Black infants and children consistently have double the risk for death compared to Whites

Embargoed for release until 5:00 p.m. ET on Monday 24 March 2025   

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Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute for the full articles as a source of information. This information is under strict embargo and by taking it into possession, media representatives are committing to the terms of the embargo not only on their own behalf, but also on behalf of the organization they represent.   
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1. Black infants and children consistently have double the risk for death compared to Whites

Racial inequities in childhood mortality between Black and White Americans have not decreased since 1950

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-24-02794

URL goes live when the embargo lifts            

A population-based surveillance study evaluated the extent and persistence of excess infant and childhood mortality among Black Americans between 1950 and 2019. The study found that while gaps in life expectancy and mortality decreased between Black and White Americans over the study period, relative mortality in infants and children increased. According to the researchers, this is the first study to systematically examine data across the entire postwar era (from the 1950s to the present day) to assess long-term trends in race-based mortality disparities in the United States across the age spectrum. The findings suggest the need for innovative social, economic and health care policies to address the structural causes of inequity affecting mortality in Black Americans. The study is published in Annals of Internal Medicine. 

An international team of researchers from Universidad Nacional de Colombia, Yale School of Medicine, Weill Cornell Medicine, and Harvard University analyzed mortality data from the Centers for Disease Control and Prevention (CDC) and the U.S. Census Bureau between 1950 and 2019 to estimate sex and age specific excess mortality burden on Black Americans compared to White Americans. The researchers gathered data from death certificates between 1960 – 2019 obtained from the CDC and death counts between 1950 – 1959 obtained from the Vital Statistics reports published by the Census Bureau. They calculated annual crude and age-standardized mortality rates, life expectancy, and years of life lost for Black and White Americans for every year in the study period. The data showed that life expectancy at birth increased by 20.4% and 13% between 1950 to 2019 among Black Americans and White Americans, respectively. In the 1950s, age-standardized mortality rate was 23% higher for Black Americans than White Americans; by the 2010s, this mortality ratio narrowed by 4% but remained 18% higher than in the White population. In Black children, a total of 522,617 excess deaths in infancy and 689,724 during childhood occurred over the 70-year period. In the 1950s, the mortality rate was 92% percent higher in Black infants compared to White infants, with an excess mortality ratio of 1.92. While the mortality rates for both Black and White infants decreased in the 2010s, the mortality ratio increased, with Black infants dying 115% more frequently than white infants for a mortality ratio of 2.15.  In the 2010s, medical conditions during the perinatal period were the largest cause of excess death in Black children younger than five years and external causes (including homicides, suicides, trauma, and accidental causes of death) were the most frequent cause of excess mortality in Black children between five to 19 years. 

While excess mortality among Black children has decreased over the past seven decades, Black children still have double the risk of death than White children, a disparity that has not decreased since the 1950s. This analysis underscores racial inequities in childhood mortality seen since the 1950s in the U.S. and suggests the urgent need for increased public health and policy actions to reduce this gap. 
 

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with corresponding author Angel Paternina-Caicedo, MD, MSc, please email ajpaterninac@unal.edu.co and apaterninac@unisinucartagena.edu.co.

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2. Most women undergo annual mammography screening, regardless of clinical guideline advice

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-24-03325

Editorial: https://www.acpjournals.org/doi/10.7326/ANNALS-25-00477

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A national cross-sectional study examined how often women in the United States undergo a mammography screening in the past year versus the past one to two years. The researchers found that over 75% of women received a mammogram in the past year, suggesting a large proportion of women undergo screening annually whether annual screening is recommended by guidelines or not. The findings are published in Annals of Internal Medicine.

Researchers from Harvard Medical School analyzed data from 20,034 women aged 40 to 84 years without breast cancer history who participated in the 2019 and 2021 National Health Interview Survey (NHIS). Clinical guidelines on the age to initiate screening, age to cease screening, and how often to screen vary widely, so the researchers aimed to determine how often women report a mammography screening by age and other sociodemographic factors. Among women aged 65 to 84 years, the researchers also examined receipt of screening in the past year vs. one to two years by 10-year life expectancy, since most guidelines recommend discontinuation of mammography screening when life expectancy is less than 10 years. The researchers found that 68.1% of participants reported mammography screening in the past 2 years, of which 75.2% reported screening in the past year. Women aged 40 to 44 years and aged 55 to 74 years were more likely to report screening in the past year than women aged 45 to 54 years or 75 to 84 years. Women with sociodemographic factors including identifying as non-Hispanic Black, having a college degree, and those from the Northeast or Midwest were more likely to report a mammography in the past year. Among those aged 65 to 84 with less than 10-year life expectancy, 71.1% of those screened in the past two years reported screening in the past year.

The findings suggest most women screen annually, with women aged 55 to 74 more likely to screen annually than women aged 45 to 54 despite recommendations for biennial screening, especially for those aged 55 and older. Additionally, non-Hispanic Black women reported some of the highest screening proportions across demographics, despite experiencing greater breast cancer death than other populations. This suggests future interventions to improve breast cancer outcomes for Black women should focus more on follow-up and treatment rather than screening. The researchers conclude that interventions to inform women over 40 of the option to screen biennially may be appropriate for health systems choosing to follow biennial screening guidelines.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with corresponding author Mara A. Schonberg, MD, MPH, please email Sophie Afdhal at safdhal@bidmc.harvard.edu or Katie Brace at Katie.Brace@bilh.org.

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3. 'Broken heart syndrome’ associated with double the risk of rehospitalization for wide range of conditions

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-24-01770

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Patients diagnosed with Takotsubo syndrome, or ‘broken heart syndrome’ face double the risk of rehospitalization for a wide range of conditions. A brief research report is published in Annals of Internal Medicine.

Recently, Takotsubo syndrome became a news story when experts hypothesized that Hollywood star Gene Hackman or his wife Betsy Arakawa may have died of "broken heart syndrome" after discovering the other dead. Takotsubo syndrome is a real and potentially serious condition characterized by transient left ventricular dysfunction, often precipitated by intense emotional or physical stress. Although its clinical presentation is like that of acute myocardial infarction, there is no coronary artery disease present. While the condition may resolve, several registries have reported reduced long-term survival after an episode of acute takotsubo syndrome.

Researchers from the Aberdeen Cardiovascular and Diabetes Centre, University of Aberdeen, Aberdeen, United Kingdom studied data from the Scottish Takotsubo Registry to explore the incidence and causes of all subsequent hospital readmissions affecting patients with the syndrome. They found that of 12,873 hospitalizations in this population, the incidence rate of hospital readmission was 743 per 1,000 person-years compared with 365 per 1,000 person-years for the general Scottish population, and 750 per 1,000 for patients with myocardial infarction. Compared with the general population, patients with takotsubo syndrome were twice as likely to be hospitalized for any cause, especially cardiovascular causes, such as myocardial infarction, heart failure, or arrythmia. The researchers also found excess admissions for mental health, stroke, gastrointestinal, and several other causes.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with an author, please email Wendy Davidson at w.davidson@abdn.ac.uk.

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