Race and Mortality Revisited

In an article in the January/February 2000 issue of Society titled “Race and Mortality,” I explained the statistical pattern, inherent in other than highly irregular risk distributions, whereby the rarer an outcome, the greater tends to be the relative (percentage) difference between the rates at which advantaged and disadvantaged groups experience the outcome and the smaller tends to be the relative difference between rates at which such groups avoid the outcome. By way of example with respect to the health and healthcare outcomes on which the article principally focused, as mortality declines, relative differences in mortality tend to increase while relative differences in survival tend to decrease; as healthcare generally improves, relative differences in receipt of appropriate care tend to decrease while relative differences in failing to receive such care tend to increase. In 2000, however, this pattern was virtually unknown to health disparities researchers or anyone else examining demographic differences in favorable or adverse outcomes. Consequently, most efforts to appraise demographic differences in such outcomes were fundamentally unsound. This article addresses the extent to which the appraisal of demographic differences in outcome rates is any sounder today than it was in 2000. In summary, while there has been increasing recognition of the ways that relative differences in outcome rates tend to be systematically affected by the prevalence (frequency) of an outcome, that recognition has yet to affect the way observers analyze group differences in outcome rates in any context. Though today vastly greater resources are devoted to the study of disparities in health and healthcare outcomes than in 2000, almost nothing said about such things as whether those disparities have increased or decreased over time or are otherwise larger in one setting than another, or even whether a disparity should be deemed large or small, has had a sound statistical basis. Meanwhile, federal regulators encourage mortgage lenders and public schools to reduce the frequency of adverse borrowing and student discipline outcomes in order to reduce the commonly observed severalfold racial and ethnic differences in rates of experiencing those outcomes. Neither the regulators, the congressional committees monitoring regulator policies, nor the institutions reducing the frequency of those outcomes in response to federal encouragements understand that reducing any outcome tends to increase, not reduce, relative differences in experiencing it. More broadly, events since 2000 do little to bolster one’s faith in the validity of accepted scholarship or the capability of individuals or institutions to recognize and acknowledge that things they have been doing for decades or generations have been incorrect or misleading.