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How Did Cause of Death Contribute to Racial Differences in Life Expectancy in the United States in 2010? What causes of death influenced the difference in life expectancy between the black and white populations in 2010?
What causes of death influenced the difference in life expectancy between black and white males in 2010?
What causes of death influenced the difference in life expectancy between black and white females in 2010? In 2010, life expectancy for the black population was 3.8 years lower than that of the white population.
Life expectancy for the black population was lower (3.8 years) than life expectancy for the white population because of higher death rates due to heart disease, cancer, homicide, diabetes, and perinatal conditions (Figure 3), which accounted for 60% of the black population disadvantage. The black disadvantage outweighed any advantages with respect to the diseases listed in Figure 3.
Higher death rates for black males due to heart disease, homicide, cancer, stroke, and perinatal conditions accounted for 65% of the black male disadvantage (Figure 4). Lower death rates for black males due to suicide, unintentional injuries, Chronic liver disease, Chronic lower respiratory diseases, and Parkinson's disease accounted for 96% of the black male advantage. Higher death rates for black females due to heart disease, cancer, diabetes, perinatal conditions, and stroke accounted for 61% of the black female disadvantage (Figure 5). Lower death rates for black females due to Chronic lower respiratory diseases, unintentional injuries, suicide, Alzheimer's disease, and Chronic liver disease accounted for 93% of the black female advantage. In 2010, life expectancy for the black population was lower than for the white population, mostly due to disparities in death rates from heart disease, cancer, and homicide. The gap in life expectancy between the white and black populations would have been larger than 3.8 years if not for the lower death rates for the black population for suicide, unintentional injuries, and Chronic lower respiratory diseases. This report is the first in a series to explore the causes of death contributing to differences in life expectancy between detailed ethnic and racial populations in the United States. Cause-of-death classification: Medical informationa€”including injury diagnoses and external causes of injurya€”that is entered on death certificates filed in the United States, and is classified and coded in accordance with the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICDa€“10) (3). Life expectancy: Average number of years that a group of infants would live if the group was to experience throughout life the age-specific death rates present in the year of birtha€”also referred to as period or current life expectancy (1). All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.
Diabetes cases among Medicaid-enrolled patients jumped 23 percent in states that expanded the program under Obamacare, a new study finds. About Speaking of DiabetesSpeaking of Diabetes is produced by Joslin Diabetes Center for people with diabetes and those who care for them.. Joslin Diabetes Center, a teaching and research affiliate of Harvard Medical School, is a one-of-a-kind institution on the front lines of the world epidemic of diabetes - leading the battle to conquer diabetes in all forms through cutting-edge research and innovative approaches to clinical care and education. This entry was posted in Diabetes Day2Day, Guideline, Type 2 Diabetes and tagged a1c, type 2 a1c targets, Type 2 Diabetes. A joint position paper by American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) questions the veracity of a one size fits all specific A1C target for non-pregnant patients with type 2 diabetes. The table below indicates the order and intensity of importance of factors to consider when deciding on individual patient treatment goals. The report appearing in the April 19 2012 issue of Diabetes Care also re-emphasized the importance of dietary and physical activity approaches and suggested that highly motivated patients who are initially diagnosed with an A1C under 7.5% be given a 3 to 6 month trial of lifestyle before initiating drug therapy. In addition, while noting that the available oral pharmaceutical agents have some variation in their ability to lower A1C, the authors concluded that all of the agents available are in the same ball park in their efficacy. Diet, exercise, and education remain the foundation of any type 2 diabetes treatment program. Ultimately, many patients will require insulin therapy alone or in combination with other agents to maintain glucose control.
The authors also made a number of recommendations about treatment for patients with type 2 diabetes who have many other medical problems. For people with heart failures, while recommending the avoidance of thiazolidinedones (TZDS) such as Actos® and Avandia® (since they can potentate fluid overload) they suggested that metformin may not be as problematic a choice of medication in this population as previously believed.
The primary goal of this educational program is to update primary care physicians on the prevention and management of type 2 diabetes.
Current guidelines recommend metformin for most patients when starting hypoglycemic agents.7 However additional patient factors determine which other agents are selected either at diagnosis or once HbA1c goals are no longer being achieved on monotherapy.
