Yan Xie1, Benjamin Bowe1, Yan Yan2, Miao Cai3, Ziyad Al-Aly4. 1. Clinical Epidemiology Center, Research and Education Service, VA Saint Louis Health Care System, Saint Louis, MO; Veterans Research & Education Foundation of Saint Louis, Saint Louis, MO; Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, Saint Louis University, Saint Louis, MO. 2. Clinical Epidemiology Center, Research and Education Service, VA Saint Louis Health Care System, Saint Louis, MO; Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, Saint Louis, MO. 3. Clinical Epidemiology Center, Research and Education Service, VA Saint Louis Health Care System, Saint Louis, MO; Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, Saint Louis University, Saint Louis, MO. 4. Clinical Epidemiology Center, Research and Education Service, VA Saint Louis Health Care System, Saint Louis, MO; Veterans Research & Education Foundation of Saint Louis, Saint Louis, MO; Department of Medicine, Washington University School of Medicine, Saint Louis, MO; Nephrology Section, Medicine Service, VA Saint Louis Health Care System, Saint Louis, MO; Institute for Public Health, Washington University in Saint Louis, Saint Louis, MO. Electronic address: zalaly@gmail.com.
Abstract
OBJECTIVE: To estimate the contribution of county-level contextual factors to differences in life expectancy in the United States. METHODS: We used a counterfactual approach to estimate the years of life expectancy lost associated with 45 potentially modifiable county-level contextual characteristics in the United States in the year 2016. Contextual data and life expectancy data were obtained from the County Health Ranking Project and the U.S. Small-Area Life Expectancy Estimates Project, respectively. RESULTS: Median census-tract-level life expectancy was 78.90 (interquartile range, 76.30-81.00) years, and the range across census tracts spanned 41.20 years. Large variations in life expectancy existed within and between states and within and between counties; the gap between counties was 20.30 years and gaps within counties ranged from 0 to 34.60 years. An array of 45 county-level factors was associated with 4.30 years of life expectancy loss. County-level adult smoking, food insecurity, adult obesity, physical inactivity, college education, and median household income were associated with 1.24-, 0.89-, 0.58-, 0.35-, 0.33-, and 0.14-year losses in life expectancy, respectively; and altogether were associated with a 3.53-year loss in life expectancy. The contribution of contextual factors to years of life expectancy lost varied among states and was more pronounced in states with lower life expectancy and in areas of increased socioeconomic deprivation and increased percentage of Black race. CONCLUSION: Substantial geographic variation in life expectancy was observed. Six county-level contextual factors were associated with a 3.53-year loss in life expectancy. The findings may inform and help prioritize approaches to reduce inequalities in life expectancy in the United States. Published by Elsevier Inc.
OBJECTIVE: To estimate the contribution of county-level contextual factors to differences in life expectancy in the United States. METHODS: We used a counterfactual approach to estimate the years of life expectancy lost associated with 45 potentially modifiable county-level contextual characteristics in the United States in the year 2016. Contextual data and life expectancy data were obtained from the County Health Ranking Project and the U.S. Small-Area Life Expectancy Estimates Project, respectively. RESULTS: Median census-tract-level life expectancy was 78.90 (interquartile range, 76.30-81.00) years, and the range across census tracts spanned 41.20 years. Large variations in life expectancy existed within and between states and within and between counties; the gap between counties was 20.30 years and gaps within counties ranged from 0 to 34.60 years. An array of 45 county-level factors was associated with 4.30 years of life expectancy loss. County-level adult smoking, food insecurity, adult obesity, physical inactivity, college education, and median household income were associated with 1.24-, 0.89-, 0.58-, 0.35-, 0.33-, and 0.14-year losses in life expectancy, respectively; and altogether were associated with a 3.53-year loss in life expectancy. The contribution of contextual factors to years of life expectancy lost varied among states and was more pronounced in states with lower life expectancy and in areas of increased socioeconomic deprivation and increased percentage of Black race. CONCLUSION: Substantial geographic variation in life expectancy was observed. Six county-level contextual factors were associated with a 3.53-year loss in life expectancy. The findings may inform and help prioritize approaches to reduce inequalities in life expectancy in the United States. Published by Elsevier Inc.