Life expectancy in the US has risen over the past 2 decades, but widespread racial and ethnic disparities have persisted, according to a new National Institutes of Health (NIH)-funded study published in The Lancet.
Although overall US life expectancy increased by 2.3 years from 76.8 years in 2000 to 79.1 years in 2019, most of these gains occurred before 2010 and were not consistent among racial and ethnic groups or across geographic areas.
“These varied outcomes in life expectancy raise significant questions. Why is life expectancy worse for some and better for others? The novel details in this study provide us the opportunity to evaluate the impact of social and structural determinants on health outcomes in unprecedented ways. This in turn allows us to better identify responsive and enduring interventions for local communities,” said study co-author Eliseo J. Pérez-Stable, MD, director of the National Institute on Minority Health and Health Disparities (NIMHD), part of the NIH, in a statement.
The study is the first time-series analysis of life expectancy in the US at the county level that includes estimates for the American Indian/Alaska Native (AIAN) and Asian/Pacific Islander (API) populations as well as Black, Latino, and White populations.
Researchers used novel small area estimation models to analyze death records from the National Vital Statistics System and population data from the National Center for Health Statistics to provide the most comprehensive data on life expectancy in the US to date.
Pérez-Stable and colleagues examined life expectancy at birth by year, county, and racial and ethnic groups (ie, White, Black, AIAN, API, and Latino) from 2000 to 2019 across 3110 counties.
At the national level, results showed an increase in life expectancy among individuals who were Black (+3.9 years), API (+2.9 years), Latino (+2.7 years), and White (+1.7 years), but remained the same for the AIAN population. Between 2010 and 2019, the API, Latino, and Black populations experienced small improvements in life expectancy.
According to the study abstract, the positive difference in life expectancy for the API and Latino populations compared with the White population increased nationally between 2000 and 2019; however, this difference declined in 42% of counties for the Latino population and in most counties (60.2%) for the API population.
For all 5 of the racial–ethnic groups, improvements in life expectancy were more widespread across counties and larger between 2000 and 2010 than 2010 and 2019.
The findings highlight substantial variation in life expectancy among racial and ethnic populations, locations, and over time, exposing negative and positive trends. The disparities noted by Pérez-Stable et al underscore the need for local-level, detailed data to support targeted efforts addressing and eliminating racial and ethnic health disparities and their root causes.
“The pandemic exposed stressors and weaknesses in local and national systems that continuously put our most vulnerable populations at risk. These findings offer county, state, and federal leaders a unique look at the pervasiveness of health disparities in their respective communities,” said lead author Laura Dwyer-Lindgren, assistant professor of health metrics at the Institute for Health Metrics and Evaluation. “It’s a call for direct action in the form of meaningful policy changes to address systemic issues and to help all people living in the USA live longer, healthier lives.”
Study limitations, the authors note, included the fact that only 5 racial-ethnic groups were included in the analysis. “Given the variability of population size among racial and ethnic groups and counties, and the need to correct for misclassification of racial and ethnic groups on death certificates, estimate uncertainty intervals varied by racial and ethnic groups and also by rural and urban status, with data on White populations and on urban areas having the highest degree of certainty,” said investigators. “This underscores the need for more robust data and more accurate collection of race and ethnicity data.”
The team also noted that life expectancy estimates were for the population of a county at a particular time and therefore should be interpreted as such, “particularly for counties with dynamic populations due to in- or out-migration, the presence of large colleges and universities, or the presence of correctional facilities.”
Reference: Dwyer-Lindgren L, Pérez-Stable EJ, Mokdad AH, et al. Life expectancy by county, race, and ethnicity in the USA, 2000-19: A systematic analysis of health disparities. Lancet. Published online ahead of print June 16, 2022. doi: 10.1016/S0140-6736(22)00876-5.