Life expectancy is considered one of the best measures of the overall health and well-being of a large population. Photo courtesy of HealthDay
Americans' life expectancy varies widely -- based not only on race, but where in the country they live.
That's one of the overarching messages from a new study that looked, state by state, at Americans' life expectancy at birth. It found that between 1990 and 2019, racial disparities in life expectancy decreased in many states. But in some, the situation worsened.
And within any one racial group, a lot rode on where you lived.
"You see some really shocking disparities," said senior researcher Dr. Gregory Roth, an associate professor of medicine at the University of Washington.
In 2019, life expectancy for Black men in Rhode Island was 81 years -- higher than the average for all U.S. men, at 76 years. But then there was Washington, D.C., where a Black man's life expectancy was only 67 years -- the norm for U.S. men 50 years ago.
Of 23 states studied, Missouri had the biggest racial gap in life expectancy by 2019: Hispanic women could expect to live about 16 years longer than Black women, while the gap between Hispanic and Black men was nearly 20 years.
"How long you live depends on race and ethnicity, but also on where you live," Roth said. "That's a piece that is often missed."
The reasons for the wide variations by state are not clear from this study, which was designed to describe what's going on.
"Our goal here was to give states a benchmark," Roth said.
But, he noted, many social and health-related policies are set by states, including rules on the Medicaid program that provides health insurance to poor Americans.
Some states get it right
There's an opportunity, Roth said, to understand what some states are doing right in closing life expectancy disparities -- "so that we don't have people living in different Americas."
Life expectancy, Roth said, is considered one of the best measures of the overall health and well-being of a large population.
Measured on the national level, Americans' life expectancy had been rising for decades, until that progress stalled out around 2010, and then declined during the COVID-19 pandemic. In 2020, average life expectancy at birth was just over 77 years, according to the U.S. Centers for Disease Control and Prevention.
Racial gaps in life expectancy have long been recognized. The same CDC data show that nationally, Hispanic Americans have the longest life expectancy, followed by White and then Black Americans.
But the new study shows that much depends on where you live, agreed Hedwig Lee, associate director of the Center for the Study of Race, Ethnicity and Equity at Washington University in St. Louis.
Lee co-wrote an editorial published with the study Tuesday in the Annals of Internal Medicine.
Many state and local policies, Lee said, could help shape residents' life expectancy -- including those on affordable housing, nutrition assistance, child care, education and criminal justice.
So while access to healthcare is vitally important, Lee said, "we also have to look beyond it."
For the study, Roth's team used Census data and death records to look at state-level patterns in life expectancy at birth between 1990 and 2019.
They had enough data to track changes in racial disparities over time within 23 states, for the three largest racial/ethnic groups: Black, White and Hispanic.
In most of those states, the researchers found, racial disparities narrowed between 1990 and 2019, with the biggest decreases seen in Massachusetts, Connecticut and Oregon. But in seven states, that gap grew among female residents; the same was true for male residents in five states. Missouri topped the list of states with worsening racial disparities.
"Things are getting better in some places," Roth said. "But they're getting worse in some, which is a concerning red flag."
When the researchers compared states with each other, they found that overall life expectancy improved over time, with a narrowing in the gap across states. By 2019, life expectancy varied by about eight years across all states.
The disparity ballooned, however, when the researchers accounted for racial/ethnic group differences across states: Life expectancy varied by 18.5 years among females, and nearly 24 years among males in 2019.
Meanwhile, there was some good news for Black Americans. Overall, their life expectancy improved over time, and Black men showed the biggest relative gain in years. Despite that, though, Black Americans still had the lowest life expectancy in nearly all states by 2019.
The problem can seem too daunting, Lee said. But she pointed out that many states have shrunk their racial disparities in life expectancy.
"There are places that are doing better. It is possible," Lee said. "State policies really do have an impact, even if it takes time to see."
Roth agreed that many policies, including ones aimed at aiding young children -- such as nutrition programs and Head Start -- are vital. But he also emphasized the importance of equity in healthcare.
Roth, a cardiologist, pointed to the example of blood pressure control. Treating high blood pressure with medication can slash the risks of heart attack and stroke -- two major killers in the United States.
"It's a great example of what healthcare can do in terms of life expectancy," Roth said.
The Commonwealth Fund has a state-by-state scorecard on health inequities.
SOURCES: Gregory Roth, MD, MPH, associate professor, medicine, and adjunct associate professor, global health and health metrics sciences, University of Washington School of Medicine, Seattle; Hedwig Lee, PhD, MA, professor, sociology, and associate director, Center for the Study of Race, Ethnicity and Equity, Washington University in St. Louis, St. Louis; Annals of Internal Medicine, June 28, 2022, online
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