Williams, Cantor, et al. Examine Black-White Death Inequities

Longitudinal Associations From US State/Local Police and Social Service Expenditures to Suicides and Police-Perpetrated Killings Between Black and White Residents

Abstract

Policy Points Despite documented inequities in suicide trends and police-perpetrated killing for Black compared with White Americans, government expenditures have not been examined as upstream drivers of these inequities. This longitudinal study found police expenditures predicted increases in suicide and police-perpetrated killings for Black, but not White, residents. Housing and community development expenditures were associated with decreases in suicide for Black residents only, and kindergarten through 12th grade (K-12) education expenditures were associated with decreases in suicide for White residents only. Findings suggest reducing police, and increasing housing, expenditures may reduce Black-White inequities in suicide and police-perpetrated killing.

Context: Despite documented inequities in suicide trends and police-perpetrated killing for Black US Americans, there is little research investigating how structural factors like government expenditures may drive these outcomes. This study examined associations from police and social services expenditures to later suicides and police-perpetrated killings for Black and White residents.

Methods: This longitudinal study analyzed 2010-2020 US Census of Governments-tracked state and local government expenditures and Centers for Disease Control and Prevention (CDC)-tracked years of potential life lost (YPLL) to suicide and police-perpetrated killing. Dynamic structural equation models estimated 1- and 5-year lagged associations. Models adjusted for reverse associations (i.e., violent death to later expenditures) and state-level variables including Medicaid expansion, Black-White population, racial residential segregation, political representation, overall expenditures, state firearm policies, and firearm violence rates.

Findings: For suicide, every $100 increase in per capita police expenditures was associated with 35 more YPLL 1 year later (γ = 0.35, 95% credible interval [CI] 0.02-0.90) and 28 more YPLL 5 years later (γ = 0.28, 95% CI 0.001-0.55) per 100,000 Black residents. For police-perpetrated killings, every $100 increase in per capita police expenditures was associated with 7 more YPLL 1 year later (γ = 0.07, 95% CI 0.02-0.12) per 100,000 Black residents. As such, a $100 per capita increase in annual police expendiutres translated to 14,385 more YPLL to suicide, and 2,877 more YPLL to police-pepetrated killing, 1 year later for the United States’ 41.1 million Black residents. There were no associations between police expenditures and outcomes for White residents. Conversely, every $100 increase in per capita housing and community development expenditures was associated with 29 fewer YPLL to suicide 5 years later per 100,000 Black residents (γ = -0.29, 95% CI -0.53 to -0.05). Every $100 increase in per capita kindergarten through 12th grade (K-12) education expenditures was associated with 4 fewer YPLL to suicide 1 year later per 100,000 White residents (γ = -0.04, 95% CI -0.07 to -0.01).

Conclusions: Consistent with CDC recommendations to promote housing stability as suicide prevention, reducing police expenditures and increasing housing expenditures may decrease Black-White inequities in YPLL to suicide and police-perpetrated killing.

Keywords: government spending; mental health; racial disparities; social determinants of health; violent death.

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