12 ms·

U.S. life expectancy varies by more than 20 years from county to county

230 points by fmihaila 9y ago

RichardHeart 9y ago
If there was no difference in behavior at all between all of the people of the USA, I think you'd still see pockets of more and less progress, just due to the natural distribution of dying. I'm curious what the expected variance by zip code would be if everyone's behavior was identical. As the article states, some countries are making more progress than the USA on modifiable risks, such as smoking. Australia is one such country. If advertising health were as profitable as advertising vices, we'd be in better shape.
- ska 9y ago
  It's not just lack of progress, in some areas it is regression. You state this obvious factor as if it were immutable. The article addresses it, unsurprisingly, and provides examples that at least suggest progress can be made to limit it.
generj 9y ago
One possible partial explanation for this is the same reason why the Bill Gates Foundation wasted a bunch of money fostering small high schools. Smaller high schools were some of the best performing schools...but also some of the worst [0]. The answer is just that small counties have high variance. By chance some small counties will be a lot higher or lower than the national average. I would be interested in seeing a Cox Proportional Hazards Model would show if the remaining changes are related to pollution, meth, economics, etc. [0]http://marginalrevolution.com/marginalrevolution/2010/09/the-small-schools-myth.html http://marginalrevolution.com/marginalrevolution/2010/09/the...
- Nacraile 9y ago
  Sample-size-based variance is a nice nit to pick, but it doesn't really seem to match the data presented in the article. Outcomes are strongly correlated in adjacent counties across the map, which is not predicted by sample-size (which would produce uncorrelated noise, in inverse proportion to population density). On the other hand, there is substantial correlation between the given geographic distribution of life expectancy changes and geographic distribution of wealth, as observed in the article.
  - generj 9y ago
    Yes, this is correct. Especially with how extreme the values are within the clusters (like in Kentucky), there is almost no chance they occurred by sample-size variance. Sample-size variance might explain some of those little counties with blips out in OK, MS, and TN though. As an aside, the color scheme on the map makes any decrease look substantially more massive. I wish we had a map which was recentered on the national average growth of life expectancy as well.
- misiti3780 9y ago
  i was ready to add that same comment.
- flexie 9y ago
  But even the small counties have populations in the several hundreds or thousands, right? Outliers that die at 33 or 103 affect the average little when you have a population of 2,000.
  - deleted 9y ago
    [deleted]
  - generj 9y ago
    You'd think that, but the US has about 724 deaths per 100,000. In a county with fewer than 10,000 people that leaves only about 72 deaths per year. Loving County in Texas has 112 residents. "35 counties have a population under 1,000; 307 counties have a population under 5,000; 709 counties have a population under 10,000" [0]. I haven't read the paper, so I don't know their exact methodology but if they just took a snapshot in 1980 and then in 2014 a county of 10,000 would only be looking at about 145 deaths total. That's small enough that it's pretty possible for outliers to have a big impact. In a county of 1,000 there are only 7 deaths a year, so if you only look at two years that's a total of 14 deaths. It doesn't take a lot to jostle the numbers when you don't have many observations. In any case, this isn't the main contributor here, as pointed out elsewhere. But it is a good thing to be aware of whenever county level statistics are provided. [0]https://en.wikipedia.org/wiki/County_(United_States)#Population https://en.wikipedia.org/wiki/County_(United_States)#Populat...
    - itissid 9y ago
      It seems they are being smart about using counties: "All analyses were carried out at the county level. Counties were combined as needed to create stable units of analysis over the period 1980 to 2014, reducing the number of areas analyzed from 3142 to 3110 (eTable 1 in the Supplement). For simplicity, these units are referred to as “counties” throughout." They also use https://en.wikipedia.org/wiki/Small_area_estimation https://en.wikipedia.org/wiki/Small_area_estimation which seems like a way to deal with the counties with small sizes. And from what I can tell they are using hierarchical models that should have some regularizing effect from larger populations.
  - 9y ago
- PeterisP 9y ago
  The largest life expectancy increase is in New York county, which has a population of 1.6 million, comparable to whole smallish countries - no, this is not explained by high variance in small counties.
- Perceval 9y ago
  Here's a post on how to address trying to map the abnormal while controlling for variance across sample sets: https://medium.com/@uwdata/surprise-maps-showing-the-unexpected-e92b67398865 https://medium.com/@uwdata/surprise-maps-showing-the-unexpec...
- aaron695 9y ago
  Failure != Wasted
binarymax 9y ago
Not only county-to-county. My friend did his PhD dissertation on how (at least in Rochester, NY), life expectancy varies by decades between zip codes. His research focused on urban Food Deserts and studied how the lack of access to healthy food nearby restricted diets to that available in convenience stores (chips, soda, etc). I wish I had access to his dissertation, but he just defended a month ago and cannot find it in any publications right now. EDIT: Not my friend's paper, but here is a similar study: https://hrs.isr.umich.edu/publications/biblio/8355 https://hrs.isr.umich.edu/publications/biblio/8355
- willvarfar 9y ago
  Please try and get it on HN when its available.
- jameshart 9y ago
  This story was shared on HN recently and suggests that even stronger correlations might be better found by looking at different boundaries than zipcodes: https://theconversation.com/how-zip-codes-nearly-masked-the-lead-problem-in-flint-65626 https://theconversation.com/how-zip-codes-nearly-masked-the-...
  - binarymax 9y ago
    Fascinating, thanks for sharing. The points made in the article seem obvious, but doesn't offer much in terms of a suggested solution (conscientiously redraw zip codes). Do you know of any effort to have a more accurate "health boundary" region designation?
    - maxerickson 9y ago
