines, please press star 1 on your phone and record your name at the prompt. Our next question comes from Maggie Fox with NBC News. Your line is open.

MAGGIE FOX/NBC NEWS: Thanks. I’m still not understanding the answers to Joel’s question about how linear the improvements are. I think what he was asking was it looks like it’s front loaded. It looks like a lot of the improvements came early in the century and the improvements have been slower ever since. Is that what you have found?

TIMOTHY CUNNINGHAM: So let’s take heart disease for an example. Deaths in African-Americans ages 65 and older, in 1999, we see that 1,900 deaths occurred per 100,000 population. But in 2015, we see that has reduced significantly by 43 percent. This is specific to heart disease for those ages 65 years and older. The declines vary according to the different leading causes of death that we considered. But we would be more than happy to follow up with you on that as well.

MAGGIE FOX/NBC NEWS: And so, in other words, is it correct to say that some of them occurred earlier, some of them occurred later, it’s a mixed bag? But it’s not like there’s been a sudden improvement since 2010 or something like that?

TIMOTHY CUNNINGHAM: Right —

MAGGIE FOX/NBC NEWS: Okay. That’s all. No need to expand. My second question is can we talk in a conversational way because I think we all want quotes for our stories as opposed to information. Some of the things that might help people better access health care and take better care of their health.

LEANDRIS LIBURD: So we talked about things that professionals can do and what other parts of the community can engage in. But, specifically what you know, people can do to protect their own health is certainly increase their consumption of healthy foods, engage in regular physical activity and they can stop smoking. They can access health care, keep appointments and keep follow-up appointments. Also they can work within their communities across sectors to create an environment that is health promoting and one that is protective of health. So those are the —

MAGGIE FOX/NBC NEWS: I’m really sorry. [ inaudible ] I’m sorry. This is suggesting that it’s all in people’s own hands. I think that the data has shown that it’s more than just telling people what they should be doing, right? So, what can doctors do? What can communities leaders do? What can people do to take care of each other, other than just throw us in you need to engage in more exercise and eat healthier foods?

TIMOTHY CUNNINGHAM: Yes, individual behaviors are important. But one challenge we face is that we have to invest in the places where people live to make healthier choices the easy choice. One thing we know is that places is a predictor of personal health. Where we live determines our health. Where we live determines the quality of housing. It determines the schools we attend. It determines our employment opportunities. It determines our health care that we have access to. So, yes, individual behaviors are important but so is intervening on the places where people live.

KATHY HARBEN: Next question, please.

OPERATOR: At this time there are no other questions.

KATHY HARBEN: Okay. Hearing no other questions, thank you, Drs. Liburd and Cunningham for joining us today. For follow up questions, please call our media line at 404-639-3286 or e-mail us at media@cdc.gov. Thank you for joining us. This concludes our call.

OPERATOR: Thank you now for your participation in today’s conference. You may now disconnect.

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES