The growth of social inequality is manifested in every facet of American life, including the health and lifespans of individuals. Inequality in life expectancy has grown substantially since 1980, a new study published May 8 in the American Medical Association’s JAMA: Internal Medicine confirms. The study documents “large—and increasing—geographic disparities among counties in life expectancy over the past 35 years.”
Researchers from the University of Washington’s Institute for Health Metrics and Evaluation (IHME) and Erasmus University in the Netherlands analyzed death records and population counts from all US counties.
Their study, “Inequalities in Life Expectancy Among US Counties, 1980 to 2014: Temporal Trends and Key Drivers,” drew data from the National Center for Health Statistics (NCHS), along with population counts from the US Census Bureau, NCHS, and the Human Mortality Database. This data set allows for a fuller picture of the scale of inequality in life expectancy that other recent research has shown. (The IHME maintains an interactive county-level map)
The study found that in 2014 life expectancy at birth for both sexes at the national level was 79.1 years (76.7 years for men and 81.5 years for women). The combined average amounts to a 5.3-year growth in life expectancy over the 1980 average of 73.8 years.
Behind this overall growth in lifespan, however, the study found a staggering 20.1-year gap between the lowest and highest life expectancy among all US counties.
Three wealthy counties in central Colorado—Summit, Eagle, and Pitkin—recorded the longest life expectancies in the country, at 86 years on average. At the other end of the spectrum, several counties in South and North Dakota had the lowest life expectancy, along with “counties along the lower half of the Mississippi [the Delta region] and in eastern Kentucky and southwestern West Virginia,” the study found. These areas “saw little, if any, improvement” since 1980. Thirteen counties registered a decline in life expectancy.
In the Dakotas, several of the shortest-lived counties encompass Native American reservations. Oglala Lakota County in South Dakota, home to the Pine Ridge Native American reservation, had the lowest life expectancy in the country in 2014, at just 66.8 years. In a press release, the IHME researchers noted that this was lower than the life expectancies of Sudan and Iraq—countries that have been torn apart by brutal wars over the course of decades.
“Looking at life expectancy on a national level masks the massive differences that exist at the local level, especially in a country as diverse as the United States,” lead author Laura Dwyer-Lindgren of IHME explained. “Risk factors like obesity, lack of exercise, high blood pressure, and smoking explain a large portion of the variation in lifespans, but so do socioeconomic factors like race, education, and income.”
The study found that all counties saw a decline in the risk of dying before age 5 since 1980, attributable to improvements in health programs for infants and children. At the same time, the data showed an increased risk of death for adults aged 25-45 in 11.5 percent of counties, a phenomenon partially explained by the rise in suicides and drug addiction.
Although the research points to “a combination of socioeconomic and race/ethnicity factors, behavioral and metabolic risk factors, and health care factors” to account for the disparities in life expectancy, all of the factors intersect with poverty. It is not a coincidence that the poorest areas recorded the shortest life expectancies and the wealthiest areas recorded the longest lifespans.
Risk factors like obesity, diabetes, high blood pressure, smoking, and physical inactivity are highly correlated to poverty, unemployment and lack of education. In areas where the population lacks access to preventive care or they cannot afford basic health care, chronic conditions become debilitating. Cancers go undetected, mental illness is undiagnosed, pregnancies are carried without adequate prenatal care, heart disease is untreated, and work-related injuries are managed with highly addictive pain medications instead of physical therapy and rest.
Of the 10 counties where lifespans fell the most since 1980, eight are in the coalfields region of eastern Kentucky: Owsley (-3 percent); Lee (-2 percent); Leslie (-1.9 percent); Breathitt (-1.4 percent); Clay (-1.3 percent); Powell (-1.1 percent); Estill (-1 percent); Perry County, Kentucky (-0.8 percent). Kiowa County, Oklahoma, (-0.7 percent), and Perry County, Alabama, (-0.6 percent) round out the list of counties where life expectancy declined the most.
Residents of Owsley County, Kentucky saw a decline in life expectancy from 72.4 in 1980 to 70.2 in 2014—comparable to the life expectancy in Kyrgyzstan or North Korea.
Owsley County was found by a 2016 Al Jazeera analysis to be the poorest white-majority county in the US. Some 45 percent of the county’s 4,500 residents, and 56.3 percent of children, live below the poverty threshold. Official unemployment stands at 10 percent, but with only 35 percent of the working age population included in the labor force, real unemployment is approaching 75 percent. Per capita income as of 2015 stands at $15,158, according to federal Census Bureau data.
As with the rest of the Appalachian coalfields region, the counties where life expectancy has dropped have seen every metric of economic and social well-being decline over the past several decades. Coal mining employment in eastern Kentucky has fallen to levels not seen in a century. With hundreds of mines shuttered, counties have lost so-called coal-severance tax revenue paid by companies per ton of coal extracted. Thousands of families have left in search of work, triggering a further collapse in the tax base for local governments, school districts, and social programs. The elimination of thousands of coal mining jobs has left mostly low-wage occupations for residents.
Lee County, second to Owsley in terms of the decline in life expectancy, is home to “America’s poorest white town”—Beattyville, Kentucky, the county seat. Beattyville has seen an explosion of opioid addiction since the closure of its few coalmines and decline of the oil and timber industries. The median household income in the town stands at $14,871, less than a third of the national median. Like its measure of life expectancy, Lee County’s household income is lower today than it was in 1980.
Kentucky and neighboring West Virginia have among the highest opioid overdose rates in the country, with the coalfields counties especially hard-hit. In 2013, drug overdoses accounted for 56 percent of all accidental deaths in Kentucky; the state’s death rate for overdoses is 29.9 per 100,000. In the eastern counties, emergency services are less able to reach and save overdose victims and health providers have struggled to afford lifesaving anti-opioid treatments like Narcan.