      The optimal solution is likely a huge set of overlapping boundaries each accounting for different things. Like if easy access to fresh groceries matters, the boundaries for that will not line up with the water system boundary (there could be some interesting correlations between the areas, but a good analysis would have to split out the boundaries to account for each effect).
tn135 9y ago
And why is that a surprise ? The public schooling in USA has widely distorted the housing market creating ghettos where similar people will get clubbed together.
- xeromal 9y ago
  Would you mind telling me what state you are from? I have a curiosity I need to satisfy.
  - tn135 9y ago
    California. Without looking into any statistics I can bet that Asian dominated Santa Clara will have much higher life expectancy than Alameda which has different racial profile mostly with low wage (H1Bs etc) Asian population. Merced which is highly Hispanic will be scraping the bottom. NOW let me check the stats : Santa Clara : 80.6 Alameda : 78.8 Merced :75.8
- wil421 9y ago
  How is this a US problem? Everywhere I've ever visited, and I've been to as many countries as I have States, has quote on quote: "Widely distorted the housing market creating ghettos where similar people will get clubbed together." I think they call them neighborhoods. Rich people live in nicer houses than other people. Pretty sure it's been like this since one caveman had a bigger cave with bigger rocks to throw. Sacasim aside I really think we need a national school system. In Georgia it varies by counties. Some counties compete on a national level others are dead last in the nation, if we aren't counting Mississippi.
  - ghaff 9y ago
    You can certainly have flat spending per pupil independent of location. Which means that many inner city school districts get less money than they do today and many affluent suburbs get more.
  - tn135 9y ago
    > How is this a US problem? One word: Mobility. I lived in a slum in India and went to a private school that catered to poor kids. Got scholarship and worked my way up to start living into a high-rise. The private school had a big role to play in it. That is not possible for low income neighbourhoods for USA anymore. The mindless regulations make private schools expensive. It is not possible for a retired school teacher to run a class-room in a garage at night and call it a school. That teacher will end up in jail and sex offenders registry. The poor hispanic neighbourhoods of south San Jose will have to rely on the pathetic public schools and those schools will ensure their students flip burgers. Those kids will find it hard to move to Palo Alto. Public schools not only distort the housing markets but they feed into that evil spiral of poverty. I would love to see department of education dismantled completely and money given to kids to chose their schools of choice and let entrepreneurs make money by catering to the needs of all kids.
irrational 9y ago
What about from country to country. I'm from the US and, at least where I live, it is rare to see someone smoking. Second hand smoke has basically become a thing of the past. But this past week we went up to Vancouver BC and we were shocked at how many people were smoking. It seemed like you couldn't go 10 feet without walking through another cloud of second-hand smoke. Apparently the anti-smoking campaigns of the US never made it up North ;-) Or maybe their socialized medicine makes it so that they don't have to worry about health consequences as much. I don't know. I just wonder if the life expectancy is lower in Canada (or at least Vancouver) since smoking seems to still be A-OK.
- rconti 9y ago
  I wonder if you were in heavily Asian areas of Vancouver? It's my impression that smoking is most popular these days in Asian countries, so more recent arrivals would be more likely to still be smokers. I have never noticed a particularly large rate of smoking in the areas of BC I've been to.
  - praneshp 9y ago
    Less cigarette smoke is definitely a perk of living in the US. I was shocked to see the amount of smoking in Switzerland when I visited recently. I'd put it at the same amount as in India (where I am from), probably. I also remember a lot of smokers in Germany when I lived there for a couple of months in 2010.
- zoren 9y ago
  Do you have numbers to back up your claim?
  - snowpanda 9y ago
    There was no general claim, he shared his first hand experience.
    - zoren 9y ago
legitster 9y ago
Is there any reason this isn't just selection bias? Young, healthy, people with good careers travel to big cities. The rest stay behind. Do we have data to compare those who stuck around vs those who grew up there but moved away?
- pdubbs90 9y ago
  The map shows life expectancy at birth, so healthy people moving from rural areas to cities shouldn't effect it.
brooklyntribe 9y ago
Rural upstate NY. Always checking out the obits. There were some weeks there when no one broke 62. Seems to stabilized, but more rural than Appalachia. The winters are brutal, MDs are hard to find.
- rm_-rf_slash 9y ago
  Truth. Here in Ithaca the health care is pretty good, but quality falls quickly after 15 minutes drive in any direction. Not to mention that, aside from college towns and the canal cities, most of upstate NY hasn't been economically prosperous for generations. It takes a toll on folks.
CoolGuySteve 9y ago
This map seems correlated with socieconomic status and all the health implications that go along with that. And it looks similar again to Republican voting districts. It's Sarah Palin's "Real America", so to speak. One thing the Democrats would do well to focus on is the fact that there's a large portion of the country that is sick, where the statistics look more like an underdeveloped country. Those of us who live in the major cities would do well to empathize with this other part of the country and their malaise, even if for our own sake of having a more sane and less partisan government.
- lotsofpulp 9y ago
  Democrat or not, those in the "other part of the country" are the ones voting against themselves, i.e. for politicians who oppose subsidized healthcare, who oppose workplace benefits such as paternity, maternity, and sick leave, those who oppose healthy food for public school students (and public schools in general...) Those living in major cities have empathized with those in areas that consistently vote for "smaller" government, by not voting for the same policies and politicians that are causing them harm.
  - hackuser 9y ago
    > the ones voting ... for politicians who oppose subsidized healthcare It's more complex than that, because those same voters are pressuring their elected representatives to retain healthcare subsidies and similar benefits.
