Health - Health Of African-americans

Cancer

Cancer distribution among various population groups varies according to racial and ethnic background. Such risk factors as occupation, use of tobacco and alcohol, sexual and reproductive behaviors, and nutritional and dietary habits influence the development of cancer. In addition to

TABLE 6.7
No health insurance coverage among persons under 65 years of age, according to selected characteristics: Selected years 1984–2001
[Data are based on household interviews of a sample of the civilian noninstitutionalized population]

Characteristic	1984	1989	1995	1996	1997¹	1998	1999	2000	2001
Location of residence³	Percent of population³
Within MSA⁶	13.3	14.9	15.2	15.6	16.7	15.8	15.3	16.3	15.6
Outside MSA⁶	16.4	16.9	18.7	19.7	19.9	19.2	18.9	18.8	18.5
#Estimates calculated upon request.
* Estimates are considered unreliable. Data not shown have a relative standard error of greater than 30 percent.
- - - Data not available.
¹In 1997 the National Health Interview Survey (NHIS) was redesigned, including changes to the questions on health insurance coverage.
²Includes all other races not shown separately and unknown poverty level.
³Estimates are for persons under 65 years of age and are age adjusted to the year 2000 standard using three age groups: under 18 years, 18–44 years, and 45–64 years.
⁴The race groups, white, black, American Indian and Alaska Native (AI/AN), Asian, Native Hawaiian and Other Pacific Islander, and 2 or more races, include persons of Hispanic and non-Hispanic origin. Persons of Hispanic origin may be of any race. Starting with data year 1999 race-specific estimates are tabulated according to 1997 Standards for Federal data on Race and Ethnicity and are not strictly comparable with estimates for earlier years. The five single race categories plus multiple race categories shown in the table conform to 1997 Standards. The 1999 and later race-specific estimates are for persons who reported only one racial group; the category "2 or more races" includes persons who reported more than one racial group. Prior to data year 1999, data were tabulated according to 1977 Standards with four racial groups and the category "Asian only" included Native Hawaiian and Other Pacific Islander. Estimates for single race categories prior to 1999 included persons who reported one race or, if they reported more than one race, identified one race as best representing their race. The effect of the 1997 Standard on the 1999 estimates can be seen by comparing 1999 data tabulated according to the two Standards: Age-adjusted estimates based on the 1977 Standards of the percent with no health insurance coverage are: 0.1 percentage points higher for the white group; identical for the black group; 0.1 percentage points lower for the Asian and Pacific Islander group; and 1.5 percentage points higher for the AI/AN group than estimates based on the 1997 Standards.
⁵Missing family income data were imputed for 15–17 percent of the sample under 65 years of age in 1994–96. Percent of poverty level was unknown for 19 percent of sample persons under 65 in 1997, 24 percent in 1998, 27 percent in 1999, and 26 percent in 2000 and 2001.
⁶MSA is metropolitan statistical area.
Note: Persons not covered by private insurance, Medicaid, State Children's Health Insurance Program (SCHIP), public assistance (through 1996), state-sponsored or other government-sponsored health plans (starting in 1997), Medicare, or military plans are included.
SOURCE: "Table 129. No Health Insurance Coverage among Persons under 65 Years of Age, According to Selected Characteristics: United States, Selected Years 1984–2001," in Health, United States, 2003, Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics, Hyattsville, MD, 2003 [Online] http://www.cdc.gov/nchs/data/hus/hus03.pdf [accessed March 11, 2004]

early detection, socioeconomic status can be an important factor in receiving and surviving cancer treatment.

Cancer incidence and mortality rates are generally higher for African-Americans than for white Americans. The Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute (NCI) is the most authoritative source of information on cancer incidence, mortality, and survival in the United States. In SEER Cancer Statistics Review, 1975–2000 (Bethesda, MD, 2003), the NCI reported that the incidence rates between 1996 and 2000 were 521.7 per 100,000 African-Americans and 479.8 per 100,000 whites. The five-year survival rate for cancer in African-Americans diagnosed between 1992 and 1999 was about 53.3 percent, compared to 64.4 percent for whites. Much of this difference in survival can be attributed to later diagnosis in African-Americans. According to data compiled by the NCHS, types of cancer for which African-Americans have significantly higher incidence and mortality rates include stomach, esophagus, myeloma, pancreas, larynx, and prostate. The most fatal type of cancer for both male and female African-Americans is lung cancer.

