In some parts of the US, people die 20 years younger than in others

Although life expectancy is rising overall in the United States, lifespans continue to shrink in some regions of the country, widening geographical disparities, according to a study published in JAMA Internal Medicine.

How to address health inequity in your community

Study Details

For the study, researchers from University of Washington's Institute for Health Metrics and Evaluation examined trends in life expectancy by county from 1980 to 2014 using death records and population counts from:

The major drivers and consequences of health disparities

• CDC's National Center for Health Statistics (NCHS);
• The Human Mortality Database; and
• The U.S. Census Bureau.

According to the researchers, the study's limitations include possible errors in county death records and a lack of data to explore the effect of migration on life expectancy.

Findings

Overall, the researchers found average life expectancy in the United States increased from 73.8 years in 1980 to 79.1 years in 2014.

The researchers observed average life expectancy gains among both men and women. For men, life expectancy increased from 70 to 76.7 years and, for women, it increased from 77.5 to 81.5 years.

However, the researchers found stark disparities across the country. For example, individuals living in counties in central Colorado had the highest life expectancies, whereas individuals living in several counties in South Dakota and North Dakota had the lowest life expectancies. According to the researchers, a baby born in South Dakota's Oglala Lakota County can expect to live just 66.8 years on average, compared with a baby born in Colorado's Summit County, who can expect to live 86.8 years on average.

In addition, the researchers found some that average life expectancies significantly increased in some and dropped sharply in others.

Areas with the biggest gains in life expectancy included:

• Loudoun County, Va.;
• Fairfax County, Va.; and
• Washington, D.C.

Three patient types key to population health success

Areas where life expectancy declined the most included 10 counties in Kentucky and one county each in Alabama and Oklahoma.

The researchers concluded that variations in life expectancy could be explained by three key factors:

• Behavioral and metabolic risk factors, such as diabetes, hypertension, obesity, and smoking;
• Health care availability, such as insurance, quality of care, and access to doctors; and
• Socio-economic and race/ethnicity factors, such as income, education levels, and unemployment rates.

Comments

Jennifer Karas Montez, a sociology researcher at Syracuse University who was not involved in the study, said, "The bottom line is that our life expectancy is increasingly being shaped by where we live within the [United States]," adding that lifestyle behaviors are actually symptoms "of the environment and the social and economic deprivation that many parts of the country … endure thanks to decades of policy decisions."

Andrew Cherlin, a professor of sociology and public policy at Johns Hopkins University who was not involved in the study, said while the increasing inequality is troubling, it remains "unclear from this study what has caused it," adding that it is "hard to separate out the consequences of lower incomes, unhealthy conditions such as obesity, less access to health care providers, and of healthier people moving out of some counties."

Ali Mokdad, a co-author of the study, said part of the reason why these disparities exist is because the United States has invested more in establishing a renowned medical and treatment system, and needs to do more to bolster preventive care efforts. He added that the country is "not doing it right, that's what the debate has to be" (Rapaport, Reuters, 5/8; Achenbach, "To Your Health," Washington Post, 5/8; Kelly, Washington Times, 5/8; Dwyer-Lindgren et al., JAMA Internal Medicine, 5/8).