Rising Geographic Disparities in US Mortality

Benjamin K. Couillard · Christopher L. Foote · Kavish Gandhi · Ellen R. Meara · Jonathan Skinner

65 citations0/0 files storedThe Journal of Economic Perspectives

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Health disparities and outcomes Healthcare Policy and Management Insurance, Mortality, Demography, Risk Management

Abstract

The 21st century has been a period of rising inequality in both income and health. In this paper, we find that geographic inequality in mortality for midlife Americans increased by about 70 percent between 1992 and 2016. This was not simply because states like New York or California benefited from having a high fraction of college-educated residents who enjoyed the largest health gains during the last several decades. Nor was higher dispersion in mortality caused entirely by the increasing importance of "deaths of despair," or by rising spatial income inequality during the same period. Instead, over time, state-level mortality has become increasingly correlated with state-level income; in 1992 income explained only 3 percent of mortality inequality, but by 2016 state-level income explained 58 percent. These mortality patterns are consistent with the view that high-income states in 1992 were better able to enact public health strategies and adopt behaviors that, over the next quarter-century, resulted in pronounced relative declines in mortality. The substantial longevity gains in high-income states led to greater cross-state inequality in mortality.

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References

2012Why Nations Fail: The Origins of Power, Prosperity and Poverty 2016The Association Between Income and Life Expectancy in the United States, 2001-2014 2015Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century 1993The Increasing Disparity in Mortality between Socioeconomic Groups in the United States, 1960 and 1986 2017Mortality and Morbidity in the 21st Century 2019Life Expectancy and Mortality Rates in the United States, 1959-2017 2008The Gap Gets Bigger: Changes In Mortality And Life Expectancy, By Education, 1981–2000 2012Neighborhood Effects on the Long-Term Well-Being of Low-Income Adults

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2022Education and income gradients in longevity: The role of policy 2022Income Inequality and Population Health: Examining the Role of Social Policy 2021The Great Divide: Education, Despair and Death 2022Educational disparities in adult health across U.S. states: Larger disparities reflect economic factors 2022U.S. State Policy Contexts and Physical Health among Midlife Adults

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