BREAST CANCER.

According to Cancer Facts and Figures for African Americans 2003–2004, produced by the American Cancer Society, African-American women experience a slightly lower rate of breast cancer than their white counterparts, but they are more likely to die as a result of their cancer. According to figures released by the National Cancer Institute in 2002, the incidence rate for African-American women was 123.7 per 100,000 for the years 1995–1999, while white women experienced breast cancer at a rate of 140.9 per 100,000. However, deaths from breast cancer during the same period occurred at a rate of 37.1 per 100,000 among African-American women and 28.2 per 100,000 among white women. For years experts assumed that the difference was due to poor health care and late treatment for African-American women. Recent studies, however, indicate that African-American women may be more susceptible to a more deadly form of the cancer. Tumors from African-American women were found to have more actively dividing cells than tumors from white women. The tumor cells in African-American women also lacked hormone receptors, another indicator of a poor prognosis. After peaking in the early 1990s, the death rate from breast cancer for African-American women had shown improvement by 2001, at 34.4 per 100,000. (See Table 6.16.)

PROSTATE CANCER.

African-American men have a particularly high incidence and mortality rate of prostate cancer. Between 1995 and 1999, the prostate cancer incidence rate among African-American men was 266.8 cases per 100,000 population, compared to a rate of only 163.2 cases per 100,000 population among whites. The mortality rate for those same years among African-American men averaged 72.8 deaths from prostate cancer per 100,000 population, compared to 31.2 deaths per 100,000 for white men, according to the American Cancer Society.

TABLE 6.8
Medicaid coverage among persons under 65 years of age, according to selected characteristics: Selected years, 1984–2001
[Data are based on household interviews of a sample of the civilian noninstitutionalized population]

