Despite some progress, major gaps in wellbeing remain across the USA, with certain racial and ethnic groups and regions facing the greatest challenges, especially in education, income, and lifespan.

In a recent study published in The Lancet, researchers from the University of Washington used a modified version of the Human Development Index (HDI) to investigate disparities in wellbeing across different demographic groups in the United States (U.S.) from 2008 to 2021.

The study examined education levels, income, and life expectancy and revealed substantial inequalities in well-being influenced by race, ethnicity, sex, age, and geography.

Background

The HDI is a metric used worldwide to gauge and compare wellbeing across countries by examining factors such as education levels, life expectancy, and income. However, the HDI averages data at the national level, which can often conceal inequalities within countries. Various approaches have been tested to capture within-country disparities using the HDI. Studies have also attempted to adjust the HDI based on regional inequalities or calculate it for specific subpopulations.

Existing efforts to adapt HDI for within-country comparisons have introduced various methods, each with advantages and limitations. The inequality-adjusted HDI accounts for disparities by applying a proportional reduction to national scores, but it does not identify the most disadvantaged groups. Subgroup-specific HDI calculates the scores for demographic or regional subsets but not within those groups. While household-based HDI provides a closer look at individual households, it often misses within-household inequalities.

About the study

In the present study, the researchers introduced an individual-level HDI for the U.S., which aimed at capturing the influences of race, ethnicity, age, sex, and geographic region on wellbeing. This study analyzed data from the American Community Survey (ACS) Public Use Microdata Sample, spanning the years from 2008 to 2021, and focused on adults 25 years and older.

Information on demographics, location, educational levels, household income, and household size was extracted for each participant. The researchers then combined this data with county-level life expectancy estimates generated through Bayesian models, for which they incorporated information on death records provided by the National Vital Statistics System.

The study focused on three main components — household consumption, education levels, and expected lifespan —to develop the individual-level HDI scores. Educational levels were based on completed years of schooling, and household consumption was estimated by adjusting income data to the rate of the dollar in 2021 using regional price levels and the consumer price index.

Additionally, to calculate expected lifespan, the study used life tables based on age, year, county, and race or ethnicity while adjusting for recent changes in mortality from the coronavirus disease 2019 (COVID-19) pandemic. These life tables were then cross-referenced with ACS data to assign life expectancy values to individuals.

Finally, the individual-level HDI scores were calculated by taking the geometric mean of the indices for household consumption, years of education, and expected lifespan. The resulting HDI values were distributed across deciles or ten ranked groups to highlight the disparities among groups, focusing on differences by race, ethnicity, sex, and geographic location.

Results

The study found that inequalities in wellbeing in the U.S. were significantly influenced by race, ethnicity, age, sex, and geographic location, with clear disparities across these demographic groups. Education, income, and lifespan values, and therefore the HDI scores, were highest among Asian and White populations, particularly among females, while American Indian and Alaska Native (AIAN) and Black males had the lowest HDI scores.

The results also showed that Asian females had the highest HDI scores, largely due to higher education levels and expected lifespan, while AIAN and Black males faced significant challenges in all three HDI components, especially lifespan. The lowest HDI decile was largely represented by AIAN, Black, and Latino males and females, while the highest decile featured a larger proportion of White and Asian individuals.

Furthermore, the longitudinal trends revealed a gradual increase in HDI from 2008 to 2019, followed by a sharp decline in 2020, which the researchers believe is primarily due to the decrease in life expectancy linked to COVID-19, which had also disproportionately affected the minority groups.

Based on geographical location, higher concentrations of individuals in the lowest decile of HDI were found in the southern states, the 13 states falling within the region of Appalachia, and the Rust Belt states, which included parts of Wisconsin, Indiana, Michigan, Ohio, Pennsylvania, and a few others.

Conclusions

Overall, the study reported that sustained disparities in wellbeing were observed across groups based on sex, race, and geography in the U.S., highlighting a need for targeted social policies aimed at improving education, income, and health access for disadvantaged groups.

The researchers stated that these policies should prioritize regions and populations that consistently show lower wellbeing, ensuring equitable education and employment opportunities and healthier, longer lives across all demographics in the country.