US State Disparities in Life Expectancy, Disability-Free Life Expectancy, and Disabled Life Expectancy Among Adults Aged 25 to 89 Years

Abstract

Objectives. To estimate total life expectancy (TLE), disability-free life expectancy (DFLE), and disabled life expectancy (DLE) by US state for women and men aged 25 to 89 years and examine the cross-state patterns.Methods. We used data from the 2013-2017 American Community Survey and the 2017 US Mortality Database to calculate state-specific TLE, DFLE, and DLE by gender for US adults and hypothetical worst- and best-case scenarios.Results. For men and women, DFLEs and DLEs varied widely by state. Among women, DFLE ranged from 45.8 years in West Virginia to 52.5 years in Hawaii, a 6.7-year gap. Men had a similar range. The gap in DLEs across states was 2.4 years for women and 1.6 years for men. The correlation among DFLE, DLE, and TLE was particularly strong in southern states. The South is doubly disadvantaged: residents have shorter lives and spend a greater proportion of those lives with disability.Conclusions. The stark variation in DFLE and DLE across states highlights the large health inequalities present today across the United States, which have significant implications for individuals' well-being and US states' financial costs and medical care burden.

FIGURE 1—

Total Life Expectancy by US State for Women by (a) Disability-Free Life Expectancy and (b) Disabled Life Expectancy: 2013–2017 Note. The 2-letter abbreviations within each figure indicate the US state. The dot indicated by “best” represents a hypothetical state that for each 5-year age band takes on the value of an actual state with the lowest disability (and mortality, respectively). Because no actual US state is “best” at every age band, this hypothetical state has lower disability than any actual state. Following the same technique as best, the dot indicated by “worst” represents the hypothetical worst-case scenario.

FIGURE 2—

Total Life Expectancy by US State for Men by (a) Disability-Free Life Expectancy and (b) Disabled Life Expectancy: 2013–2017 Note. The 2-letter abbreviations within each figure indicate the US state. The dot indicated by “best” represents a hypothetical state that for each 5-year age band takes on the value of an actual state with the lowest disability (and mortality, respectively). Because no actual US state is “best” at every age band, this hypothetical state has lower disability than any actual state. Following the same technique as best, the dot indicated by “worst” represents the hypothetical worst-case scenario.