Life expectancy by county, race, and ethnicity in the USA, 2000-19: a systematic analysis of health disparities

Abstract

Background: There are large and persistent disparities in life expectancy among racial-ethnic groups in the USA, but the extent to which these patterns vary geographically on a local scale is not well understood. This analysis estimated life expectancy for five racial-ethnic groups, in 3110 US counties over 20 years, to describe spatial-temporal variations in life expectancy and disparities between racial-ethnic groups.

Methods: We applied novel small-area estimation models to death registration data from the US National Vital Statistics System and population data from the US National Center for Health Statistics to estimate annual sex-specific and age-specific mortality rates stratified by county and racial-ethnic group (non-Latino and non-Hispanic White [White], non-Latino and non-Hispanic Black [Black], non-Latino and non-Hispanic American Indian or Alaska Native [AIAN], non-Latino and non-Hispanic Asian or Pacific Islander [API], and Latino or Hispanic [Latino]) from 2000 to 2019. We adjusted these mortality rates to correct for misreporting of race and ethnicity on death certificates and then constructed abridged life tables to estimate life expectancy at birth.

Findings: Between 2000 and 2019, trends in life expectancy differed among racial-ethnic groups and among counties. Nationally, there was an increase in life expectancy for people who were Black (change 3·9 years [95% uncertainty interval 3·8 to 4·0]; life expectancy in 2019 75·3 years [75·2 to 75·4]), API (2·9 years [2·7 to 3·0]; 85·7 years [85·3 to 86·0]), Latino (2·7 years [2·6 to 2·8]; 82·2 years [82·0 to 82·5]), and White (1·7 years [1·6 to 1·7]; 78·9 years [78·9 to 79·0]), but remained the same for the AIAN population (0·0 years [-0·3 to 0·4]; 73·1 years [71·5 to 74·8]). At the national level, the negative difference in life expectancy for the Black population compared with the White population decreased during this period, whereas the negative difference for the AIAN population compared with the White population increased; in both cases, these patterns were widespread among counties. The positive difference in life expectancy for the API and Latino populations compared with the White population increased at the national level from 2000 to 2019; however, this difference declined in a sizeable minority of counties (615 [42·0%] of 1465 counties) for the Latino population and in most counties (401 [60·2%] of 666 counties) for the API population. For all racial-ethnic groups, improvements in life expectancy were more widespread across counties and larger from 2000 to 2010 than from 2010 to 2019.

Interpretation: Disparities in life expectancy among racial-ethnic groups are widespread and enduring. Local-level data are crucial to address the root causes of poor health and early death among disadvantaged groups in the USA, eliminate health disparities, and increase longevity for all.

Funding: National Institute on Minority Health and Health Disparities; National Heart, Lung, and Blood Institute; National Cancer Institute; National Institute on Aging; National Institute of Arthritis and Musculoskeletal and Skin Diseases; Office of Disease Prevention; and Office of Behavioral and Social Science Research, US National Institutes of Health.

Figure 1:. National life expectancy by racial/ethnic group, 2000–2019

National life expectancy at birth by year and racial/ethnic group for 2000–2019. Solid lines indicate the mean estimates, and shaded areas indicate 95% uncertainty intervals.

Figure 2:. County life expectancy by racial/ethnic group, 2019

County life expectancy at birth by racial/ethnic group in 2019. The colour scale is truncated at 65 and 95 years, as indicated by the ranges in the legend. Estimates of life expectancy in county-racial/ethnic group combinations with an average annual population less than 1000 people and/or estimates with an uncertainty interval width greater than ten years are masked and depicted here in grey.

Figure 3:. Differences in county life expectancy among racial/ethnic groups compared to the White population, 2019

Absolute difference in county life expectancy at birth by racial/ethnic group in 2019, relative to life expectancy for the White population in the same county. The colour scale is truncated at −15 and 15 years, as indicated by the ranges in the legend. Grey boundaries around a county indicate an estimated difference in life expectancy that is statistically significant. Estimates of life expectancy in county-racial/ethnic group combinations with an average annual population less than 1000 people and/or estimates with an uncertainty interval width greater than ten years are masked and depicted here in grey.

Figure 4:. Change in county life expectancy by racial/ethnic group, 2000–2019

Absolute change in county life expectancy at birth from 2000 to 2019 by racial/ethnic group. The colour scale is truncated at an absolute difference of −6 and 6 years, as indicated by the ranges in the legend. Grey boundaries around a county indicate an estimated change in life expectancy that is statistically significant. Estimates of life expectancy in county-racial/ethnic group combinations with an average annual population less than 1000 people and/or estimates with an uncertainty interval width greater than ten years are masked and depicted here in grey.

Figure 5:. Change in county life expectancy by racial/ethnic group compared to the White population, 2000–2019

Absolute change in county life expectancy at birth from 2000 to 2019 for each racial/ethnic group compared to this same change for the White population in the same county. Each point corresponds to a county. The colour of each point indicates the difference in life expectancy in this county in 2019 between the racial/ethnic group specified in the panel title and the White population, and the size of the point indicates the population in this county in 2019 for the racial/ethnic group specified. The axes are truncated at −10 and 10 years, as indicated by the axis labels, and the colour scale is truncated at – 15 and 15 years, as indicated by the ranges in the legend. Estimates of life expectancy in county-racial/ethnic group combinations with an average annual population less than 1000 people and/or estimates with an uncertainty interval width greater than ten years are not displayed.

Figure 6:. Change in differences in county life expectancy among racial/ethnic groups compared to the White population, 2000–2019

Absolute difference in county life expectancy at birth by racial/ethnic group in 2000 and 2019, relative to life expectancy for the White population in the same county. Each arrow corresponds to a county, and the arrow starts at the difference in life expectancy between the racial/ethnic group specified in the panel title and the White population in that county in 2000 and ends at the same quantity in 2019. The colour of each arrow indicates the change in life expectancy over this period in a given county for the specified racial/ethnic group, and the size of the arrow indicates the population of this racial/ethnic group in 2019. The colour scale is truncated at an absolute difference of −6 and 6 years, as indicated by the ranges in the legend. Estimates of life expectancy in county-racial/ethnic group combinations with an average annual population less than 1000 people and/or estimates with an uncertainty interval width greater than ten years are not displayed.