Abstract

BackgroundLarge disparities in mortality exist across racial–ethnic groups and by location in the USA, but the extent to which racial–ethnic disparities vary by location, or how these patterns vary by cause of death, is not well understood. We aimed to estimate age-standardised mortality by racial–ethnic group, county, and cause of death and describe the intersection between racial–ethnic and place-based disparities in mortality in the USA, comparing patterns across health conditions.MethodsWe applied small-area estimation models to death certificate data from the US National Vital Statistics system and population data from the US National Center for Health Statistics to estimate mortality by age, sex, county, and racial–ethnic group annually from 2000 to 2019 for 19 broad causes of death. Race and ethnicity were categorised as non-Latino and non-Hispanic American Indian or Alaska Native (AIAN), non-Latino and non-Hispanic Asian or Pacific Islander (Asian), non-Latino and non-Hispanic Black (Black), Latino or Hispanic (Latino), and non-Latino and non-Hispanic White (White). We adjusted these mortality rates to correct for misreporting of race and ethnicity on death certificates and generated age-standardised results using direct standardisation to the 2010 US census population.FindingsFrom 2000 to 2019, across 3110 US counties, racial–ethnic disparities in age-standardised mortality were noted for all causes of death considered. Mortality was substantially higher in the AIAN population (all-cause mortality 1028·2 [95% uncertainty interval 922·2–1142·3] per 100 000 population in 2019) and Black population (953·5 [947·5–958·8] per 100 000) than in the White population (802·5 [800·3–804·7] per 100 000), but substantially lower in the Asian population (442·3 [429·3–455·0] per 100 000) and Latino population (595·6 [583·7–606·8] per 100 000), and this pattern was found for most causes of death. However, there were exceptions to