  - TheAdamAndChe 9y ago
    There was much more involved in the election than healthcare alone. There were cultural concerns(people in big cities worry about very different things than the rest of the country), economic concerns(outsourcing and illegal immigration have brought down wages for the lower and middle classes) and even democratic concerns(the DNC suppressed Sanders from being the Democratic candidate). Those are all legitimate concerns, and on top of that you've got to consider gerrymandering and the emotional aspect of voting that isn't rational. Trump recognized a large part of the country that wasn't acknowledged by Hillary, and that boosted the Republican party as a whole.
throwawaysf9 9y ago
I create a throw away account and say this almost every time a post hints at something like this: It is commonly taught at the school of public health at Cal that "your zip code is a stronger indication of your life expectancy (and quality) than the color of your skin". This has been known for years now.
nolemurs 9y ago
I couldn't help but notice that the top three counties (Summit, Pitkin, and Eagle counties in CO) are largely empty space with some of the country's best ski resorts. I suspect that the life expectancy there may largely be driven by fit retirees who move there.
- blacksmythe 9y ago
  Or access to great skiing promotes a healthier lifestyle.
- rsync 9y ago
  Not merely ski resorts, but specifically Aspen (in Pitkin County) and Vail (in Eagle County). These are not merely fit retirees, but the richest retirees in the world. Further, there is a bit of selection bias here in that the town of Aspen is at 8000 feet of elevation. You need to have a decent baseline of physical fortitude just to step off the plane there as an older person... Finally, for what it is worth, day to day life in Aspen (even outside of the ski season) is extremely active and everything about the town promotes that activity. I personally don't think there is anything actionable or interesting[1] about Aspen and Vail having high life expectancies - they are completely non-representative of any piece of the real world. [1] Well, other than fitness and activity increasing your lifespan, but we all know that already.
- abritinthebay 9y ago
  Having lived in Aspen for a while (no longer) I do have to say: everyone that lives there is extremely fit compared to say... the Bay Area. Not just the rich people - the average person (who is more likely a retail/food service worker) is just more active - going on several 1000ft hikes in spring & summer weekly, or long bike rides, etc. It's very very easy to be healthy there: I got fitter, skinnier, and healthier in the 8 months I was there.
MR4D 9y ago
Some random information in this article.... For instance, they cite almost no lung cancer deaths in Summit county Colorado, while the highest rate is found in Florida. Well, duh - why the heck would a lung cancer patient want to try and breathe thin air at 9,000 ft??? Sea-level would be much more comfortable. Not picking on the statistics, but they could have pointed out that some of the variation is purely logical.
- rodionos 9y ago
  I didn't look into the data, but the CDC and other agencies have policies that set values to 0 in public versions of their datasets if there is a risk of inadvertent PII disclosure. This is particularly the case with smaller cities/counties and rare diseases.
- efm 9y ago
  The three mountain counties in Colorado with the lowest death rates in the US don't have major hospitals. Without hospitals, fewer deaths.
protomyth 9y ago
Oglala Lakota County which is completely contained inside the Pine Ridge Indian Reservation is served by Indian Health Service with 94%+ of the population being eligible for free, government provided medical care. I notice, other than pointing it out on the map, they didn't discuss it in the article. http://www.richheape.com/american-indian-healthcare.htm http://www.richheape.com/american-indian-healthcare.htm
notadoc 9y ago
Of course life expectancy is going to vary by county, because the variables that contribute to life expectancy; income, lifestyles, dietary habits, quality of health care, and access to health care are vastly different. I assume you'd need a broad cultural shift in attitudes about food consumption, obesity, physical activity, and vast health care networks that ignore income to change it.
davidf18 9y ago
A very similar article by many of the same authors was reported in JAMA in Dec 2016. From JAMA Arch Int Med article from today, p. E6: "...At the same time, 74% of the variation was explained by behavioral and metabolic risk factors alone, while one marginally more variation was explained by socioeconomic and race/ethnicity factors, behavioral and metabolic risk factors, and health care factors combined." From the WaPo article: "Mokdad said countries such as Australia are far ahead of the United States in delivering preventive care and trying to curb such harmful behaviors as smoking. “Smoking, physical inactivity, obesity, high blood pressure — these are preventable risk factors,” Mokdad said." In NYC, and not just Manhattan, New Yorkers are doing better because of a number of interventions initiated in 2001, when Mayor Bloomberg and Dr. Tom Frieden took over as Mayor and Health Commissioner. Adult smoking is 14% in NYC, 24% in Louisiana. Raising the cost of tobacco contributes more than half the effect of getting smokers to quit and to stop teens from ever starting. NYS tobacco tax is $4.35 per pack and the city is an additional $1.50. Cigarette sell for at least $12 per pack here. The tax is $1.08 in Louisiana. Mokdad mentions Australia, where the tobacco tax is $14 per pack plus an additional $2 sales tax. The ACA made a huge mistake in not raising the about $1 US Federal tax to a much higher number for the 13 billion packs smoked each year. Raising the Federal tax by $4 would raise at least $30 billion each year for helping those with high risk preexisting conditions.
- chimeracoder 9y ago
  > Raising the cost of tobacco contributes more than half the effect of getting smokers to quit and to stop teens from ever starting. Yes, though it's also created a thriving black market for cigarettes, often trafficked from other states or otherwise sold without paying end-consumer taxes[0]. Separately, it's worth noting that the age for purchasing tobacco in NYC is 21, as opposed to 18 in most other places. Furthermore, it's also just really damn hard to smoke in NYC. It's been banned in restaurants and bars for fifteen years, long before that was commonplace in other places. More and more buildings are smoke-free, which makes it less and less convenient for people to maintain a smoking habit. [0] The cost of having an illegal market isn't always monetary. For example, Eric Garner was killed after an encounter in which police approached him because they claimed he was selling untaxed cigarettes: https://en.wikipedia.org/wiki/Death_of_Eric_Garner https://en.wikipedia.org/wiki/Death_of_Eric_Garner