Characteristic	1984	1989	1995	1996	1997¹	1998	1999	2000	2001
	Number in millions
Total²	14.0	15.4	26.6	25.8	22.9	21.1	21.9	22.9	25.2
	Percent of population
Total, age adjusted^2,3	6.7	7.1	11.3	10.9	9.6	8.8	9.0	9.4	10.3
Total, crude²	6.8	7.2	11.5	11.1	9.7	8.9	9.1	9.5	10.4
Age
Under 18 years	11.9	12.6	21.5	20.7	18.4	17.1	18.1	19.4	21.2
Under 6 years	15.5	15.7	29.3	28.2	24.7	22.4	23.5	24.3	25.8
6–17 years	10.1	10.9	17.4	16.9	15.2	14.5	15.5	17.0	19.0
18–44 years	5.1	5.2	7.8	7.6	6.6	5.8	5.7	5.6	6.3
18–24 years	6.4	6.8	10.4	9.7	8.8	8.0	8.1	8.1	8.4
25–34 years	5.3	5.2	8.2	7.8	6.8	5.7	5.7	5.5	6.2
35–44 years	3.5	4.0	5.9	6.2	5.2	4.6	4.3	4.3	5.1
45–64 years	3.4	4.3	5.6	5.3	4.6	4.5	4.4	4.5	4.7
45–54 years	3.2	3.8	5.1	4.9	4.0	4.1	3.9	4.2	4.4
55–64 years	3.6	4.9	6.4	5.9	5.6	5.0	5.3	4.9	5.2
Sex³
Male	5.2	5.6	9.2	8.9	8.1	7.5	7.7	8.0	8.9
Female	8.0	8.6	13.3	12.8	11.0	10.1	10.4	10.8	11.6
Race^3,4
White only	4.6	5.1	8.8	8.7	7.5	6.7	6.9	7.2	8.1
Black or African American only	18.9	17.8	26.0	23.0	20.5	19.6	18.7	19.4	20.4
American Indian and Alaska Native only	#	#	#	#	#	#	41.3	44.2	15.5
Asian only	9.1	11.3	10.7	*11.5	9.4	6.7	8.4	7.8	8.8
Native Hawaiian and Other Pacific Islander only	- - -	- - -	- - -	- - -	- - -	- - -	*	*	*
2 or more races	- - -	- - -	- - -	- - -	- - -	- - -	15.8	15.6	14.6
Hispanic origin and race^3,4
Hispanic or Latino	12.2	12.7	19.8	18.5	16.0	14.1	14.1	14.2	16.0
Mexican	11.1	11.5	18.8	17.6	15.3	12.6	12.4	12.5	14.6
Puerto Rican	28.6	26.9	31.1	31.3	28.9	24.5	27.0	27.6	28.5
Cuban	4.8	7.8	13.8	*13.1	8.2	*9.1	8.3	9.7	12.2
Other Hispanic or Latino	7.4	10.4	16.9	15.0	13.9	13.9	13.8	14.1	15.0
Not Hispanic or Latino	6.2	6.6	10.2	9.7	8.7	8.0	8.2	8.6	9.3
White only	3.7	4.2	7.1	7.0	6.2	5.7	6.0	6.3	7.0
Black or African American only	19.1	17.8	25.6	22.7	20.3	19.4	18.7	19.3	20.3
Age and percent of poverty level⁵
All ages:³
Below 100 percent	30.5	35.3	44.7	42.9	38.8	37.9	36.8	37.2	39.0
100–149 percent	7.5	11.0	18.0	17.4	17.5	16.0	18.6	20.3	23.5
150–199 percent	3.1	5.0	7.9	8.0	7.4	7.2	9.8	10.8	13.3
200 percent or more	0.6	1.1	1.8	1.7	1.7	1.8	2.0	2.3	2.6
Under 18 years:
Below 100 percent	43.1	47.8	66.0	65.2	59.7	58.7	59.9	60.9	64.3
100–149 percent	9.0	12.3	27.2	26.6	30.2	25.9	33.5	37.1	41.4
150–199 percent	4.4	6.1	13.1	12.2	12.2	12.8	18.0	21.5	26.5
200 percent or more	0.8	1.6	3.3	2.8	2.9	3.2	3.7	4.7	5.3

In 2001, while the mortality rate from prostate cancer among African-American men was a full ten points lower than it was in 1995, at 66.1 deaths per 100,000 population, it remained significantly higher than for other racial and ethnic groups. (See Table 6.16.)

Heart Disease, Hypertension, and Stroke

Rates of heart disease vary considerably by race, with higher rates for African-Americans. Along with age and sex, race, as part of heredity, is one of the risk factors for heart disease that cannot be changed. However, due to their higher rates of incidence of heart disease and stroke, African-Americans are encouraged to control other risk factors, including use of tobacco and alcohol, blood pressure and cholesterol levels, physical activity, weight, and stress.

According to the American Heart Association, the prevalence of hypertension, or high blood pressure, in both African-American males and females is significantly higher than in white males and females. The Association reported that in 2001 approximately 41.6 percent of African-American males and 44.7 percent of African-American females suffered from high blood pressure. African-Americans develop high blood pressure at younger ages than whites do. Hypertension is also generally more severe in African-Americans than in whites and, as a result, African-Americans have greater rates of both nonfatal and fatal strokes. Geography also appears to play

