Gaps found in death rates

Disparities in race, gender identified in county’s data

Depending on whether you are black or white, male or female, in Allegheny County there remain big differences in what might kill you and when.

For example, the homicide rate is more than 23 times higher for blacks compared to whites, and 9.6 times higher for all men than for females. The suicide rate for men is four times higher than women, and the death rate from Parkinson’s disease is more than 2½ times higher for men.

Those statistics are contained in a new Allegheny County Health Department review that shows that in 2015, premature mortality rates in the county were declining overall and for most causes of death — a good thing.

But the mortality numbers also show that gender and race disparities continue to exist, and drug overdoses are increasing more than any other premature cause of death.

And a companion review by the University of Pittsburgh’s Department of Biostatistics comparing premature mortality rates in 43 U.S. counties with populations of more than 1 million shows Allegheny County’s ranking has gotten worse, dropping from 31st in 1990 to 39th in 2015, the last year for which data was available. Overall, Fairfax, Va., a Washington, D.C. suburb, was ranked No. 1.

Compared to the other 42 counties for the 25 years from 1990 to 2015 covered by the data, Allegheny County’s mortality ranking for black men fell from 29th to 40th; for black women, from 20th to 42nd;

for all races ages 1 to 19, from second to 30th; and for all races ages 20 to 64, from 21st to 38th.

LuAnn Brink, head of the ACHD’s Bureau of Epidemiology, said those county rankings can fluctuate year to year, but consistently better ranked counties may have policies and programs in place that are working to improve public health outcomes.

“Our focus at this point is on disparities within Allegheny County, because if you can’t improve those, you’re not going to reach the level of Fairfax,” said Ms. Brink, who presented the report at the county Board of Health meeting Wednesday.

The Health Department director, Karen Hacker, said the comparison data will be used by her department and other local health service organizations to help address “health inequities” in the county.

“Our numbers are actually improving, but not as fast as other places,” Dr. Hacker said. “We’re moving in the right direction, but now we can compare how we rank with those other areas, why we have such dramatic differences in health outcomes for gender and race and geography.”

She said the mortality data can be used to justify more preventive screening for things such as breast cancer, heart disease, asthma and diabetes, and more programs to prevent such things as drug abuse, suicide and homicides.

“Not only will this help us focus our own initiatives,” Dr. Hacker said, “but it will enable us to learn from other counties in the U.S. where dramatic changes in policies and programs have produced good results, and bring those kinds of efforts here to address our problems.”

Joylette Portlock, a health department board member, said it’s good to call attention to and address the social causes of premature mortality, but she noted that pollution control remains a prime health issue in the county.

“I don’t want environmental health issues to get lost,” she said. “Air pollution contributes to heart health issues.”

Donald Burke, another health board member, said the county’s low rankings in a number of mortality categories point to a lack of coordination by medical, community and social services.

“We have outstanding ‘meds and eds,’ but the data tells me we are not getting at some of the root causes of our high mortality rates,” Dr. Burke said.

“We are not addressing some of the social determinants of mortality, and we need to do more. Others are improving faster than we are, and this should be a clarion call to to bring health and social services together to address these issues.”

Dr. Hacker said health issues in the county’s minority neighborhoods are multilayered.

“It starts with poverty, then includes layers of pollution, obesity, asthma, diabetes, hypertension and lack of education,” she said. “The problems are so interrelated that it makes regional approaches challenging.”

Mapping done for the mortality data review will help to guide county public health programming decisions, Dr. Hacker said.

“The maps show where the big challenges are — environmental justice, obesity, smoking. And we know our river valley communities have a lot of challenges,” she said. “We also show some big disparities between black and white mortality.

“We’re seeing some of that disparity decrease in other counties, but that really isn’t present here. It tells us there is work to do.”

“It starts with poverty, then includes layers of pollution, obesity, asthma, diabetes, hypertension and lack of education.” — Donald Burke, Allegheny County Health Department