Key Points Question How do all-cause mortality rates and racial inequities in rates vary across the 30 most populous US cities? Findings In this cross-sectional study of more than 26 million death records during a 10-year period, city mortality rates differed widely as did inequities between Black and White populations. Overall mortality rates improved in less than half of the 30 cities, and racial inequities worsened in more cities than in which they improved. Meaning Given the substantial variation in city-level mortality rates and racial inequities, cities need data specific to their jurisdiction to inform local health policy.

Striking disparities between neighborhoods and racial/ethnic groups in adult influenza and pneumococcal vaccination coverage highlight the need for improved local-level immunization coverage data.

Introduction The Affordable Care Act’s (ACA) preventive services provision (PSP) removes copayments for preventive services such as cancer screening. We examined: 1) whether a shift in breast cancer stage occurred, and 2) the impact of the provision on racial/ethnic disparities in stage. Materials and Methods: Data from the National Cancer Data Base were used. The pre- and post-PSP periods were identified as 2007–2009 and 2011–2013, respectively. Proportion differences (PDs) and 95% confidence Intervals (CIs) were calculated. Results: All three racial/ethnic groups experienced a statistically significant shift toward Stage I breast cancer. Pre-PSP, black:white disparity in Stage I cancer was −9.5 (95% CI: −8.9, −10.4) and the Latina:white disparity was −5.2 (95% CI: −4.0, −6.1). Post-PSP, the disparities improved slightly. Discussion: Preliminary data suggest that the ACA’s PSP may have a meaningful impact on cancer stage overall and by race/ethnicity. However, more time may be needed to see reductions in disparities. METHODS A sensitivity analysis was also carried out to examine if changes in the pre- and post-PSP periods could be accounted for by secular trends such as the observed decline in the rate of late stage breast cancer.1 Therefore, the overall and racial/ethnic-specific proportions in stage I cancer were examined for 2004–2006 and compared to those of the pre- and post-PSP periods. RESULTS Sensitivity Analysis. The sensitivity analysis revealed that between 2004–2006 and the pre-PSP period (2007–2009), the proportion of stage I breast cancers had statistically significantly increased by 1.4 and 1.5 percentage points for white and black women, respectively, but did not change for Latina women (PD=−0.5; 95% CI: −1.0 – 2.1). However, the shift toward stage I breast cancers that occurred between the pre- and post-PSP periods was considerably larger (Figure 1). It increased by 3.2, 4.0, and 4.1 percentage points for white, black, and Latina women respectively. Supplementary data can be found in the online version of this paper. DISCUSSION In addition, we carried out a sensitivity analysis to better understand how secular trends might account for the changes we observed between the pre- and post-PSP periods.

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