worldsayshi 9y ago
> "We are falling behind our competitors in health. That is going to impact our productivity; that’s going to take away our competitive edge when it comes to the economy" Interesting how it seems like health itself isn't seen as the target metric. Nope, economy is what's important.
pnathan 9y ago
Not surprised. Visited the Midwest a few years ago, and obesity was ridiculously off the charts compared to the Intermountain West or WA/CA. The are significant social factors playing out on a wide and complex scale. My advice, if you're stuck in one an area with unhealthy habits, is to move to an area with healthy habits.
Zyst 9y ago
There's a phrase that stood out to me: >“We are falling behind our competitors in health. That is going to impact our productivity; that’s going to take away our competitive edge when it comes to the economy,” Mokdad said. “What we’re doing right now is not working. We have to regroup.” What's the logic behind this? Out of curiosity. It's a morbid thing I hesitate to say, but from a purely utilitarian view isn't it better for a country— from a macro perspective— if people die as close as possible as they finish their working life and retire? I might be completely off base there, and this is mostly a request for more information, not saying people should die early. As far as I'm concerned I hope we all live to 200.
- tofupup 9y ago
  People often just don't die instantaneously, they get sick and require care this taking up resources. Also, some people don't die but are permanently disabled or others get better.
- csa 9y ago
  Death can often be a very slow process. Sometimes it will cause a worker (and the worker's company) to be less efficient due to health-related issues. Not to mention that caregivers (e.g., family) may also be less efficient by taking time off from work or quitting work all together. Sometimes people will be put on disability for health reasons before they should need to retire. This is a drag on the welfare system and (often) the economy if they had been a productive member of the workforce. There is also a potential quality of life issue (both present and expected), but that's not as easy to measure as the previous points. It also has some potentially complex implications that are beyond the scope of this post.
  - Zyst 9y ago
    What would be a better scenario, though. Do we not die slowly even if we are older, which also requires more caretaking? What's the difference between having it happen early and late? I do agree with the Quality of life issue, though. If I'm a highly skilled worker (And thus have prospects to migrate) And some people in say, a country in Europe, live to see 150 years of age, while in my country on average people live to 70 I'm moving out as soon as humanly possible. Realistically the gap doesn't grow that large, but I'm using hyperbole to make a point. I might be too dumb to articulate it though.
JohnGB 9y ago
I really wish that journalists would learn some 3rd grade maths before writing anything with numbers in it. How does the life expectancy vary by "more than 20 years" when the difference between the counties with the highest (85) and lowest (67) life expectancies is 18 years?
- suneilp 9y ago
  It's called sensationalism. Thanks for pointing it out. Really dislike that kind of bs.
- mikeyouse 9y ago
  You should be more diligent if you're going to be so snarky... 85 wasn't the highest life expectancy. WaPo noted three adjacent counties with very high life expectancy and captioned the graphic, "Summit, Pitkin, and Eagle Counties, each at more than 85 years." Their actual values were 86.83 years, 86.52 and 85.94 years. Oglala Lakota County had a life expectancy of 66.81. Lo and behold, 86.83 - 66.81 is more than 20 years. From the source article: > Counties were combined as needed to create stable units of analysis over the period 1980 to 2014, reducing the number of areas analyzed from 3142 to 3110. In 2014, life expectancy at birth for both sexes combined was 79.1 (95% uncertainty interval [UI], 79.0-79.1) years overall, but differed by 20.1 (95% UI, 19.1-21.3) years between the counties with the lowest and highest life expectancy. Pretty cool data viz here: https://vizhub.healthdata.org/subnational/usa https://vizhub.healthdata.org/subnational/usa
dkarapetyan 9y ago
Heck I bet within a 5 mile radius it varies. Just go to east palo alto and then go to "not east" palo alto. The reasons I think are pretty obvious and almost certainly correlated with how affluent your neighbors are. Money basically solves all problems when it comes to wealth related problems like access to good schools and healthcare. Even though in theory healthcare and education should not be so strongly coupled to money.
cylinder 9y ago
Not everything is the government's fault. Go observe the lifestyle choices and dietary choices some of these people make, and then add in the drinking and smoking.
dainichi 9y ago
The "life expectancy of a county" is not a trivial thing to define if you ask me. Is it how long children born now in a county can expect to live, no matter where they live or die, does it only depend on people who die in the county, or is it somehow weighted by the time people live in the county? Maybe there's a standard definition, but my guess is that most people don't know.
- finolex1 9y ago
  Conventional life expectancy measures are calculated based on the death rates at each age of the residents in that place. Therefore the death rates of people at 80+ or 90+ years may be affected by their lifestyles 30-50 years ago, so it's not always an accurate measure of how long you would expect a child just born to survive in that place. AFAIK it's not weighted by the time people live in that place. Perhaps areas with lots of affluent retirees will have distorted life expectancy rates that may not be reflective of people who are born and spend their lives in that area.
  - dainichi 9y ago
    Thanks for that explanation. So if a county has, say, a lot of hospices (and people change their residency when they go there, not sure how that works in the US), that will affect the expectancy negatively, saying nothing about how living in that county affects longevity.