Characteristic	1984	1989	1995	1996	1997¹	1998	1999	2000	2001
Geographic region³	Percent of population
Northeast	8.5	6.8	11.7	11.5	11.2	9.8	10.1	10.5	10.8
Midwest	7.2	7.5	10.3	8.7	8.2	7.5	7.3	7.9	9.0
South	5.0	6.4	11.1	11.1	8.6	8.6	8.9	9.4	10.7
West	6.9	8.2	12.4	12.4	11.4	9.7	10.3	10.2	10.6
Location of residence³
Within MSA⁶	7.1	7.0	11.1	10.4	9.5	8.5	8.4	8.8	9.8
Outside MSA⁶	5.9	7.8	12.0	12.7	9.9	9.8	11.5	11.9	12.4
# Estimates calculated upon request.
* Estimates are considered unreliable. Data preceded by an asterisk have a relative standard error of 20–30 percent. Data not shown have a relative standard error of greater than 30 percent.
- - - Data not available.
¹In 1997 the National Health Interview Survey (NHIS) was redesigned, including changes to the questions on health insurance coverage.
²Includes all other races not shown separately and unknown poverty level.
³Estimates are for persons under 65 years of age and are age adjusted to the year 2000 standard using three age groups: under 18 years, 18–44 years, and 45–64 years.
⁴The race groups, white, black, American Indian and Alaska Native (AI/AN), Asian, Native Hawaiian and Other Pacific Islander, and 2 or more races, include persons of Hispanic and non-Hispanic origin. Persons of Hispanic origin may be of any race. Starting with data year 1999 race-specific estimates are tabulated according to 1997 Standards for Federal data on Race and Ethnicity and are not strictly comparable with estimates for earlier years. The five single race categories plus multiple race categories shown in the table conform to 1997 Standards. The 1999 and later race-specific estimates are for persons who reported only one racial group; the category "2 or more races" includes persons who reported more than one racial group. Prior to data year 1999, data were tabulated according to 1977 Standards with four racial groups and the category "Asian only" included Native Hawaiian and Other Pacific Islander. Estimates for single race categories prior to 1999 included persons who reported one race or, if they reported more than one race, identified one race as best representing their race. The effect of the 1997 Standard on the 1999 estimates can be seen by comparing 1999 data tabulated according to the two Standards: Age-adjusted estimates based on the 1977 Standards of the percent with Medicaid are: 0.1 percentage points higher for the white group; 0.8 percentage points higher for the Asian and Pacific Islander group and 0.8 percentage points higher for the AI/AN group than estimates based on the 1997 Standards.
⁵Missing family income data were imputed for 15–17 percent of the sample under 65 years of age in 1994–96. Percent of poverty level was unknown for 19 percent of sample persons under 65 in 1997, 24 percent in 1998, 27 percent in 1999, and 26 percent in 2000 and 2001.
⁶MSA is metropolitan statistical area. Note: Medicaid includes other public assistance through 1996. Starting in 1997 includes state-sponsored health plans. Starting in 1999 includes State Children's Health Insurance Program (SCHIP). In 2001, 7.9 percent were covered by Medicaid, 1.2 percent by state-sponsored health plans, and 1.2 percent by SCHIP.
SOURCE: "Table 128. Medicaid Coverage among Persons under 65 Years of Age, According to Selected Characteristics: United States, Selected Years, 1984–2001," in Health, United States, 2003, Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics, Hyattsville, MD, 2003 [Online] http://www.cdc.gov/nchs/data/hus/hus03.pdf [accessed March 11, 2004]

a role, with African-Americans who live in the South experiencing greater prevalence of high blood pressure and stroke than those in other areas of the country. High blood pressure remains a leading cause of stroke for non-Hispanic African-Americans age twenty and older.

Researchers are not yet sure why African-Americans have a greater tendency toward high blood pressure, but a possible genetic predisposition toward high blood pressure in African-Americans may stem from a strong tendency to retain salt in their bodies. Scientists have hypothesized that this developed as an adaptation to living in a very hot climate where excessive salt loss could result in death.

Approximately 20 percent of African-Americans experience high serum cholesterol levels of greater than 240 mg/dl, which is about the same rate as other racial and ethnic groups in the United States. However, the American Heart Association warns that another 25 percent have total blood cholesterol levels over 200 mg/dl and are thus at risk of developing high cholesterol.

Sickle-Cell Anemia

Sickle-cell anemia, a hereditary disease that primarily strikes African-American people in the United States, is a blood disorder in which defective hemoglobin causes red blood cells to become sickle shaped, rather than round. This can create blockages in small arteries and can result in many problems, including chronic anemia, episodes of intense pain, strokes, and death. Scientists believe the genetic trait arose randomly in Africa and survived as a defense against malaria. The disease can be inherited only when both parents have the sickle-cell trait and the child inherits the defective gene from both parents. One of every twelve African-Americans is a carrier for sickle-cell anemia, and about one of every 500 African-American infants is born with it. According to the National Institutes of Health (NIH), many non-African-Americans with ancestors from malaria regions—parts of Greece, Italy, the Near East, and India—also have the disease. However, of the 72,000 Americans the NIH estimated had sickle-cell anemia in 2002 most were of African descent.