These recommendations are based on current evidence about medication efficacy in relation to clinical outcomes and not only HbA1c levels, as well as data on drug side effects.
The content of this website is educational in nature and includes general recommendations only; specific clinical decisions should only be made by a treating physician based on the individual patient’s clinical condition. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33).
Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34).
The projected average annual growth rate under the assumption of no further unexplained growth is 1.8%.
Using both population growth forecasts (one according to the birth rate, the other with unexplained growth factored in, as discussed above) the ABS estimates the proportion of the total Indigenous population aged less than 15 years is projected to fall from 39% at June 2001 to 35% in 2009. After his doctor told him that ‘time was running out’ and that his life expectancy was being reduced more and more each day, at 54 years of age, he made a conscious effort to turn his life around.
At the time, Christian a German baker by trade, created a low carb, high protein, low GI bread for the Australian market.
Type 2 Diabetes is the most common form of diabetes and is known as the ‘lifestyle diabetes’. Recent studies by the Newcastle University in the United Kingdom have found that it is possible to reverse diabetes through a controlled low energy diet. You can get active in lots of ways, but walking is one of the easiest steps you can take to improve your health. For some time now I have been a passionate supporter of the American Heart Association and of National Walking Day. Lace up and get moving with the American Heart Association in celebration of National Walking Day, Wednesday, April 6 and the health benefits of an active lifestyle. These days, we're spending more time at work and sitting in front of a screen than ever before. Increasing your physical activity, including simply walking more, has many health benefits.
Being inactive is a risk factor for heart disease and stroke, which are the nation's leading cause of death and a leading cause of disability. So be sure to pack your walking shoes and take them to work with you on Wednesday, April 6. Essentially obesity is caused when the number of calories consumed through eating is greater than the calories used in physical activity. Morbid obesity is a complex medical disorder, however, and there are a number of other contributing factors. It has also been suggested that psychological and environmental factors can influence your body weight.
Environmental factors could include your lifestyle behaviours, for example the way in which you cook food, the type of job you have and also whether you incorporate exercise within your day-to-day life. Obese people have a high proportion of body fat, and more fat deposits in arteries to the heart. Being overweight contributes to angina which is a chest pain caused by decreased oxygen to the heart.
The extra weight that is carried on the body puts pressure on the joints, especially the knees, ankles and lower back.
In both males and females, obesity increases the risk of developing cancer of the large intestine and the rectum.
As well as the medical problems caused by being obese it can also be hugely detrimental to your level of self-esteem, motivation and body image. The surgical treatment of obesity is called bariatric surgery after the Greek word baros meaning "weight" and iatrikos meaning "the art of healing".
Weight loss (bariatric) surgery is an extremely effective way of losing weight and keeping the weight off long term. Bariatric surgery outcome data illustrates that weight loss is the most powerful therapy we have in medicine today. After Bariatric surgery, most patients lose 50-60% of their excess body weight (%EBW) within three years. The following graph demonstrates how over that last two decades, there has been an exponential increase in numbers of people who are affected by extreme obesity. It is well established that the significant excess weight loss achieved via bariatric surgery in high risk patients improves life expectancy. In another study 1,468 patients who underwent a gastric band procedure were followed up for an average of 3.6years to assess mortality in the medium term following the procedure. In a review of pooled data from 136 studies involving bariatric surgery, participants experienced a mean excess weight loss of 61.2%.
No other treatment other than significant weight loss can have such a powerful effect on type 2 diabetes. The Swedish Obese Subjects (SOS) study has followed patients over 10years post Bariatric surgery. The SOS study demonstrated the following improvement in health outcomes were achieved as a result of patients undergoing bariatric surgery4. Several studies report superior rates of diabetes remission following gastric bypass in relation to those achieved with gastric banding. An important study randomised 30 with type 2 diabetes to receive gastric banding and 30 patients to receive conventional medical therapy in order to compare these two different treatment approaches. The Lap-band now has a European licence for the treatment of type 2 diabetes via weight loss. Bariatric surgeons in particular and the wider medical profession in general are understandably extremely impressed with the results of bariatric surgery in terms of significantly improved health outcomes following surgery.

It is however important to exercise a degree of caution when describing a surgical cure for a chronic disease such as type 2 diabetes which may have been present for some years prior to bariatric surgical intervention.
