Rising Geographic Disparities in US Mortality Rising Geographic Disparities in US Mortality

By Benjamin K. Couillard, Christopher L. Foote, Kavish Gandhi, Ellen Meara, and Jonathan Skinner

Studies of life expectancy in the United States increasingly find disparities among different groups in the population. For example, a recent report by the National Academies of Science, Engineering, and Medicine finds large and widening mortality differences based on race, ethnicity, economic status, and geography.

This paper documents and analyzes rising mortality disparities at the state level. Like the National Academies study and much of the recent research on life expectancy, the paper focuses on mortality trends for persons at midlife, defined as ages 25 through 64. Consistent with the thrust of previous research, the paper finds that state-level midlife mortality rates have become much more unequal over time.

One explanation for this divergence is that state-level disparities are driven by differences in education levels and labor market prospects. A second and possibly related explanation is that greater state-level dispersion has been driven by rising spatial inequality in income. A third possibility is that the widening divergence in mortality stems from a portmanteau of place effects that are independent of state-level income. These effects would capture both the health behaviors of individuals who live in a place as well as the evolving features of the region’s overall health environment.

The paper use data on mortality, income, health behavior, and health-care quality to test how well each of these hypotheses explains the data.

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