230 points by fmihaila 9y ago

If there was no difference in behavior at all between all of the people of the USA, I think you'd still see pockets of more and less progress, just due to the natural distribution of dying. I'm curious what the expected variance by zip code would be if everyone's behavior was identical. As the article states, some countries are making more progress than the USA on modifiable risks, such as smoking. Australia is one such country. If advertising health were as profitable as advertising vices, we'd be in better shape.

ska 9y ago
It's not just lack of progress, in some areas it is regression. You state this obvious factor as if it were immutable. The article addresses it, unsurprisingly, and provides examples that at least suggest progress can be made to limit it.

generj 9y ago

One possible partial explanation for this is the same reason why the Bill Gates Foundation wasted a bunch of money fostering small high schools. Smaller high schools were some of the best performing schools...but also some of the worst [0]. The answer is just that small counties have high variance. By chance some small counties will be a lot higher or lower than the national average. I would be interested in seeing a Cox Proportional Hazards Model would show if the remaining changes are related to pollution, meth, economics, etc. [0]http://marginalrevolution.com/marginalrevolution/2010/09/the-small-schools-myth.html http://marginalrevolution.com/marginalrevolution/2010/09/the...

Nacraile 9y ago
Sample-size-based variance is a nice nit to pick, but it doesn't really seem to match the data presented in the article. Outcomes are strongly correlated in adjacent counties across the map, which is not predicted by sample-size (which would produce uncorrelated noise, in inverse proportion to population density). On the other hand, there is substantial correlation between the given geographic distribution of life expectancy changes and geographic distribution of wealth, as observed in the article.
- generj 9y ago
  Yes, this is correct. Especially with how extreme the values are within the clusters (like in Kentucky), there is almost no chance they occurred by sample-size variance. Sample-size variance might explain some of those little counties with blips out in OK, MS, and TN though. As an aside, the color scheme on the map makes any decrease look substantially more massive. I wish we had a map which was recentered on the national average growth of life expectancy as well.
misiti3780 9y ago
i was ready to add that same comment.
flexie 9y ago
But even the small counties have populations in the several hundreds or thousands, right? Outliers that die at 33 or 103 affect the average little when you have a population of 2,000.
- deleted 9y ago
  [deleted]
- generj 9y ago
  You'd think that, but the US has about 724 deaths per 100,000. In a county with fewer than 10,000 people that leaves only about 72 deaths per year. Loving County in Texas has 112 residents. "35 counties have a population under 1,000; 307 counties have a population under 5,000; 709 counties have a population under 10,000" [0]. I haven't read the paper, so I don't know their exact methodology but if they just took a snapshot in 1980 and then in 2014 a county of 10,000 would only be looking at about 145 deaths total. That's small enough that it's pretty possible for outliers to have a big impact. In a county of 1,000 there are only 7 deaths a year, so if you only look at two years that's a total of 14 deaths. It doesn't take a lot to jostle the numbers when you don't have many observations. In any case, this isn't the main contributor here, as pointed out elsewhere. But it is a good thing to be aware of whenever county level statistics are provided. [0]https://en.wikipedia.org/wiki/County_(United_States)#Population https://en.wikipedia.org/wiki/County_(United_States)#Populat...
  - itissid 9y ago
    It seems they are being smart about using counties: "All analyses were carried out at the county level. Counties were combined as needed to create stable units of analysis over the period 1980 to 2014, reducing the number of areas analyzed from 3142 to 3110 (eTable 1 in the Supplement). For simplicity, these units are referred to as “counties” throughout." They also use https://en.wikipedia.org/wiki/Small_area_estimation https://en.wikipedia.org/wiki/Small_area_estimation which seems like a way to deal with the counties with small sizes. And from what I can tell they are using hierarchical models that should have some regularizing effect from larger populations.
- 9y ago
PeterisP 9y ago
The largest life expectancy increase is in New York county, which has a population of 1.6 million, comparable to whole smallish countries - no, this is not explained by high variance in small counties.
Perceval 9y ago
Here's a post on how to address trying to map the abnormal while controlling for variance across sample sets: https://medium.com/@uwdata/surprise-maps-showing-the-unexpected-e92b67398865 https://medium.com/@uwdata/surprise-maps-showing-the-unexpec...
aaron695 9y ago
Failure != Wasted

binarymax 9y ago

Not only county-to-county. My friend did his PhD dissertation on how (at least in Rochester, NY), life expectancy varies by decades between zip codes. His research focused on urban Food Deserts and studied how the lack of access to healthy food nearby restricted diets to that available in convenience stores (chips, soda, etc). I wish I had access to his dissertation, but he just defended a month ago and cannot find it in any publications right now. EDIT: Not my friend's paper, but here is a similar study: https://hrs.isr.umich.edu/publications/biblio/8355 https://hrs.isr.umich.edu/publications/biblio/8355

willvarfar 9y ago
Please try and get it on HN when its available.
jameshart 9y ago
This story was shared on HN recently and suggests that even stronger correlations might be better found by looking at different boundaries than zipcodes: https://theconversation.com/how-zip-codes-nearly-masked-the-lead-problem-in-flint-65626 https://theconversation.com/how-zip-codes-nearly-masked-the-...
- binarymax 9y ago
  Fascinating, thanks for sharing. The points made in the article seem obvious, but doesn't offer much in terms of a suggested solution (conscientiously redraw zip codes). Do you know of any effort to have a more accurate "health boundary" region designation?
  - maxerickson 9y ago
    The optimal solution is likely a huge set of overlapping boundaries each accounting for different things. Like if easy access to fresh groceries matters, the boundaries for that will not line up with the water system boundary (there could be some interesting correlations between the areas, but a good analysis would have to split out the boundaries to account for each effect).