It is important to understand that type 2 diabetes is associated with increased risk of cardiovascular disease, and is the condition is often present for several years prior to diagnosis.
Surgery results in biochemical resolution of type 2 diabetes in approximately 60% -75% of patients post gastric banding: the so-called "remitted diabetic state".
This person may now exhibit normal glucose regulation without diabetes medication and therefore may be able to discontinue insulin therapy for example. The person having undergone surgery may therefore benefit from continuing some medication postoperatively e.g.
It is important to consider two important concepts regarding health outcomes in relation to Bariatric surgery.
The two most common bariatric procedures are laparoscopic adjustable gastric banding (LAGB) and gastric bypass, also known as Roux en Y gastric bypass (RYGB).
In addition to a restrictive component, the gastric bypass also promotes weight loss via introducing an element of malabsorption.
Placement of a gastric band just below the gastro-oesophageal junction creates a small pouch of stomach and a degree of restriction which delays the passage of food into the main body of the stomach. As the signal of feeling full logically comes most strongly from stretching of the top of the stomach when it is full, the restriction at the top of the stomach by the band causes a feeling of fullness very quickly after eating a small amount of food. The gastric bypass procedure involves surgically fashioning a small pouch of stomach, involving surgical dissection and a stomach stapling procedure.
The small bowel is divided below the duodenum and the distal end of the small bowel is brought up to attach to the newly fashioned stomach pouch. The entirely malabsorptive procedures biliopancreatic diversion (BPD) with duodenal switch (DS) are less common procedures and in the main should be regarded as less suitable than the restrictive procedures for the majority of patients considering bariatric surgery in view of the higher operative risk and more significant long term post operative sequele associated with purely malabsortive procedures. Both LAGB and RYBG should be regarded as safe procedures with operative mortality approaching zero in experience centres. Gastric band (LAGB) requires re-operation in 5-10% of cases, laparoscopically in the vast majority of cases to remedy generally minor occurrences such as slippage of the band, a degree of bowel protrusion above the band (prolapse), or problems with the injection port of tubing. The change in upper gastrointestinal tract anatomy as a result of gastric bypass brings with it significant benefits such as promoting immediate duodenal rest and facilitating rapid remission of type 2 diabetes. Gastric bypass is very effective in producing a dramatic improvement and remission of type 2 diabetes, often within days of surgery.
Iron and B12 malabsorption are a consequence of rendering the main body of the stomach obsolete.
Laparoscopic adjustable gastric band (LAGB) is the safest bariatric operation and might well be the preferred weight loss surgery procedure for the great majority of patients, particularly given recent data suggesting equitable weight loss outcomes between the LAGB and more invasive procedures such as gastric bypass when analysed 3years post operatively. The information presented here comparing gastric bypass (Roux en Y) and laparoscopic gastric band (LAGB) procedures may serve to explain the dramatic rise in gastric band procedures in Australia against a background low level of gastric pass surgery over the last 14years. The following paper also provides a useful review of the issues relating to these bariatric procedures and highlights the advantages of the gastric band over Roux en Y gastric bypass. This difference was due to higher death rates for the black population for heart disease, cancer, homicide, diabetes, and perinatal conditions.
This difference was due to higher death rates for black males for heart disease, homicide, cancer, stroke, and perinatal conditions. This difference was due to higher death rates for black females for heart disease, cancer, diabetes, perinatal conditions, and stroke. Higher heart disease mortality for the black population accounted for a loss of 1.007 years in life expectancy. But differences between the white and black populations still exist, with a gap in life expectancy of 3.8 years. Similarly, the differences between black and white male life expectancy (4.7 years) were due to disparities in death rates from heart disease, homicide, and cancer. Data showing life expectancy for 2010 are based on a newly revised methodology and may differ from figures previously published. Phase I Report: Recommendations for the framework and format of Healthy People 2020, Appendix 11. International statistical classification of diseases and related health problems, tenth revision (ICDa€“10). How did cause of death contribute to racial differences in life expectancy in the United States in 2010? The disease is responsible for .332 years of the difference in life expectancy between blacks and whites.
