Certain death? Black-White death dispersions

New research report, after rumination.

Knowing the exact moment of death is a common fantasy. How would it change your life? Here’s a concrete example: when I got a usually-incurable form of cancer, and the oncologist told me the median survival for my condition was 10 to 20 years, I treated myself to the notion that at least I wasn’t going to the dentist anymore (6 years later, with no detectable cancer, I’m almost ready to give up another precious hour to dentistry).

I assume most people don’t want to die at a young age, but is that because it makes life shorter or because it makes them think about death sooner? When a child discovers a fear of death, isn’t it tempting to say, “don’t worry: you’re not going to die for a long, long time”? The reasonable certainty of long life changes a lot about how we think and interact (one of the many reasons you can’t understand modernity without knowing some basic demography). I wrote in that cancer post, “Nothing aggravates the modern identity like incalculable risk.” I don’t know that’s literally true, but I’m sure there’s some connection between incalculability and aggravation.

Consider people who have to decide whether to get tested for the genetic mutation that causes Huntington’s disease. It’s incurable and strikes in what should be “mid”-life. Among people with a family history of Huntington’s disease, Amy Harmon reported in the New York Times, the younger generation increasingly wants to know:

More informed about the genetics of the disease than any previous generation, they are convinced that they would rather know how many healthy years they have left than wake up one day to find the illness upon them.

The subject of Harmon’s story set to calculating (among other things) whether she’d finish paying off her student loans before her first symptoms appeared.

The personal is demographic

So what is the difference between two populations, one of which has a greater variance in age at death than the other? (In practice, greater variance usually means more early deaths, and the risk of a super long life probably isn’t as disturbing as fear of early death.) Researchers call the prevalence of early death — as distinct from a lower average age at death — “life disparity,” and it probably has a corrosive effect on social life:

Reducing early-life disparities helps people plan their less-uncertain lifetimes. A higher likelihood of surviving to old age makes savings more worthwhile, raises the value of individual and public investments in education and training, and increases the prevalence of long-term relationships. Hence, healthy longevity is a prime driver of a country’s wealth and well-being. While some degree of income inequality might create incentives to work harder, premature deaths bring little benefit and impose major costs. (source)

That’s why reducing life disparity may be as important socially as increasing life expectancy (the two are highly, but not perfectly, correlated).

New research

Consider a new paper in Demography by Glenn Firebaugh and colleagues, “Why Lifespans Are More Variable Among Blacks Than Among Whites in the United States.”

I previously reported on the greater life disparity and lower life expectancy among Blacks than among Whites. Here is Firebaugh et al’s representation of the pattern (the distribution of 100,000 deaths for each group):

bwdeaths

Black deaths are earlier, on average, but also more dispersed. The innovation of the paper is that they decompose the difference in dispersion according to the causes of death and the timing of death for each cause. The difference in death timing results from some combination of three patterns. Here’s their figure explaining that (to which I added colors and descriptions, as practice for teaching myself to use an illustration program — click to enlarge):

bw death disparities

The overall difference in death timing can result from the same causes of death, with different variance in timing for each around the same mean (spread); different causes of death, but with the same age pattern of death for each cause (allocation); and the same causes of death, but different average age at death for each (timing). Above I said greater variability in life expectancy usually means more early deaths, but with specific causes that’s not necessarily the case. For example, one group might have most of its accidental deaths at young ages, while another has them more spread over the life course.

Overall, the spread effect matters most. They conclude that even if Blacks and Whites died from the same causes, 87% of the difference in death timing would persist because of the greater variance in age at death for every major cause. There are differences in causes, but those mostly offset. Especially dramatic are greater variance in the timing of heart disease (especially for women), cancer, and asthma (presumably more early deaths), The offsetting causes are higher Black rates of homicide (for men) and HIV/AIDS deaths, versus high rates of suicide and accidental deaths among White men (especially drug overdoses).

The higher variance in causes of death seems consistent with problems of disease prevention and disparities in treatment access and quality. (I’m not expert on this stuff, so please don’t take it exclusively from me — read the paywalled paper or check with the authors if you want to pursue this.)

Are these differences in death timing enough to create differences in social life and outlook, or health-related behavior, between these two groups? I don’t know, but it’s worth considering.

1 Comment

Filed under Research reports

One response to “Certain death? Black-White death dispersions

  1. It’s complicated this planning for life and death and everything in between.
    Marcy Westerling
    http://livinglydying.com/

    Like

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