tn135 9y ago

And why is that a surprise ? The public schooling in USA has widely distorted the housing market creating ghettos where similar people will get clubbed together.

xeromal 9y ago
Would you mind telling me what state you are from? I have a curiosity I need to satisfy.
- tn135 9y ago
  California. Without looking into any statistics I can bet that Asian dominated Santa Clara will have much higher life expectancy than Alameda which has different racial profile mostly with low wage (H1Bs etc) Asian population. Merced which is highly Hispanic will be scraping the bottom. NOW let me check the stats : Santa Clara : 80.6 Alameda : 78.8 Merced :75.8
wil421 9y ago
How is this a US problem? Everywhere I've ever visited, and I've been to as many countries as I have States, has quote on quote: "Widely distorted the housing market creating ghettos where similar people will get clubbed together." I think they call them neighborhoods. Rich people live in nicer houses than other people. Pretty sure it's been like this since one caveman had a bigger cave with bigger rocks to throw. Sacasim aside I really think we need a national school system. In Georgia it varies by counties. Some counties compete on a national level others are dead last in the nation, if we aren't counting Mississippi.
- ghaff 9y ago
  You can certainly have flat spending per pupil independent of location. Which means that many inner city school districts get less money than they do today and many affluent suburbs get more.
- tn135 9y ago
  > How is this a US problem? One word: Mobility. I lived in a slum in India and went to a private school that catered to poor kids. Got scholarship and worked my way up to start living into a high-rise. The private school had a big role to play in it. That is not possible for low income neighbourhoods for USA anymore. The mindless regulations make private schools expensive. It is not possible for a retired school teacher to run a class-room in a garage at night and call it a school. That teacher will end up in jail and sex offenders registry. The poor hispanic neighbourhoods of south San Jose will have to rely on the pathetic public schools and those schools will ensure their students flip burgers. Those kids will find it hard to move to Palo Alto. Public schools not only distort the housing markets but they feed into that evil spiral of poverty. I would love to see department of education dismantled completely and money given to kids to chose their schools of choice and let entrepreneurs make money by catering to the needs of all kids.

irrational 9y ago

What about from country to country. I'm from the US and, at least where I live, it is rare to see someone smoking. Second hand smoke has basically become a thing of the past. But this past week we went up to Vancouver BC and we were shocked at how many people were smoking. It seemed like you couldn't go 10 feet without walking through another cloud of second-hand smoke. Apparently the anti-smoking campaigns of the US never made it up North ;-) Or maybe their socialized medicine makes it so that they don't have to worry about health consequences as much. I don't know. I just wonder if the life expectancy is lower in Canada (or at least Vancouver) since smoking seems to still be A-OK.

rconti 9y ago
I wonder if you were in heavily Asian areas of Vancouver? It's my impression that smoking is most popular these days in Asian countries, so more recent arrivals would be more likely to still be smokers. I have never noticed a particularly large rate of smoking in the areas of BC I've been to.
- praneshp 9y ago
  Less cigarette smoke is definitely a perk of living in the US. I was shocked to see the amount of smoking in Switzerland when I visited recently. I'd put it at the same amount as in India (where I am from), probably. I also remember a lot of smokers in Germany when I lived there for a couple of months in 2010.
zoren 9y ago
Do you have numbers to back up your claim?
- snowpanda 9y ago
  There was no general claim, he shared his first hand experience.
  - zoren 9y ago

legitster 9y ago

Is there any reason this isn't just selection bias? Young, healthy, people with good careers travel to big cities. The rest stay behind. Do we have data to compare those who stuck around vs those who grew up there but moved away?

pdubbs90 9y ago
The map shows life expectancy at birth, so healthy people moving from rural areas to cities shouldn't effect it.

brooklyntribe 9y ago

Rural upstate NY. Always checking out the obits. There were some weeks there when no one broke 62. Seems to stabilized, but more rural than Appalachia. The winters are brutal, MDs are hard to find.

rm_-rf_slash 9y ago
Truth. Here in Ithaca the health care is pretty good, but quality falls quickly after 15 minutes drive in any direction. Not to mention that, aside from college towns and the canal cities, most of upstate NY hasn't been economically prosperous for generations. It takes a toll on folks.

CoolGuySteve 9y ago

This map seems correlated with socieconomic status and all the health implications that go along with that. And it looks similar again to Republican voting districts. It's Sarah Palin's "Real America", so to speak. One thing the Democrats would do well to focus on is the fact that there's a large portion of the country that is sick, where the statistics look more like an underdeveloped country. Those of us who live in the major cities would do well to empathize with this other part of the country and their malaise, even if for our own sake of having a more sane and less partisan government.

