Historical slavery predicts contemporary disparities in mortality between Black and White Americans

We tested whether contemporary Black–White mortality disparities in the United States may be rooted in the historical legacy of slavery and perpetuated through structural inequalities. Linking county-level data on the proportion of enslaved people in 1860 with structural inequality indicators from 1990 to 2000 and mortality outcomes from 2010 to 2020, we find that historical slavery is robustly associated with contemporary racial mortality gaps. Our model estimates ~22 additional deaths per 100,000 among Black Americans relative to White Americans for every 10% increase in the 1860 enslaved population. Path analysis models showed that segregation, economic inequality, and racial disparities in poverty and education statistically mediated this effect. We test the plausibility of a causal pathway using an instrumental variable analysis and explore the robustness of our theoretical model in multiple supplemental analyses. Our analyses held even after controlling for a comprehensive suite of historical and contemporary covariates. These findings are consistent with a model wherein slavery’s legacy continues to shape present-day Black–White racial health disparities via enduring structural inequities.