Increased Black-White disparities in mortality after the introduction of lifesaving innovations: a possible consequence of US federal laws

Am J Public Health. 2010 Nov;100(11):2176-84. doi: 10.2105/AJPH.2009.170795. Epub 2010 Sep 23.


Objectives: We explored whether the introduction of 3 lifesaving innovations introduced between 1989 and 1996 increased, decreased, or had no effect on disparities in Black-White mortality in the United States through 2006.

Methods: Centers for Disease Control and Prevention data were used to assess disease-, age-, gender-, and race-specific changes in mortality after the introduction of highly active anti-retroviral therapy (HAART) for treatment of HIV, surfactants for neonatal respiratory distress syndrome, and Medicare reimbursement of mammography screening for breast cancer.

Results: Disparities in Black-White mortality from HIV significantly increased after the introduction of HAART, surfactant therapy, and reimbursement for screening mammography. Between 1989 and 2006, these circumstances may have accounted for an estimated 22,441 potentially avoidable deaths among Blacks.

Conclusions: These descriptive data contribute to the formulation of the hypothesis that federal laws promote increased disparities in Black-White mortality by inadvertently favoring Whites with respect to access to lifesaving innovations. Failure of legislation to address known social factors is a plausible explanation, at least in part, for the observed findings. Further research is necessary to test this hypothesis, including analytic epidemiological studies designed a priori to do so.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Aged
  • Antiretroviral Therapy, Highly Active / mortality
  • Antiretroviral Therapy, Highly Active / statistics & numerical data
  • Black People / statistics & numerical data*
  • Breast Neoplasms / mortality
  • Breast Neoplasms / prevention & control
  • Female
  • HIV Infections / drug therapy
  • HIV Infections / mortality
  • Health Services Accessibility / legislation & jurisprudence*
  • Health Services Accessibility / statistics & numerical data
  • Health Status Disparities*
  • Humans
  • Infant, Newborn
  • Male
  • Mammography / economics
  • Mammography / statistics & numerical data
  • Medicare / statistics & numerical data
  • Middle Aged
  • Mortality*
  • Pulmonary Surfactants / therapeutic use
  • Respiratory Distress Syndrome, Newborn / drug therapy
  • Respiratory Distress Syndrome, Newborn / mortality
  • Sex Factors
  • United States / epidemiology
  • White People / statistics & numerical data*
  • Young Adult


  • Pulmonary Surfactants