美国的种族-族裔群体和地理位置之间存在着巨大的死亡率差异，但种族-族裔差距在地理位置上的变异程度以及这些模式在死因上的变异程度并不十分清楚。我们的目标是通过种族-族裔群体、县市和死因对标化死亡率进行估算，并描述种族-族裔和基于地理区域的死亡率差异在美国的交叉点，比较不同健康状况下的模式。我们运用小区域估计模型对美国国家重要统计数据系统的死亡证明数据和美国国家卫生统计中心的人口数据进行处理，从2000年到2019年每年对19种广义死因进行按年龄、性别、县市和种族-族裔群体的死亡率进行估算。种族和族裔被分类为非拉美裔和非西班牙裔的美洲印第安人或阿拉斯加原住民（AIAN）、非拉美裔和非西班牙裔的亚洲人或太平洋岛民（亚洲）、非拉美裔和非西班牙裔的黑人（黑人）、拉美裔或西班牙裔（拉美裔）以及非拉美裔和非西班牙裔的白人（白人）。我们对这些死亡率进行了校正，以纠正死亡证明上种族和族裔的错误报告，并使用2010年美国人口普查数据进行了标准化，生成了标准化的年龄结果。从2000年到2019年，在美国的3110个县市中，所有考虑的死因的年龄标准化死亡率都存在种族-族裔差距。AIAN人口（2019年全因死亡率为1028.2 [95%不确定性区间922.2-1142.3]每10万人口）、黑人人口（953.5 [95%不确定性区间947.5-958.8]每10万人口）的死亡率显著高于白人人口（802.5 [95%不确定性区间800.3-804.7]每10万人口），而亚洲人口（442.3 [95%不确定性区间429.3-455.0]每10万人口）和拉美裔人口（595.6 [95%不确定性区间583.7-606.8]每10万人口）的死亡率显著较低，并且这种模式在大多数死因中都存在。然而，也存在着这种模式的例外情况，不同死因中种族-族裔群体之间的确切顺序、绝对和相对差异的大小以及这些差异随时间变化的程度因死因而异。同样，在所有死因中，无论是整体还是在每个种族-族裔群体内部，都观察到了相当大的地理差异。在全国范围内观察到的种族-族裔差异反映了县市层面上广泛存在的差异，尽管这些差异的大小在县市之间变化很大。某些差异模式在几乎所有县市中几乎普遍存在；例如，在2019年，AIAN人口比白人人口在至少95%的县市的皮肤和皮下疾病（465个没有蒙面估计的县市中的455个 [97.8%]）和HIV/AIDS和性传播感染（所有县市的1486个 [100.0%]）方面死亡率更高，而黑人人口比白人人口在几乎所有县市中在皮肤和皮下疾病（1486个县市中的1436个 [96.6%]）、糖尿病和肾脏疾病（1473个 [99.1%]）、孕产妇和新生儿疾病（1486个全县、市）和HIV/AIDS和性传播感染（1486个全县、市）方面死亡率更高。种族-族裔群体间的死亡差异是普遍存在的，不仅在美国各地，而且在各种健康状况下都存在。有迫切的需求来解决这些普遍存在的差距的共享结构因素。美国卫生研究院的少数民族健康与健康差距研究所、国家心脏、肺部和血液研究所、国家癌症研究所、国家老龄化研究所、国家关节炎和肌肉骨骼皮肤疾病研究所、疾病预防署和行为和社会科学研究办公室，美国国家卫生研究院。版权所有©2023 Elsevier Ltd。保留所有权利。

Large 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.We 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.From 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 this pattern, and the exact order among racial-ethnic groups, magnitude of the disparity in both absolute and relative terms, and change over time in this magnitude varied considerably by cause of death. Similarly, substantial geographical variation in mortality was observed for all causes of death, both overall and within each racial-ethnic group. Racial-ethnic disparities observed at the national level reflect widespread disparities at the county level, although the magnitude of these disparities varied widely among counties. Certain patterns of disparity were nearly universal among counties; for example, in 2019, mortality was higher among the AIAN population than the White population in at least 95% of counties for skin and subcutaneous diseases (455 [97·8%] of 465 counties with unmasked estimates) and HIV/AIDS and sexually transmitted infections (458 [98·5%] counties), and mortality was higher among the Black population than the White population in nearly all counties for skin and subcutaneous diseases (1436 [96·6%] of 1486 counties), diabetes and kidney diseases (1473 [99·1%]), maternal and neonatal disorders (1486 [100·0%] counties), and HIV/AIDS and sexually transmitted infections (1486 [100·0%] counties).Disparities in mortality among racial-ethnic groups are ubiquitous, occurring across locations in the USA and for a wide range of health conditions. There is an urgent need to address the shared structural factors driving these widespread disparities.National Institute on Minority Health and Health Disparities; National Heart, Lung, and Blood Institute; National Cancer Institute; National Institute on Aging; National Institute of Arthritis and Musculoskeletal and Skin Diseases; Office of Disease Prevention; and Office of Behavioral and Social Sciences Research, US National Institutes of Health.Copyright © 2023 Elsevier Ltd. All rights reserved.