which Blacks had considerably higher rates than Whites or Hispanics. Compared to Blacks and Whites, Hispanics had a lower rate of drug-use history and lower current and lifetime rates of schizophrenia and drug abuse, but higher current rates of alcohol abuse and affective disorder. Hispanic data, however, were limited to a sample drawn from the Los Angeles area.

Findings from the National Comorbidity Survey (NCS), the first to use a national probability sample to assess psychiatric disorders in the United States, are generally consistent with those of the EGA (see Table 14–10 ; Kessler et al., 1994). These data show that Blacks do not have higher rates than Whites for any of the major classes of disorders. Instead, lower rates for Blacks are especially pronounced for the affective disorders (depression) and the substance abuse disorders (alcohol and drug abuse). In NCS, Hispanics had higher rates of disorder than Whites. These data should be interpreted with caution because of the relatively small sample of Hispanics (n=737). Large epidemiological surveys like EGA and NCS provide no data on the mental health problems of Asians or Pacific Islanders or Native Americans or Alaska Natives.

It is also important to attend to racial differences in the severity and course of disease. Mortality rates in a given year are a function not only of the number of persons who die because of a disease but also of the severity and the progression of that disease. Higher death rates for minority populations tend to reflect both higher levels of ill health and greater severity of disease. Higher rates may also reflect differences in access to medical care and racial disparities in the modalities of treatment. Data in Table 14–11 illustrate the pattern in differential outcomes of cancer survival. Five-year survival rates are shown for all sites and for the three most common cancers for both genders and for Blacks and Whites from 1974 to 1994 (National Center for Health Statistics, 1998). For males, the data indicate that during 1974 to 1979, 43 percent of White males had a five-year survival rate compared to 32 percent of Black males. Over time