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Jim Crow and Premature Mortality Among the US Black and White Population, 1960–2009: An Age–Period–Cohort Analysis

Krieger, Nancya; Chen, Jarvis T.a; Coull, Brent A.b; Beckfield, Jasonc; Kiang, Mathew V.a; Waterman, Pamela D.a

doi: 10.1097/EDE.0000000000000104

Background: Scant research has analyzed the health impact of abolition of Jim Crow (ie, legal racial discrimination overturned by the US 1964 Civil Rights Act).

Methods: We used hierarchical age–period–cohort models to analyze US national black and white premature mortality rates (death before 65 years of age) in 1960–2009.

Results: Within a context of declining US black and white premature mortality rates and a persistent 2-fold excess black risk of premature mortality in both the Jim Crow and non-Jim Crow states, analyses including random period, cohort, state, and county effects and fixed county income effects found that, within the black population, the largest Jim Crow-by-period interaction occurred in 1960–1964 (mortality rate ratio [MRR] = 1.15 [95% confidence interval = 1.09–1.22), yielding the largest overall period-specific Jim Crow effect MRR of 1.27, with no such interactions subsequently observed. Furthermore, the most elevated Jim Crow-by-cohort effects occurred for birth cohorts from 1901 through 1945 (MRR range = 1.05–1.11), translating to the largest overall cohort-specific Jim Crow effect MRRs for the 1921–1945 birth cohorts (MRR ~ 1.2), with no such interactions subsequently observed. No such interactions between Jim Crow and either period or cohort occurred among the white population.

Conclusion: Together, the study results offer compelling evidence of the enduring impact of both Jim Crow and its abolition on premature mortality among the US black population, although insufficient to eliminate the persistent 2-fold black excess risk evident in both the Jim Crow and non-Jim Crow states from 1960 to 2009.

Supplemental Digital Content is available in the text.

From the aDepartment of Social and Behavioral Sciences, Harvard School of Public Health (HSPH), Boston, MA; bDepartment of Biostatistics, HSPH, Boston, MA; and cDepartment of Sociology, Harvard University, Cambridge, MA.

Submitted 24 May 2013; accepted 7 January 2014; posted 12 May 2014.

Supported by Robert Wood Johnson Health and Society Scholars at Harvard Seed Grant and National Institutes of Health/National Cancer Institute 1R21CA168470.

The authors report no conflicts of interest.

Supplemental digital content is available through direct URL citations in the HTML and PDF versions of this article ( This content is not peer-reviewed or copy-edited; it is the sole responsibility of the author.

Correspondence: Nancy Krieger, Department of Social and Behavioral Sciences, Harvard School of Public Health, Kresge 717, 677 Huntington Avenue, Boston, MA 02115. E-mail:

© 2014 by Lippincott Williams & Wilkins, Inc