Instead it suggests focusing on individually targeted glycemic goals based on a series of patient attributes including patient desires and attitudes toward treatment, potential for hypoglycemia, disease duration, life expectancy, co-morbidities, vascular complications and patient resources. In addition to glycemic control the position statement recommends clinicians and patients take into account cardiovascular risk management due to the high morbidity load this places on patients with type 2 diabetes. Therefore, the decision of second or third drug to add as should be based on patient co-morbidities and drug side- effect profiles. Combination therapy with an additional 1–2 oral or injectable agents is reasonable, aiming to minimize side effects where possible.
In patients with minimal to moderate ventricular dysfunction, stable cardiovascular status and normal renal function, it could be considered.
We present the risks and benefits of the different treatment options and provide guidance on selecting the most appropriate agent for each patient. National diabetes statistics report: estimates of diabetes and its burden in the United States.
Projection of the year 2050 burden of diabetes in the US adult population: dynamic modeling of incidence, mortality and prediabetes prevalence. The influence of age on the effects of lifestyle modification and metformin in prevention of diabetes.
Effects of aerobic and resistance training on hemoglobin A1c levels in patients with type 2 diabetes: a randomized controlled trial. This compares with 3.4% for annual growth rate assuming the continuing unexplained growth continues[20]. Indigenous persons aged 65 years and over comprised 3% of the total Indigenous population in 2001. Not just for me, but for other obese people, for diabetics, for vegetarians, for people looking to build muscle mass, or for any person who just wants the simple goal of living a healthy lifestyle,” he said. We have demonstrated that in people who have had type 2 diabetes for 4 years or less, major weight loss returns insulin secretion to normal. Too much fat within liver and pancreas prevents normal insulin action and prevents normal insulin secretion.
Union Bank is a proud sponsor of the AHA's National Walking Day activities because we believe in the direct correlation between good physical health and good fiscal health. We're becoming less active, which can increase our risk of heart disease, stroke and other diseases. Research has shown that every hour of regular exercise can add about two hours to life expectancy, even if you don't start until midlife. The American Heart Association recommends that adults should get at least 150 minutes of physical activity a week, and kids should get 60 minutes of physical activity every day. The extra weight puts added stress on every part of your body and creates many risks to your health.
It has been proven that the chance of having morbid obesity is increased if other people in your family have the condition. Most people are aware when they are full through eating because our stomach tells our brain it is full and to stop.
Although being overweight is relatively harmless, being obese or morbidly obese can cause long term health risks and reduce overall life expectancy. This can develop into diabetes, a condition where a person’s body is unable to control their sugar levels. Too much cholesterol in your blood can damage your blood vessels and lead to heart disease or a stroke. It has been suggested obesity in women creates hormonal imbalance with disruption to the menstrual cycles. It is when you stop breathing during sleep, due to the weight of excess fat around the neck.
Bariatric surgery is the only effective treatment for morbid obesity in terms of inducing and maintaining satisfactory weight loss and significantly decreasing weight related co-morbidities.
Significant weight loss achieved via bariatric surgery results in a high rate of remission of important obesity-related diseases such as type 2 diabetes, hypertension and obstructive sleep apnoea. Rather they are a lifelong process requiring careful patient selection and programme for long-term follow up and support. This usually equates to a weight loss of 30-40kg (5-6 stones) or more depending upon starting weight.
People with a BMI >35 have twice the risk of death at any age when compared to people who have a BMI within the normal range.
This surgically treated group were compared to 2119 obese patients who had been followed up over 12years to assess mortality rate. The SOS data demonstrates impressive long term resolution of significant obesity-related co-morbidities as a result of between 13% and 25% loss of total body weight (note this outcome data appears less impressive as the weight loss is expressed as total body weight loss rather than excess weight loss) achieved via a range of bariatric surgical approaches. Bariatric surgery can result in significant improvements in cholesterol levels and restoration of normal glucose regulation indicating biochemical resolution of T2DM. However this person continues to be at increased risk compared with a person of 100kg with no prior history of being 130kg and no prior history of type 2 diabetes. Both procedures facilitate weight loss either solely in the case of LAGB or predominantly in the case of gastric bypass, by limiting food intake and enhancing a feeling of fullness (satiety) by effectively reducing stomach size. As you can see from the following diagram, the gastric bypass involves re-directing or re-routing ingested food away from the main body of the stomach and first part of the small intestine. The gastric band is a purely restrictive procedure and involves no changing of bowel anatomy to re-route of food and no stomach stapling surgery.