lotsofpulp 9y ago
Democrat or not, those in the "other part of the country" are the ones voting against themselves, i.e. for politicians who oppose subsidized healthcare, who oppose workplace benefits such as paternity, maternity, and sick leave, those who oppose healthy food for public school students (and public schools in general...) Those living in major cities have empathized with those in areas that consistently vote for "smaller" government, by not voting for the same policies and politicians that are causing them harm.
- hackuser 9y ago
  > the ones voting ... for politicians who oppose subsidized healthcare It's more complex than that, because those same voters are pressuring their elected representatives to retain healthcare subsidies and similar benefits.
- TheAdamAndChe 9y ago
  There was much more involved in the election than healthcare alone. There were cultural concerns(people in big cities worry about very different things than the rest of the country), economic concerns(outsourcing and illegal immigration have brought down wages for the lower and middle classes) and even democratic concerns(the DNC suppressed Sanders from being the Democratic candidate). Those are all legitimate concerns, and on top of that you've got to consider gerrymandering and the emotional aspect of voting that isn't rational. Trump recognized a large part of the country that wasn't acknowledged by Hillary, and that boosted the Republican party as a whole.

throwawaysf9 9y ago

I create a throw away account and say this almost every time a post hints at something like this: It is commonly taught at the school of public health at Cal that "your zip code is a stronger indication of your life expectancy (and quality) than the color of your skin". This has been known for years now.

nolemurs 9y ago

I couldn't help but notice that the top three counties (Summit, Pitkin, and Eagle counties in CO) are largely empty space with some of the country's best ski resorts. I suspect that the life expectancy there may largely be driven by fit retirees who move there.

blacksmythe 9y ago
Or access to great skiing promotes a healthier lifestyle.
rsync 9y ago
Not merely ski resorts, but specifically Aspen (in Pitkin County) and Vail (in Eagle County). These are not merely fit retirees, but the richest retirees in the world. Further, there is a bit of selection bias here in that the town of Aspen is at 8000 feet of elevation. You need to have a decent baseline of physical fortitude just to step off the plane there as an older person... Finally, for what it is worth, day to day life in Aspen (even outside of the ski season) is extremely active and everything about the town promotes that activity. I personally don't think there is anything actionable or interesting[1] about Aspen and Vail having high life expectancies - they are completely non-representative of any piece of the real world. [1] Well, other than fitness and activity increasing your lifespan, but we all know that already.
abritinthebay 9y ago
Having lived in Aspen for a while (no longer) I do have to say: everyone that lives there is extremely fit compared to say... the Bay Area. Not just the rich people - the average person (who is more likely a retail/food service worker) is just more active - going on several 1000ft hikes in spring & summer weekly, or long bike rides, etc. It's very very easy to be healthy there: I got fitter, skinnier, and healthier in the 8 months I was there.

MR4D 9y ago

Some random information in this article.... For instance, they cite almost no lung cancer deaths in Summit county Colorado, while the highest rate is found in Florida. Well, duh - why the heck would a lung cancer patient want to try and breathe thin air at 9,000 ft??? Sea-level would be much more comfortable. Not picking on the statistics, but they could have pointed out that some of the variation is purely logical.

rodionos 9y ago
I didn't look into the data, but the CDC and other agencies have policies that set values to 0 in public versions of their datasets if there is a risk of inadvertent PII disclosure. This is particularly the case with smaller cities/counties and rare diseases.
efm 9y ago
The three mountain counties in Colorado with the lowest death rates in the US don't have major hospitals. Without hospitals, fewer deaths.

protomyth 9y ago

Oglala Lakota County which is completely contained inside the Pine Ridge Indian Reservation is served by Indian Health Service with 94%+ of the population being eligible for free, government provided medical care. I notice, other than pointing it out on the map, they didn't discuss it in the article. http://www.richheape.com/american-indian-healthcare.htm http://www.richheape.com/american-indian-healthcare.htm

notadoc 9y ago

Of course life expectancy is going to vary by county, because the variables that contribute to life expectancy; income, lifestyles, dietary habits, quality of health care, and access to health care are vastly different. I assume you'd need a broad cultural shift in attitudes about food consumption, obesity, physical activity, and vast health care networks that ignore income to change it.

davidf18 9y ago

A very similar article by many of the same authors was reported in JAMA in Dec 2016. From JAMA Arch Int Med article from today, p. E6: "...At the same time, 74% of the variation was explained by behavioral and metabolic risk factors alone, while one marginally more variation was explained by socioeconomic and race/ethnicity factors, behavioral and metabolic risk factors, and health care factors combined." From the WaPo article: "Mokdad said countries such as Australia are far ahead of the United States in delivering preventive care and trying to curb such harmful behaviors as smoking. “Smoking, physical inactivity, obesity, high blood pressure — these are preventable risk factors,” Mokdad said." In NYC, and not just Manhattan, New Yorkers are doing better because of a number of interventions initiated in 2001, when Mayor Bloomberg and Dr. Tom Frieden took over as Mayor and Health Commissioner. Adult smoking is 14% in NYC, 24% in Louisiana. Raising the cost of tobacco contributes more than half the effect of getting smokers to quit and to stop teens from ever starting. NYS tobacco tax is $4.35 per pack and the city is an additional $1.50. Cigarette sell for at least $12 per pack here. The tax is $1.08 in Louisiana. Mokdad mentions Australia, where the tobacco tax is $14 per pack plus an additional $2 sales tax. The ACA made a huge mistake in not raising the about $1 US Federal tax to a much higher number for the 13 billion packs smoked each year. Raising the Federal tax by $4 would raise at least $30 billion each year for helping those with high risk preexisting conditions.

