Large Gap in Life Expectancy Reveals Growing Inequality Across US

In 13 counties across the United States, children born in 2014 are expected to live shorter lives than their parents.

New research from the University of Washington in Seattle has revealed large and growing geographical inequality in the life expectancy of Americans drawn along lines of risky behavior, race, education, and access to health care.

The study is the first of its kind to track health disparities at the county level, offering granulated data that authors hope could be used to inform better, more targeted policies that could reverse a growing trend of inequality in life expectancy.

“We hope that our findings start this debate,” said Ali Mokdad, a doctor at the Institute for Health Metrics and Evaluation and author on the paper. “We need to invest in keeping people living longer and healthier.”

While the authors found that life expectancy at the national level had increased by an average of 5.3 years between 1980 and 2014 to 79.1 years for men and women combined, they also found the number to be highly misleading — a statistic that “masks massive variation at the county level.”

Oglala Lakota County in South Dakota — home to the Pine Ridge Native American Reservation — has the lowest life expectancy in the United States, at 66.8 years. Residents of Summit County in central Colorado, by contrast, are expected to live nearly 20 years longer, topping the list of the 3,110 areas evaluated with a life expectancy of 88.6 years. 

The study, published today in JAMA Internal Medicine, found that counties with the biggest drop in life expectancy over the past 35 years were clustered in Kentucky, West Virginia, Alabama, and further north along the Mississippi. Those with the biggest increase in life expectancy were largely located in coastal Alaska and central Colorado.

In addition to determining county variation of life expectancy, researchers at the University of Washington also sought to better understand the factors driving local geographic disparities.

Using numbers from 2009, the year when the best data coverage was available, researchers filtered life expectancy data according to three sets of variables. The first looked at socioeconomic indicators — poverty rates, income, education, unemployment, and race. The second set considered behavioral and metabolic risk factors, including obesity, lack of exercise, smoking, hypertension, and diabetes. Finally, the authors considered factors related to health care access and quality.

They found that individual risk factors accounted for 74 percent of the documented variation, while socioeconomic variables independently corresponded to 60 percent of the documented inequality. Health care access and quality — calculated according to the percentage of people under 65 with insurance, the number of physicians per capita, and other variable related to primary care access — accounted for 27 percent of the outcomes.

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The results suggest that differences in longevity are derived by a complex set of individual risk factors, socioeconomic determinants, and the quality and availability of health care. They also indicate that current health care policy, in addition to being ineffective for large geographical areas, has also carried an exorbitant cost.  

According to authors, the United States spent $9,237 on health care per person in 2014, a massive amount when compared to Australia, which has a life expectancy of 82.3 years and spends a mere $4,032 per person. In Japan, where $3,816 is paid per person for health insurance annually, life expectancy is 83.1 years.

“A balance has to exist between health care spending and prevention of risk factors and addressing the social determinants of health,” said Mokdad.

In fact, the study showed that the risk of death among infants below the age of five had consistently decreased in all of the counties evaluated, indicating that at least at birth, such inequalities had been limited, likely by programs targeting infants and children. With age, however, the divergence in health outcomes grew larger.

Researchers found that 11.5 percent of counties saw an increased risk of death between adults aged 25 to 45 during the period of study and that the mortality risk — the probability of dying — among people aged 45 to 85 has continued to grow since 1980.

The state of Kentucky offered particularly concerning data, accounting for 10 of the 13 counties where the generation born in 2014 is not expected to outlive their parents. It also provides a case study in the politics and reality of health care as a state that voted forcefully for Trump and, yet, overwhelmingly signed up for Obamacare, legislation that Trump has promised to repeal or drastically alter.

While the research out of the University of Washington did not intend to link health outcomes to policy, authors recognize the irrefutable influence of policy reflected in their numbers.

“One of the drivers of these disparities is access to health care — insurance,” Mokdad said. “Access to health care should be addressed in the US at all levels — local, state, and federal — to reduce health disparities.”

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