Left behind: widening disparities for males and females in US county life expectancy, 1985-2010

The United States spends more than any other country on health care, but US life expectancy at birth ranked 40th for males and 39th for females globally in 2010. To help understand this poor national performance, as well as the large disparities seen in life expectancy across communities, researchers estimated age-specific mortality rates for males and females by US county from 1985 to 2010.

The researchers used mortality data from the National Center for Health Statistics by age, sex, race, and county for the US from 1985 to 2010. They used a mixed-effects Poisson statistical model with time, geospatial, and covariate components and Gaussian Process Regression to estimate annual life expectancy for US counties.

Female life expectancy in the United States increased from 78 years in 1985 to 80.9 years in 2010, while male life expectancy increased from 71 years in 1985 to 76.3 years in 2010. For males at the county level, the highest life expectancy increased from 75.5 years in 1985 to 81.7 years in 2010, and the lowest life expectancy remained under 65, which ranks below male life expectancy in Indonesia. For women at the county level, the highest life expectancy increased from 81.1 years in 1985 to 85 years in 2010, and the lowest life expectancy remained at roughly 73 years, which is lower than female life expectancy in Algeria. Compared to only 154 counties where male life expectancy remained stagnant or declined, 1,405 out of 3,143 counties (45%) have seen no significant change or a significant decline in female life expectancy from 1985 to 2010. In all time periods, the lowest county-level life expectancies were seen in the South, the Mississippi basin, West Virginia, Kentucky, and selected counties with large Native American populations.

While life expectancy in most US counties is increasing, there are widening disparities between counties, and US life expectancy is increasing more slowly compared to other countries, especially for women. The researchers call for increased attention on socioeconomic factors such as poverty and education, lack of access to or poor quality of health care, and risk factors such as poor diet, physical inactivity, and smoking to determine why the US has failed to make any progress in reducing disparities at the county level.