If Your Are Poor in the US, Your Life Depends on Where You Live

It is well-known that death rates vary geographically within the United States, with the usual explanation focusing on higher death rates among African-Americans, especially in southern states. Since those also tend to be among the poorer states, there is an obvious geographic association between mortality and where you live. But a group of researchers from Stanford and Harvard have just published a paper in the Journal of the American Medical Association that controls for race and ethnicity and comes up with the fascinating conclusion that "The Rich Live Longer Everywhere. For the Poor, Geography Matters." Now, to be fair, that headline is from the Upshot at the NYTimes. The journal article is more sedately titled "The Association Between Income and Life Expectancy in the United States, 2001-2014."

For poor Americans, the place they call home can be a matter of life or death. The poor in some cities — big ones like New York and Los Angeles, and also quite a few smaller ones like Birmingham, Ala. — live nearly as long as their middle-class neighbors or have seen rising life expectancy in the 21st century. But in some other parts of the country, adults with the lowest incomes die on average as young as people in much poorer nations like Rwanda, and their life spans are getting shorter.

One conclusion from this work, published on Monday in The Journal of the American Medical Association, is that the gap in life spans between rich and poor widened from 2001 to 2014. The top 1 percent in income among American men live 15 years longer than the poorest 1 percent; for women, the gap is 10 years. These rich Americans have gained three years of longevity just in this century. They live longer almost without regard to where they live. Poor Americans had very little gain as a whole, with big differences among different places.

As the article notes, these results are in line with the highly publicized findings of Deaton and Case regarding the increasing mortality among less well-educated whites in the U.S.  Indeed, one of the lead authors on this research--David Cutler of Harvard--has published health research with Angus Deaton in the past. 

Life expectancy for the poor is lowest in a large swath that cuts through the middle of the country, and it appears in pockets in the rest of the country, in places like Nevada. David M. Cutler, a Harvard economist and an author of the paper, calls it the “drug overdose belt,” because the area matches in part a map of where the nation’s opioid epidemic is concentrated.

The new findings dovetail with a much-discussed paper by Anne Case and Angus Deaton published last year. That research showed rising death rates among middle-age white Americans, especially those with low education. It also showed a sharp increase in drug and alcohol poisonings, suicides and accidents in the first years of this century. Research from the Brookings Institution published in February also found a growing gap in life span between the rich and the poor.

The map below illustrates this swath of low life expectancy among the poor in the U.S. Go here for the interactive map to check the data for your area.