Alzheimer's Disease

The results of a study, "The APOE4 Allele and the Risk of Alzheimer Disease among African-Americans, Whites, and Hispanics," conducted between 1991 and 1996 by Columbia University, were published in the Journal of the American Medical Association (vol. 279, no. 10, March 1998). The findings indicated that African-Americans and Hispanics might be at greater risk for Alzheimer's disease than whites. In 1992 scientists first

TABLE 6.9
Percentage of persons aged >18 years reporting cigarette use during the preceding month, by race/ethnicity and sex—National Survey on Drug Use and Health, 1999–2001

Race/ethnicity	Male %	Female %	Total %
Non-Hispanic
White	29.1	25.9	27.4
Black	30.1	22.2	25.7
American Indian/Alaska Native	40.9	40.0	40.4
Hawaiian/Other Pacific Islander	—¹	—	—
Asian²	24.1	9.1	16.2
Chinese	19.3	5.9	12.3
Filipino	—	6.9	14.8
Japanese	18.3	—	19.0
Asian Indian	20.0	3.0	12.6
Korean	—	—	27.2
Vietnamese	—	—	26.5
Hispanic²	29.2	17.3	23.1
Mexican	29.8	15.6	22.8
Puerto Rican	34.2	27.3	30.4
Central or South American	26.3	16.9	21.3
Cuban	21.1	17.5	19.2
Total	29.2	24.1	26.5
¹Data unreliable.
²Includes respondents reporting racial/ethnic subgroups not shown and respondents reporting more than one subgroup.
SOURCE: Adapted from "Table 2. Percentage of Persons Aged >18 Years Reporting Cigarette Use during the Preceding Month, by Race/Ethnicity and Sex—National Survey on Drug Use and Health, United States, 1999–2001," in Prevalence of Cigarette Use among 14 Racial/Ethnic Populations—United States, 1999–2001, Morbidity and Mortality Weekly Report, vol. 53, no. 3, Centers for Disease Control and Prevention, Atlanta, GA, January 30, 2004 [Online] http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5303a2.htm [accessed March 11, 2004]

discovered that people with the apolipoprotein-E gene, or APOE4 (approximately 25 percent of the total population), are at greater risk for developing the disease. The Columbia University research, however, showed that the increased risk associated with the APOE4 gene applies only to whites. The study showed that African-Americans and a group of Hispanic Americans, mainly from the Caribbean, who do not have the gene, are still at greater risk for Alzheimer's disease than whites.

The researchers surveyed 1,079 elderly men and women and found that African-Americans who lacked the APOE4 gene were four times more likely than whites to get Alzheimer's disease. Since the APOE4 could not account for the increased cases in African-Americans and Hispanics, researchers now believe that there are other genetic or environmental factors affecting minorities that increase their risk of developing Alzheimer's disease. None of the subjects of the study had the disease when the study began, but 221 developed Alzheimer's by the time the study ended.

Diabetes

Another health problem in the African-American community is the high incidence of diabetes. Diabetes was the seventh-leading cause of death for African-American men in 2001 and the fourth-leading cause of death for African-American women in the same year. One of the reasons diabetes is such a dangerous disease is because it can cause many different complications, including heart disease, kidney failure, and loss of circulation in the extremities. Lack of circulation in the lower limbs can lead to infection of small wounds and gangrene eventually requiring leg amputation. According to the CDC, 11.4 percent of all non-Hispanic blacks age twenty years or older have diabetes, compared with 8.4 percent of non-Hispanic whites and 8.2 percent of all Hispanic Americans of similar age.

Life Expectancy

Women tend to live longer than men, and whites are likely to live longer than African-Americans. In 2001, when comparing the life expectancies at birth of African-Americans and whites, African-American men (68.6 years) had the shortest life expectancy, while white women (80.2 years) had the longest life expectancy. African-American females had a life expectancy of 75.5 years, and white men could expect to live approximately seventy-five years. (See Table 6.17.)