This operation renders to main body of the stomach redundant as it receives no ingested nutrients.

Ingested food receives less digestion as it avoids the stomach and less exposure to stomach acid. As gastric bypass involves stomach stapling, dividing and re-joining bowel (anastamosis), the procedure carries more operative risk then the gastric band (LAGB). It is important to remember that 90-95% of patients do not require any surgical "maintenance" of this nature. In a questionnaire distributed to 470 consecutive patients undergoing bariatric operation in two major centres in two different countries, 85% chose LAGB with 49% claiming "safety" as the reason over gastric bypass and BPD with DS. Although impressive weight loss is achieved within the first year of the gastric bypass procedure, the inability to make adjustments to the gastric bypass postoperatively may have implications with regards a reduction in medium to long term efficacy of this procedure and achievement of weight loss maintenance.
There is also a significant drawbacks of this procedure as it causes a degree of permanent malabsorption of ingested nutrients. The rapid improvement is possibly related to diversion of ingested nutrients away from the proximal small bowel or duodenum: Gastric bypass is a very effective way of inducing so-called "duodenal rest". Reduction in fat absorption and therefore fat-soluble vitamin absorption following gastric bypass is a result of reduced contact of ingested food with lipases.
Countries such as Australia and USA who have significant experience of a range of bariatric surgical procedures are demonstrating a trend towards less invasive surgical approaches to weight loss such as LAGB. Access to the materials on this web site for the sole purpose of personal educational use only. These disparities in life expectancy at birth between the black and white populations can be examined to determine which leading causes of death contribute most to the differences. For black females, diabetes is added to heart disease and cancer as the major causes contributing to the differences in life expectancy (3.3 years) compared with white females. Without the advantage of these three causes of death, the gap in life expectancy would increase to 4.4 years.
A complete description of the Arriaga life table partitioning methodology can be found in references 5 and 6. Anderson are with the Centers for Disease Control and Prevention's National Center for Health Statistics, Division of Vital Statistics, Mortality Statistics Branch. Many oral agents are cleared through the kidneys and doses need to be reduced for those with renal impairments.
All materials contained on this site are protected by United States copyright law and may be used for personal, noncommercial use only. However a tighter target, such as ?6.5%, may be appropriate for younger patients and newly diagnosed patients without existing cardiovascular disease.
But about half of us don't make exercise a regular habit, and almost a third of us report participating in no physical activity at all. Diabetes is a serious health condition and can increase the risk of kidney failure and blindness. Whereas in men it can result in lower levels of the hormone testosterone, a diminished sex drive and a reduced ability to produce sperm. It is now well established that bariatric surgery also significantly reduces mortality in those patients eligible for treatment. As such this form of intervention should only be undertaken by centres offering experienced multidisciplinary pre-operative patient assessment. A bariatric procedure would be considered unsuccessful with excess weight loss of less than 25% at two years. The death rate in the surgical intervention group was 89% less than in the group which did not have surgery2. Of the surgically treated group, 5 patients had died compared to 225 who had died in the group of patients that had not lost weight. Bariatric surgery data demonstrates that in most cases type 2 diabetes disappears with weight loss. It is also important to appreciate that total body weight loss following gastric banding is now in the region of 20% rather than the 13.2% quoted here, as a result of improvements in technique and patient follow-up protocols. Cottam et al observed Type 2 diabetes remission in 78% and 50% of diabetic RYGB and LAGD patients respectively after a 3-year follow up, however several other studies have found no significant differences in rates of diabetes remission between the two procedures [ see Favaretti paper listed below for a review].
The study found marked differences in outcomes in favour of the gastric band at 2years from the start of the treatment. Bariatric surgery undoubtedly reduces risk and is known to reduce diabetes-related death as a result of remission of this disease postoperatively. This effectively reduces contact with digestive enzymes which enter the bowel at this point. It also receives delayed exposure to digestive enzymes from the pancreas which enter the duodenum and only has a chance to mix with ingested food once the food passes beyond the Y- shaped small-bowel anastamosis (anastamosis essentially means the point at which the divided bowel has been re-joined). It is also important to note that re-operation in the case of gastric bypass patients is often required for more complex problems such as internal hernia or narrowing of the junctions between the surgically divided and re-joined bowel (anastomotic stenosis) . The adjustability of the gastric band (LAGB) is a significant advantage over gastric bypass.
