1. Zolot, Joan PA


These geographic disparities have been increasing over the past 35 years.


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The difference in life expectancy between the U.S. county with the highest life expectancy and the one with the lowest is a staggering 20.1 years. This was one of the important findings from a recent study that compared life expectancy by county from 1980 to 2014, using data from death and census records.


Nationally, the life expectancy at birth was 79.1 years in 2014. At the county level, the lowest life expectancies were in several North Dakota and South Dakota counties, especially those with Native American communities, as well as in counties along the lower half of the Mississippi River and in Kentucky and West Virginia. The highest life expectancies were in central Colorado. Life expectancy nationwide increased by 5.3 years from 1980 to 2014, from 73.8 to 79.1 years, but there were marked geographic inequalities. Counties in Colorado, Alaska, and on both coasts showed large increases, while some southern counties in states from Oklahoma to West Virginia experienced little or no improvement.


To identify age-specific trends in life expectancy, the likelihood of death for five age groups was assessed separately. From 1980 to 2014, geographic differences in life expectancy decreased for children and adolescents. But they increased over the study period for adults-most dramatically for those ages 65 to 85 years.


The researchers sought explanations for the disparities by studying variables associated with life expectancy. Variables included socioeconomic/demographic factors (poverty rate, household income, education level, race, and ethnicity), behavioral and metabolic risk factors (obesity, physical activity, cigarette smoking, and hypertension and diabetes prevalence), and factors relating to health care (access, quality, insurance). Socioeconomic/demographic factors and behavioral and metabolic risk factors accounted for most of the geographic disparities in life expectancy. Health care access and quality were less influential.


The authors concluded that the best hope for reducing geographic inequalities is to implement policies and programs that help to modify socioeconomic and behavioral and metabolic risk factors.-Joan Zolot, PA




Dwyer-Lindgren L, et al JAMA Intern Med 2017 177 7 1003-11