In 2001, as reported by the Centers for Disease Control, African-Americans died at a higher rate than white Americans, with an age-adjusted rate of 1,101.2 African-American deaths per 100,000 people, compared with 836.5 white deaths per 100,000. (See Table 6.16.) During the same year, the number of infants who died during the first year of life for African-Americans was 2.5 times greater than for the white population, and maternal mortality, the number of women who died during childbirth or from its complications, was 3.4 times greater for African-Americans than for white women. On the other hand, non-Hispanic African-American individuals are significantly less likely than non-Hispanic whites to die of suicide. In 2001 the African-American suicide rate, at 5.5 per 100,000 population, was half that of the non-Hispanic white population, which numbered 12.5 per 100,000. (See Table 6.16.)

Leading Causes of Death

Heart disease was the leading cause of death among non-Hispanic African-Americans in 2001, according to the National Center for Health Statistics. That year more than 25 percent of deaths of African-American males and 28.7 percent of deaths of African-American females were attributed to heart disease. Cancer was the second-leading cause of death among African-Americans, and stroke the third leading cause among African-American women, though men died more often from unintentional injuries.

HOMICIDE.

Homicides are disproportionately high in the non-Hispanic African-American population, and the

TABLE 6.10
Alcohol consumption by persons 18 years of age and over, according to selected characteristics: Selected years 1997–2001
[Data are based on household interviews of a sample of the civilian noninstitutionalized population]

