The black/white ratio of death rates (before 65 years of age) in 1994-1996 for a group of "sentinel" causes, regarded as preventable by medical treatment and as useful in assessing overall quality of health care, was examined for 60 US counties located in large metropolitan areas. Counties with the highest black/white death rate ratios (>3.5) and the highest death rates for blacks included the District of Columbia; Essex (Newark), New Jersey; Cook (Chicago), Illinois; Wayne (Detroit), Michigan; and Dade (Miami), Florida. In these five counties, in contrast to the US, the death rate from the sentinel causes for blacks had not declined from 1979-1981 to 1994-1996. The findings suggest that racial inequities in health care may be unusually great in certain counties in large metropolitan areas, and that further studies are needed to explain the variation among counties in the black-white ratio of mortality from the sentinel causes.