Americans as a whole may be living longer, but two recent studies reveal growing and disturbing disparities in longevity.  In fact, not all Americans are living longer; life expectancy in some areas of the country is actually declining.

Two weeks ago, the Congressional Budget Office released a report (“Growing Disparities in Life Expectancy”) that found:

Though the gaps in life expectancy between men and women and between whites and blacks have narrowed somewhat, differences by income and educational attainment have been growing. The close relationship between socioeconomic status and mortality—the flip side of longevity—has been long observed and is well documented.5 Individuals with higher lifetime earnings or more education experience lower mortality rates than those with lower lifetime earnings or less education. But in recent decades, socioeconomic status has become an even more important indicator of life expectancy, whether measured at birth or at age 65. 

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  • In 1980, life expectancy at birth was 2.8 years more for the highest socioeconomic group than for the lowest. By 2000, that gap had risen to 4.5 years. The 1.7-year increase in the gap amounts to more than half of the increase in overall average life
    Expectancy at birth between 1980 and 2000.
  • In 1980, the difference in life expectancy at age 65 between the highest and lowest socioeconomic groups was 0.3 years. By 2000, the difference had grown to 1.6 years. That increase in the gap equals more than 80 percent of the increase in overall average
    Life expectancy at age 65 over that period.

Changes in life expectancy between 1990 and 2000 show a similar pattern among people with different levels of educational attainment. The gap in life expectancy at age 25 between individuals with a high school education or less and individuals with any college education increased by about 30 percent over that period. The gap widened because of increases in life expectancy for the better-educated group; life expectancy for those with less education did not increase over that period. The growing differentials by level of educational attainment have occurred for both men and women and for both blacks and whites.

A second study (“The Reversal of Fortunes: Trends in County Mortality and Cross-County Mortality Disparities in the United States”) published in the Journal PLoS Medicine, found that rising mortality from lung cancer, diabetes, and chronic pulmonary disease is beginning to offset some of the progress made in reducing mortality from cardiovascular disease. The study found “overall life expectancy in the U.S. increased more than seven years for men and more than six years for women between 1960 and 2000,” but that, “These gains are not reaching many parts of the country; rather, the life expectancy of a significant segment of the population is actually declining or at best stagnating.”

The report by researchers at the Harvard School of Public Health ( HSPH ) and the University of Washington found that, “4% of the male population and 19% of the female population experienced either decline or stagnation in mortality beginning in the 1980s.”

The study looked at geographical disparities in longevity at the county level and found a significant number of counties where longevity had declined.  The report found that “The majority of the counties that had the worst downward swings in life expectancy were in the Deep South, along the Mississippi River, and in Appalachia, extending into the southern portion of the Midwest and into Texas.”

A number of factors may account for these differences in life expectancy, including smoking, obesity, and disparities in health care treatment, but whatever the causes, the reports suggest that we have long a way to go in reducing health care gaps in America.