	Both sexes			Male			Female
Characteristic	1997	2000	2001	1997	2000	2001	1997	2000	2001
Drinking status¹				Percent distribution
18 years and over, age adjusted²
All	100.0	100.0	100.0	100.0	100.0	100.0	100.0	100.0	100.0
Lifetime abstainer	21.2	24.1	22.6	14.0	17.5	15.2	27.6	29.9	29.2
Former drinker	15.7	14.4	14.9	16.2	14.9	16.0	15.3	14.2	14.0
Infrequent	9.0	8.2	8.5	7.7	7.0	7.7	10.1	9.2	9.1
Regular	6.7	6.3	6.4	8.5	7.8	8.3	5.2	5.0	4.8
Current drinker	63.1	61.5	62.5	69.8	67.7	68.8	57.0	55.8	56.8
Infrequent	15.0	14.7	12.8	11.7	11.1	9.2	18.1	18.2	16.2
Regular	48.1	46.7	48.7	58.1	56.6	58.4	38.9	37.7	39.7
18 years and over, crude
All	100.0	100.0	100.0	100.0	100.0	100.0	100.0	100.0	100.0
Lifetime abstainer	21.1	24.0	22.5	14.0	17.5	15.2	27.7	30.1	29.3
Former drinker	15.5	14.3	14.8	15.6	14.3	15.5	15.4	14.3	14.1
Infrequent	8.9	8.1	8.4	7.5	6.8	7.5	10.1	9.3	9.2
Regular	6.6	6.2	6.4	8.1	7.5	8.0	5.2	5.0	4.9
Current drinker	63.4	61.7	62.7	70.5	68.2	69.3	57.0	55.6	56.6
Infrequent	15.0	14.7	12.9	11.7	11.1	9.3	18.1	18.1	16.2
Regular	48.4	46.9	48.8	58.8	57.2	58.9	38.8	37.5	39.5
Age	Percent current drinkers among all persons
All persons:
18–44 years	69.4	67.4	69.0	74.8	73.0	75.0	64.2	61.9	63.2
18–24 years	62.2	59.4	63.6	66.7	64.0	69.6	57.7	54.9	57.7
25–44 years	71.6	69.9	70.8	77.2	76.0	76.8	66.1	64.1	65.0
45–64 years	63.3	62.0	62.5	70.8	68.1	67.8	56.2	56.3	57.5
45–54 years	67.1	65.1	65.6	73.8	70.3	70.1	60.7	60.1	61.2
55–64 years	57.3	57.2	57.6	65.8	64.6	64.2	49.4	50.6	51.6
65 years and over	43.4	42.1	42.0	52.7	50.0	50.9	36.6	36.2	35.5
65–74 years	48.6	46.9	45.8	56.7	52.6	55.2	42.0	42.2	38.2
75 years and over	36.6	36.3	37.6	46.7	46.6	45.1	30.2	29.7	32.6
Race^2,3
White only	66.0	64.6	65.8	71.8	69.7	71.0	60.7	59.9	61.0
Black or African American only	47.8	46.8	46.6	56.9	56.2	56.9	40.9	39.4	38.6
American Indian and Alaska Native only	53.9	54.2	51.5	66.1	62.6	62.8	45.2	46.9	38.6
Asian only	45.8	43.0	44.7	60.1	55.9	59.7	31.6	29.3	30.1
Native Hawaiian and Other Pacific Islander only	- - -	*	*	- - -	*	*	- - -	*	*
2 or more races	- - -	61.6	68.5	- - -	70.5	69.9	- - -	52.7	67.1
Hispanic origin and race^2,3
Hispanic or Latino	53.4	52.1	49.8	64.6	63.7	61.2	42.1	41.2	39.0
Mexican	53.0	50.6	49.8	66.9	64.4	63.0	38.9	36.8	36.7
Not Hispanic or Latino	64.1	52.1	49.8	70.2	63.7	61.2	58.7	41.2	39.0
White only	67.5	66.0	67.7	72.7	70.4	72.0	62.9	61.9	63.7
Black or African American only	47.8	46.8	46.5	57.1	56.4	57.0	40.7	39.3	38.4
Geographic region²
Northeast	68.7	68.0	68.4	74.4	73.2	73.8	63.8	63.7	63.7
Midwest	66.8	65.6	67.1	73.0	70.7	71.7	61.1	61.1	63.0
South	56.2	54.3	55.5	63.9	62.1	63.2	49.2	47.1	48.5
West	64.9	62.8	64.0	71.5	68.4	70.5	58.9	57.2	57.6
Location of residence²
Within MSA⁴	64.7	63.0	64.1	71.0	69.0	70.4	59.1	57.5	58.3
Outside MSA⁴	57.4	56.0	56.9	65.7	62.6	62.8	49.5	50.3	51.6
Level of alcohol consumption in past year for current drinkers⁵	Percent distribution of current drinkers
18 years and over, age adjusted²	Percent distribution of current drinkers
All drinking levels	100.0	100.0	100.0	100.0	100.0	100.0	100.0	100.0	100.0
Light	69.6	70.6	68.8	59.5	60.4	59.1	81.0	82.0	79.6
Moderate	22.5	22.2	23.4	31.8	32.0	32.6	12.0	11.5	13.0
Heavier	7.9	7.1	7.9	8.7	7.7	8.3	7.0	6.5	7.3

high homicide rate among African-Americans might be one of the reasons African-American men in their twenties and thirties have a higher death rate than men that age in other ethnic and racial groups. In 2001 there were 267.2 deaths per 100,000 non-Hispanic African-American men between the ages of twenty-five and thirty-four. In comparison, there were 131.4 deaths per 100,000 in that age group among non-Hispanic white males, 182.2 deaths per 100,000 in that age group among Native American males, 61.2 per 100,000 among Asian and Pacific Islander males,

