July 28, 2025
Research Professor Robert Kaestner

A new working paper coauthored by Harris Research Professor Robert Kaestner examines the persistent and complex problem of the reality that black people die at a higher rate across their lifespans than whites. The paper, “Racial Disparities in Mortality by Sex, Age, and Cause of Death,” recently published by National Bureau of Economic Research, uses the latest evidence to paint a portrait of how and why these racial disparities in mortality endure – and why, despite progress, equality has not yet been reached.

“Rather than relying on broad assumptions or uniform models of the effects of racism, we track racial disparities in mortality from ages 40 to 80 by sex and cause of death, providing a detailed portrait of where disparities are greatest, what drives them, and how they evolve with age,” Kaestner said.

Although racial disparities in mortality persist, the death rate of Black adults (age 45 and over) have decreased significantly over the last 40 years. In fact, the decrease in the death rate of Black adults was larger than the analogous decrease for white adults. There were 715 more white men than Black men alive per 100,000 people over age 45 in the year 1980, the study reports. By 2022, that gap had narrowed to 562. However, because Black people started at a substantially higher rate of death compared to white people, the racial gap remains.

“The relatively larger improvement in death rates for Black Americans suggests that society-wide changes have reduced deaths in the Black community as much, or more, than for whites,” Kaestner added. “Black Americans have seen real progress, often faster than that of white Americans.”

“While racism is widely understood to be a fundamental cause of these disparities, the precise ways in which racism operates – its pathways through stress, economic disadvantage, or reduced access to care – are still not fully understood or well-supported by empirical evidence,” Kaestner explained. “Instead of starting with assumptions about racism’s effects, we build a set of age- and cause-specific concerns about mortality differences that any credible theory looking at racial health disparities must address.”

The main objective of the article was to assess how racial disparities in death rates evolve as people age to answer questions such as whether racial disparities grow as people age or whether racial disparities are the result of unequal rates of death for specific diseases. Results indicate that racial disparities grow at each age but at a decreasing rate. This suggests that, if racism is a cause of racial disparities, its influence is present at all ages, but its effect decreases with age. It is also the case that the major cause of racial disparities in mortality is because of racial disparities in diseases for which there are available and effective treatment such as cardiovascular disease. These are illnesses that can be effectively prevented or treated with timely and high-quality medical care. Interestingly, racial disparities in cancer deaths are small and generally not significant despite the fact that cancer accounts for approximately one-third of all deaths among adults. over death

The pattern of results that the authors found suggests that “…investment in health – both health behavior and quantity and effectiveness of treatment –  continues to fall short for the Black people in America compared to white people,” Kaestner explained. “The cause of those shortfalls in health investments is unknown with certainty but is likely caused by in large part by disparities in economic resources between blacks and whites.”

“The results show that what we should be doing is intervening between the time someone gets treatment and the outcome to make the treatment more effective,” Kaestner added. “The disparity seems to be occurring mostly between the time of treatment and the outcome. For the Black population in America, that key area is where we need to turn most of our attention.”

This points to a key takeaway. Rather than theories which suggest racism’s impact on health accumulates steadily over time, the results instead point to racism acting as a limiting – but not prohibitive – force. When the researchers adjust for differences in economic resources and baseline health, they find that these factors explain nearly all the observed disparities in mortality.

The paper discusses interventions like the successful barbershop hypertension initiative (where barbers were trained in explaining the ills of, and treatments for, hypertension) and Delaware’s colon cancer screening program as promising models.

The findings underline the complexity of the mortality-gap challenge and the need for a new generation of policy research that engages with racial inequality in health outcomes in specific, data-driven ways.