Excess Mortality and Years of Potential Life Lost Among Black People in the US from 1999 to 2020

Importance Amid efforts in the United States to promote health equity, there is a need to assess progress in reducing excess deaths and years of potential life lost (YPLL) among Black people compared with White people. Objective To evaluate trends in excess mortality and YPLL among Black people compared with White people. Design Serial cross-sectional. Setting National data from the Centers for Disease Control and Prevention, 1999-2020 Participants Non-Hispanic White and non-Hispanic Black people Exposures Race as documented in the death certificates. Main outcomes and measures Excess age-adjusted all-cause and disease-specific mortality rate (per 100,000 individuals) and YPLL among Black people compared with White people. Results From 1999 to 2020, the total number of excess deaths was 658,356 and 1,154,108 among Black females and males, representing 34,938,070 and 47,005,048 excess YPLL among Black females and males. The excess deaths and YPLL were largest among infants and non-elderly adults. Heart disease had the most excess deaths. From 1999, the age-adjusted excess mortality rate declined at an annual average of -9.0 (95% CI: -10.0, -8.0; P<0.001) until 2015 among Black women and at an annual average of -16.3 (95% CI: -20.9, -11.6; P<0.001) until 2012 among Black men, followed by no significant change until 2019 in either group. From 2019 to 2020, excess deaths increased from 90.4 to 192 per 100,000 Black women and from 209.8 to 395 per 100,000 Black men, reaching rates approximating those of 1999. The trends in rates of excess YPLL followed a similar pattern. Conclusions and relevance Over a recent 22-year period, Black people in the US lost more than 80 million years of life when compared with White people. After a period of progress, improvements stalled, and most gains were eliminated in 2020. Question How many excess deaths and years of potential life lost (YPLL) for Black people, compared with White people, occurred in the United States from 1999 through 2020? Findings Based on Centers for Disease Control and Prevention data, excess deaths and YPLL persisted throughout the period, with initial progress followed by little improvement, and then worsening in 2020 to about 1999 levels. Black people had 1.8 million excess deaths and over 80 million YPLL over the study period. Meaning After initial progress, excess mortality and YPLL among Black people stagnated and then worsened, indicating a need for new approaches. ### Competing Interest Statement In the past three years, Harlan Krumholz received expenses and/or personal fees from UnitedHealth, Element Science, Aetna, Reality Labs, Tesseract/4Catalyst, F-Prime, the Siegfried and Jensen Law Firm, Arnold and Porter Law Firm, and Martin/Baughman Law Firm. He is a co-founder of Refactor Health and HugoHealth, and is associated with contracts, through Yale New Haven Hospital, from the Centers for Medicare & Medicaid Services and through Yale University from Johnson & Johnson. Herman A. Taylor has worked as an advisor and consultant for United Health Group, Pfizer, and Novartis. The other authors had nothing to disclose. ### Funding Statement This study did not receive external funding. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The Yale Institutional Review Boards waived this study from review. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes All data used in this study is publicly available from . All the code files used to analyze the data are publicly available from Dr. Caraballo had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.