	Both sexes			Male			Female
Characteristic	1997	2000	2001	1997	2000	2001	1997	2000	2001
18 years and over, crude	Percent distribution of current drinkers
All drinking levels	100.0	100.0	100.0	100.0	100.0	100.0	100.0	100.0	100.0
Light	69.8	70.8	69.0	59.6	60.5	59.2	81.4	82.3	79.9
Moderate	22.3	22.1	23.2	31.7	31.8	32.4	11.7	11.3	12.9
Heavier	7.9	7.1	7.8	8.8	7.7	8.4	6.9	6.4	7.2
Number of days in the past year with 5 or more drinks
18 years and over, crude
All current drinkers	100.0	100.0	100.0	100.0	100.0	100.0	100.0	100.0	100.0
No days	65.9	68.2	67.6	54.7	56.9	57.2	78.6	80.6	79.0
At least 1 day	34.1	31.8	32.4	45.3	43.1	42.8	21.4	19.4	21.0
1–11 days	18.5	17.4	17.1	22.0	21.2	19.9	14.6	13.3	14.0
12 or more days	15.6	14.4	15.3	23.4	21.9	22.8	6.8	6.1	7.0
Hispanic origin, race, and age³	Percent of persons with 5 or more drinks on at least one day among current drinkers
All persons:
18 years and over, age adjusted²	32.4	30.3	30.6	43.3	41.2	40.5	20.2	18.5	19.9
18 years and over, crude	34.1	31.8	32.4	45.3	43.1	42.7	21.4	19.4	20.9
18–44 years	42.4	40.4	41.4	54.6	52.3	52.2	28.7	27.0	29.2
18–24 years	51.6	52.2	51.8	61.5	60.8	60.1	40.2	42.4	41.7
25–44 years	40.0	37.1	38.3	52.8	49.9	49.7	25.7	22.8	25.7
45–64 years	25.3	23.5	23.8	36.1	35.0	34.7	12.9	10.8	11.9
45–54 years	28.5	25.5	26.4	40.1	37.9	38.0	15.3	12.0	14.0
55–64 years	19.6	19.9	18.9	28.9	29.9	28.7	8.3	8.7	8.0
65 years and over	11.2	9.1	8.2	17.8	14.8	13.1	4.4	3.4	3.1
65–74 years	13.9	11.3	10.2	21.6	18.3	15.5	5.5	4.2	4.0
75 years and over	6.7	5.8	5.3	11.0	9.5	9.1	*2.5	*	*
Race^2,3
White only	33.3	31.0	31.8	44.4	41.8	42.0	20.9	19.2	20.7
Black or African American only	23.6	23.9	20.6	31.7	34.1	27.5	14.9	12.7	12.5
American Indian and Alaska Native only	54.5	45.0	34.6	70.5	47.0	35.9	38.4	34.7	*27.9
Asian only	25.5	20.3	23.2	30.7	25.4	28.9	16.6	10.8	*12.9
Native Hawaiian and Other Pacific Islander only	- - -	*	*	- - -	*	*	- - -	*	*
2 or more races	- - -	44.0	41.6	- - -	53.1	59.9	- - -	31.5	24.3
Hispanic origin and race^2,3
Hispanic or Latino	36.8	31.9	32.2	46.3	43.0	41.9	22.3	16.0	17.9
Mexican	39.0	37.5	35.6	50.1	49.0	45.9	20.3	17.9	17.7
Not Hispanic or Latino	31.9	31.9	32.2	42.7	43.0	41.9	20.0	16.0	17.9
White only	33.2	31.2	32.0	44.5	42.1	42.2	21.0	19.7	21.3
Black or African American only	23.4	23.8	20.5	31.7	33.8	27.4	14.4	12.7	12.5
Geographic region	Percent of persons with 5 or more drinks on at least one day among current drinkers
Northeast	31.3	28.9	30.0	43.1	39.7	41.4	18.9	18.1	18.8
Midwest	33.8	33.3	33.6	44.7	44.7	44.4	21.6	21.5	22.4
South	30.9	27.4	27.9	40.5	37.1	36.1	19.2	15.6	18.0
West	33.4	32.0	31.7	44.6	43.1	41.4	20.8	18.8	20.1

and 115.5 per 100,000 among Hispanic males. (See Table 6.18.) The age-adjusted rate of deaths attributable to homicide ranges from 5.6 per 100,000 for non-Hispanic white males to 36.2 for black males. (See Table 6.19.)

HUMAN IMMUNODEFICIENCY VIRUS (HIV) DISEASE.

The difference in death rate from HIV disease among the racial and ethnic groups is staggering, with a much higher rate among African-Americans than any other group of Americans. In 2001, the death rate from HIV disease per 100,000 population among African-Americans was 22.8 compared with 6.2 deaths among Hispanics, 2.7 deaths among Native Americans/Alaska Natives, 2.1 deaths among non-Hispanic whites, and .07 deaths among APIs. (See Table 6.16.)