It appears that resting the duodenum from contact with nutrients and dietary fat is a significant factor in promoting diabetes resolution.
These fat-digesting enzymes enter the rested segment of bypassed duodenum via the pancreatic duct and have no contact with ingested food until they reach the anastomosis between the Roux limb with the ileum. 14,000 bariatric procedures are now performed in Australia each year and over 90% of these are Laparoscopic Adjustable Gastric Banding. Surgery decreases long-term mortality, morbidity, and health care use in morbidly obese patients.
A case-controlled matched pair cohort study of laparoscopic roux-en-y gastric bypass and Lap-Band patients in a single US center with three year follow up.
Adjustable gastric banding and conventional therapy for type 2 diabetes: a randomized controlled trial.
Studies of Swedish adjustable gastric band and Lap-Band: Systemic review and meta-analysis. Objective comparison of complications resulting from laparoscopic gastric banding for treatment of morbid obesity.
Downloads of patients monitoring sheets may be freely copied and where appropriate a single print out of a reasonable proportion of these materials may be made for personal education, research and private study.
For the white population, life expectancy increased 10%, and for the black population the increase was 17%.
For black males, the causes that show an advantage over white males were suicide, unintentional injuries, and Chronic liver disease, while the advantageous causes for black females were the same as the causes for the black population.
Glyburide, a drug which stays in the body for a long time, should be avoided in this population due to its potential to cause sustained hypoglycemia. For patients with multiple comorbidities, frail elderly, those at greatest risk of hypoglycemia or with a limited life expectancy, a less stringent HbA1c ?8% may be reasonable. By not identifying when the stomach is full, some individuals continue to consume more food.
Crucially, centres should provide evidence of a well established protocol for long term post-operative management as this is so important in ensuring a successful outcome following surgery1. In centres of excellence approximately 3% of patients are deemed to have had unsuccessful weight-loss surgical intervention by this criterion.
Following adjustment for length of follow up, sex and weight differences between the two groups to allow direct comparison, the risk of dying had been reduced by 73% in the gastric band-treated cohort3.
Treatment with the lap-band resulted in 73% remission in type 2 diabetes, associated with a 20.7% loss of total body weight.
However surgery does not reset risk - some excess residual increased risk remains in view of the past history of diabetes. One study looked at 780 bariatric procedures retrospectively and found that total complications rates were 9% for LABG and 23% for RYGB8.
Similarly the main body of the stomach ordinarily produces a factor to facilitate B12 absorption (intrinsic factor).
Materials should not be further copied, photocopied or reproduced, or distributed in electronic form.
Nevertheless, differences in life expectancy by race have been observed and have persisted at least since official estimates have been recorded.
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The high rate of success in these centres reflects significant experience in pre-operative counselling and patient selection and excellent long term post-operative support and follow up.
The conventional medical therapy group achieved a 13% remission rate in type 2 diabetes and a 1.7% loss of body weight.
As this normal physiology is disrupted with bypass surgery, patients are rendered dependent upon lifelong 3 monthly B12 injections to prevent B12 deficiency and resultant pernicious anaemia after gastric bypass surgery. Measuring health disparities, including life expectancy at birth, is part of the Healthy People 2020 recommendations (2).
This highly significant result represents a 5.5-fold greater remission rate of type 2 diabetes with surgical gastric band treatment when compared with medical therapy5.
Although this remains within the obese range, there is a high chance that associated co-morbidities will be resolved by surgery, and as we have seen, bariatric surgery outcome data demonstrates impressive reduction in mortality as a result of this degree of weight loss. Any other unauthorised use or distribution of the materials may constitute an infringement of Cut the Waist Limited's copyright and may lead to legal action. These disparities can be examined by looking at the leading causes of death and how these causes influence life expectancy at birth.
In this report, differences in the leading causes of death among black and white populations are examined to determine which causes contributed to the difference in life expectancy between the black and white populations in 2010. Walking as form of exercise has helped me stay fit and focused on maintaining good heart health.

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