New analysis reveals how geography, race, and income drive widening health disparities, underscoring the urgent need for targeted action to reduce inequities in longevity.

Study: Ten Americas: a systematic analysis of life expectancy disparities in the USA. Image Credit: Shutterstock AI / Shutterstock.com

In a recent study published in The Lancet, researchers updated their analysis from the original Eight Americas study to reflect current life expectancy disparities in the United States.

What is the Eight Americas study?

The Eight Americas study was published nearly two decades ago to provide crucial insights into life expectancy inequities in the United States. Herein, the U.S. population was categorized into eight groups based on race, geographical location, urbanicity, income per capita, and homicide rates.

In 2001, the Eight Americas study reported gaps of 12.8 years for females and 15.4 years for males in life expectancy, with the observed disparities in mortality particularly large for young and middle-aged males.

In the current study, scientists update and expand the original Eight Americas study by examining trends in life expectancy between 2000 and 2021 for ten Americas categorized by age, sex, and age group. The ten Americas included analogs to the original eight groups, as well as two additional groups comprising the U.S. Hispanic or Latino population.    

Important observations

The ten categories of Americas included Asian individuals, Latino individuals in other counties, White, Asian, and American Indian or Alaska Native (AIAN) individuals in other counties, White individuals in non-metropolitan and low-income Northlands, Latino individuals in the Southwest, Black individuals in other counties, Black individuals in highly segregated metropolitan areas, White individuals in low-income Appalachia and Lower Mississippi Valley, Black individuals in the non-metropolitan and low-income South, and AIAN individuals in the West. 

The lowest life expectancy in 2000 was among Black Americans residing in non-metropolitan and low-income counties in the South and highly segregated metropolitan regions, as well as AIAN individuals in the West. The second lowest life expectancy was observed for White Americans in low-income counties in Appalachia and the Lower Mississippi Valley.

Between 2000 and 2010, life expectancy increased for all Americas except for AIAN individuals in the West, who experienced a one-year reduction.

Further reduction in life expectancy was observed for AIAN individuals in the West between 2010 and 2019. A smaller reduction was observed among White Americans residing in low-income counties in Appalachia and the Lower Mississippi Valley, Black Americans in non-metropolitan and low-income counties in the South, as well as White Americans in non-metropolitan and low-income counties in the Northlands.

During the first year of the coronavirus disease 2019 (COVID-19) pandemic, life expectancy significantly decreased across the Americas. However, the extent of this decline varied widely among Americans.

A slight recovery of life expectancy was observed for Black Americans in highly segregated metropolitan areas, Asian Americans, and Latino Americans in other countries between 2020 and 2021. However, for other Americans, life expectancy continued to decline during this period.

In some cases, significant variations in life expectancy rates were observed by sex and age group. Significant variations in income and educational attainment were also observed between the ten Americas.

These differences had varying impacts on life expectancy. For example, AIAN individuals residing in other counties had the highest income and educational attainment in most years; however, these individuals were ranked fourth or fifth in life expectancy before 2020.

These disparities reflect the unequal and unjust distribution of resources and opportunities and have profound consequences for the wellbeing and longevity of marginalized populations.”

Conclusions

In 2000, a 12.6-year gap in life expectancy was observed among the Americas, which gradually increased by 2010 and accelerated to 20.4 years after the first two years of the COVID-19 pandemic.

AIAN individuals in the West were the only Americans who experienced a reduction in life expectancy over the two-decade period preceding the COVID-19 pandemic. Low healthcare accessibility, unemployment, low education attainment, and systemic discrimination may contribute to reduced life expectancy among AIAN individuals in the West.    

A significant improvement in life expectancy was observed among the three categories of Black Americans during the study period. A significant improvement in educational facilities, reduction in human immunodeficiency virus (HIV)- and cardiovascular disease-related deaths, and reduced homicide rates likely contributed to the improved longevity and reduced life expectancy disparities among Black Americans.

A significantly longer life expectancy was observed among Latino Americans as compared to that of White Americans. The longer life expectancy might be associated with the higher life expectancy, specifically among foreign-born Latino individuals.

The largest reduction in life expectancy during the first year of the COVID-19 pandemic was observed among AIAN, Black, and Latino Americans, which may be attributed to systemic racism and racial inequities observed during the pandemic. Considerable inequalities among White Americans by geographical location and income level were also observed, which may be due to variations in income and educational attainment among these individuals.

These findings emphasize the importance of addressing and analyzing the different factors contributing to life expectancy disparities in the U.S. to ensure that all Americans can live healthy lives, regardless of their geographical location, race, ethnicity, or income.

It is time for us to take collective action; to invest in equitable health care, education, and employment opportunities; and to challenge the systemic barriers that create and perpaetuate these disparities.”