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Health Gap Widens Between Rich, Poor : Mortality: Federal report also shows big differences in death rates among ethnic groups. White House uses figures to push reform plan.


WASHINGTON — The disparity in death rates between affluent suburbanites and poor residents of inner-city and rural areas is widening, providing further evidence of uneven access to medical care nationwide, the government said Wednesday in its annual report on the state of Americans' health.

The report, released by the Department of Health and Human Services, also demonstrated that while Americans' life expectancy is at an all-time high of 75.5 years--and infant mortality is at an all-time low--enormous differences in death rates exist among various ethnic groups.

While strides have been made in reducing deaths from the major killers--heart disease and stroke--the homicide rate is on the increase, particularly among youths 15 to 24 years old.

This year, for the first time, the government analyzed death rates by educational level and found the relationship striking.

The annual report was prepared by the nonpartisan National Center for Health Statistics and was based on the most recent figures available in various categories.

It was released by Health and Human Services Secretary Donna Shalala, who used the opportunity to promote the Clinton Administration's proposals for overhauling the nation's health care system.

Shalala blamed many of the disparities in death rates, for example, on the inability of large numbers of Americans to gain access to proper health care services--something the Administration has vowed to change.

"Many Americans can't afford or can't obtain the care they need to prevent illness and maintain good health," Shalala said as she released the report. "It's unfair to our citizens--and unwise as a nation--to fail to deliver basic services because of an individual's inability to pay or a family's health insurance coverage."

The report said that compared to suburbanites, death rates are 12% higher in rural counties and 19% higher in core metropolitan counties.

By comparison, during the 1980s, death rates declined by 10% in the suburbs, but only by half as much in the inner cities.

Black Americans had disproportionately high mortality rates from many of the major causes of death compared to other groups, while Asian-Americans had the lowest, the report said.

From 1988 to 1990, for example, Asian-Americans 45 years of age and older had the lowest death rates from heart disease. The rates were about 25% lower than for Latinos and American Indians, about half that of whites and 63% lower than that of blacks, the report said.

Furthermore, the report said, the infant-mortality rate among blacks is more than twice that of whites.

In its analysis of the connection between mortality and education, the study said that from 1989 to 1990, death rates for men and women 25 to 44 years old without a high school education were about three times that of college graduates. In middle age, the difference was about twofold, the report said.

The difference may indicate that education plays a role in an individual's awareness of health issues and affects living conditions and access to care, the report said.

Reiterating an oft-repeated Administration figure, the report said that since 1987, the number of uninsured Americans has grown from 31 million to 37 million.

Citing census statistics, the HHS estimated that 21% of blacks and 32% of Latinos were uninsured, compared with 11% of white non-Latinos.

In addition to the average two-year increase in life expectancy, infant mortality in 1992 reached a record low of 8.5 per 1,000 live births. That was a decline of 4% from the previous year and a "dramatic" decline since the 1970 figure of 20 deaths per 1,000 births, preliminary data shows.

Death rates for heart disease--the leading killer of men and women--dropped 25% between 1980 and 1990. For stroke, the third-leading cause of death, the rate declined 32% during the past 10 years, the report said.

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