chimeracoder 9y ago
> Raising the cost of tobacco contributes more than half the effect of getting smokers to quit and to stop teens from ever starting. Yes, though it's also created a thriving black market for cigarettes, often trafficked from other states or otherwise sold without paying end-consumer taxes[0]. Separately, it's worth noting that the age for purchasing tobacco in NYC is 21, as opposed to 18 in most other places. Furthermore, it's also just really damn hard to smoke in NYC. It's been banned in restaurants and bars for fifteen years, long before that was commonplace in other places. More and more buildings are smoke-free, which makes it less and less convenient for people to maintain a smoking habit. [0] The cost of having an illegal market isn't always monetary. For example, Eric Garner was killed after an encounter in which police approached him because they claimed he was selling untaxed cigarettes: https://en.wikipedia.org/wiki/Death_of_Eric_Garner https://en.wikipedia.org/wiki/Death_of_Eric_Garner

worldsayshi 9y ago

> "We are falling behind our competitors in health. That is going to impact our productivity; that’s going to take away our competitive edge when it comes to the economy" Interesting how it seems like health itself isn't seen as the target metric. Nope, economy is what's important.

pnathan 9y ago

Not surprised. Visited the Midwest a few years ago, and obesity was ridiculously off the charts compared to the Intermountain West or WA/CA. The are significant social factors playing out on a wide and complex scale. My advice, if you're stuck in one an area with unhealthy habits, is to move to an area with healthy habits.

Zyst 9y ago

There's a phrase that stood out to me: >“We are falling behind our competitors in health. That is going to impact our productivity; that’s going to take away our competitive edge when it comes to the economy,” Mokdad said. “What we’re doing right now is not working. We have to regroup.” What's the logic behind this? Out of curiosity. It's a morbid thing I hesitate to say, but from a purely utilitarian view isn't it better for a country— from a macro perspective— if people die as close as possible as they finish their working life and retire? I might be completely off base there, and this is mostly a request for more information, not saying people should die early. As far as I'm concerned I hope we all live to 200.

tofupup 9y ago
People often just don't die instantaneously, they get sick and require care this taking up resources. Also, some people don't die but are permanently disabled or others get better.
csa 9y ago
Death can often be a very slow process. Sometimes it will cause a worker (and the worker's company) to be less efficient due to health-related issues. Not to mention that caregivers (e.g., family) may also be less efficient by taking time off from work or quitting work all together. Sometimes people will be put on disability for health reasons before they should need to retire. This is a drag on the welfare system and (often) the economy if they had been a productive member of the workforce. There is also a potential quality of life issue (both present and expected), but that's not as easy to measure as the previous points. It also has some potentially complex implications that are beyond the scope of this post.
- Zyst 9y ago
  What would be a better scenario, though. Do we not die slowly even if we are older, which also requires more caretaking? What's the difference between having it happen early and late? I do agree with the Quality of life issue, though. If I'm a highly skilled worker (And thus have prospects to migrate) And some people in say, a country in Europe, live to see 150 years of age, while in my country on average people live to 70 I'm moving out as soon as humanly possible. Realistically the gap doesn't grow that large, but I'm using hyperbole to make a point. I might be too dumb to articulate it though.

JohnGB 9y ago

I really wish that journalists would learn some 3rd grade maths before writing anything with numbers in it. How does the life expectancy vary by "more than 20 years" when the difference between the counties with the highest (85) and lowest (67) life expectancies is 18 years?

suneilp 9y ago
It's called sensationalism. Thanks for pointing it out. Really dislike that kind of bs.
mikeyouse 9y ago
You should be more diligent if you're going to be so snarky... 85 wasn't the highest life expectancy. WaPo noted three adjacent counties with very high life expectancy and captioned the graphic, "Summit, Pitkin, and Eagle Counties, each at more than 85 years." Their actual values were 86.83 years, 86.52 and 85.94 years. Oglala Lakota County had a life expectancy of 66.81. Lo and behold, 86.83 - 66.81 is more than 20 years. From the source article: > Counties were combined as needed to create stable units of analysis over the period 1980 to 2014, reducing the number of areas analyzed from 3142 to 3110. In 2014, life expectancy at birth for both sexes combined was 79.1 (95% uncertainty interval [UI], 79.0-79.1) years overall, but differed by 20.1 (95% UI, 19.1-21.3) years between the counties with the lowest and highest life expectancy. Pretty cool data viz here: https://vizhub.healthdata.org/subnational/usa https://vizhub.healthdata.org/subnational/usa

dkarapetyan 9y ago

Heck I bet within a 5 mile radius it varies. Just go to east palo alto and then go to "not east" palo alto. The reasons I think are pretty obvious and almost certainly correlated with how affluent your neighbors are. Money basically solves all problems when it comes to wealth related problems like access to good schools and healthcare. Even though in theory healthcare and education should not be so strongly coupled to money.

cylinder 9y ago

Not everything is the government's fault. Go observe the lifestyle choices and dietary choices some of these people make, and then add in the drinking and smoking.

dainichi 9y ago

The "life expectancy of a county" is not a trivial thing to define if you ask me. Is it how long children born now in a county can expect to live, no matter where they live or die, does it only depend on people who die in the county, or is it somehow weighted by the time people live in the county? Maybe there's a standard definition, but my guess is that most people don't know.

finolex1 9y ago
Conventional life expectancy measures are calculated based on the death rates at each age of the residents in that place. Therefore the death rates of people at 80+ or 90+ years may be affected by their lifestyles 30-50 years ago, so it's not always an accurate measure of how long you would expect a child just born to survive in that place. AFAIK it's not weighted by the time people live in that place. Perhaps areas with lots of affluent retirees will have distorted life expectancy rates that may not be reflective of people who are born and spend their lives in that area.
- dainichi 9y ago
  Thanks for that explanation. So if a county has, say, a lot of hospices (and people change their residency when they go there, not sure how that works in the US), that will affect the expectancy negatively, saying nothing about how living in that county affects longevity.