12 ms·

Widening Gap in U.S. Life Expectancy

59 points by sciadvance 10y ago

zajd 10y ago
Economic inequality, duh
- vorotato 10y ago
  hahah beat me to it I was about to say money.
jfaucett 10y ago
"But nearly three-fourths of the variation in longevity is accountable to behavioral and metabolic risk factors, including obesity, exercise, smoking, alcohol and drug addiction, blood pressure, and diabetes" After searching a bit, it seems like there is a lot of overlay with the obesity maps of the usa here: https://www.cdc.gov/obesity/data/prevalence-maps.html https://www.cdc.gov/obesity/data/prevalence-maps.html not as much precision but exercise seems like it could also be a legit factor according to these maps: https://nccd.cdc.gov/dnpao_dtm/rdPage.aspx?rdReport=DNPAO_DTM.ExploreByTopic&islClass=PA&islTopic=PA1&go=GO https://nccd.cdc.gov/dnpao_dtm/rdPage.aspx?rdReport=DNPAO_DT... What would be interesting is to see if there are places where there is perhaps an inverse relationship and figure out what there the offsetting factors are. Does anyone have links for maps of the others by any chance?
- flexie 9y ago
  To imagine that a 20 year old college kid from Akron Colorado can reasonably expect to outlive most people just born a few hours drive away in South Dakota...
  - planteen 9y ago
    Sadly, those low counties in South Dakota line up with reservations.
- JBReefer 9y ago
  Walkability and density is a giant, giant factor, and no one seems to want change the status quo. Anecdata, but most of the 60+ year olds I know that spent their lives in the suburbs can barely walk, all of the 60+ year olds that live in my city walk faster than I do.
- Balgair 9y ago
  It would be nice to see these maps in a population adjustment way, like the last map here: http://www.businessinsider.com/2016-election-results-maps-population-adjusted-cartogram-2016-11/#counties-themselves-arent-uniformly-blue-or-red-looking-at-a-color-gradient-using-varying-shades-of-purple-we-can-see-most-counties-had-a-tight-split-between-republican-and-democratic-voters-although-a-few-islands-of-deep-red-and-blue-still-remain-6 http://www.businessinsider.com/2016-election-results-maps-po...
frgtpsswrdlame 10y ago
This is probably as good of a space as any, what do you guys see as politically feasible solutions to our obesity problem? Politically feasible would probably entail not angering food lobbies. Or is taxing corn/soda/meat really the only way?
- overcast 10y ago
  Fat tax, just like Japan. You want to be a fat ass, and drain resources, then you pay for it. Just like car insurance. You want to drive dangerous sports cars, then you pay a higher price to cover liability.
  - frankc 10y ago
    Well, I don't think that is going to "solve" the underlying problem. It might help the government pay for things, but it's not going to solve the obesity epidemic. There are already huge intrinsic and extrinsic negative impacts to your life if you are obese. One more negative impact is not likely to suddenly make you thin. What we need to do is figure out why people are getting fatter despite how much they don't want to be fat.
    - NikolaeVarius 10y ago
      Sedentary lifestyle, cheap food (and not just junk food, calories in general are insanely cheap), eating too much of said cheap food.
      - frankc 10y ago
        Those are hypothetical causes but they don't actually line up with all the observations. For instances, poor people are fatter than rich people. Shouldn't rich people be fatter since they 1) don't have to work as much manual labor 2) have more access to food. You can try complicate the explanations to account for this but the fact is that it shows that the 'obvious' reasons most people surmise are not so clear cut and need to be tested like any hypothesis. It's a hard problem to test and there are several other competing hypothesis. The best I can say for my own beliefs is that we need to have more studies that need to be done before I'm convinced of any of them.
niftich 10y ago
It's unfortunate that this blog post does not cite another study, the results of which were published a month prior to the post's publication, which investigates in detail this issue: The Association Between Income and Life Expectancy in the United States, 2001–2014 [1]. That study actually offers insight into which particular factors correlate weakly or strongly with other factors, and offers charts and figures in key places to illustrate more detail than a mere line that mentions "socioeconomic factors, including race, education, and income, and access to health care". It's not a long read at all, and highly recommended. [1] doi:10.1001/jama.2016.4226 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4866586/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4866586/
dahart 10y ago
I'm disappointed by the intentional conflation of life expectancy and longevity. They are two different things, and the NIH knows it. Life expectancy has larger and sometimes completely different variations than longevity. Yet the first and last paragraphs are pretending they're exactly the same thing, using evidence and variations in expectancy to make statements about longevity.
- alphaoverlord 10y ago
  For the uninitiated, could you explain the difference?
  - dahart 10y ago
    Sure, life expectancy is the average age at death for all people, and longevity is the average age at which people die of old age. Death by car crash, for example, affects life expectancy heavily, but doesn't contribute to longevity at all. All accidental deaths & infant mortality lower life expectancy but not longevity.
    - LifeExpectancy 9y ago
      I was just a reader so far but I had to register now. As someone who works full-time in this field: - You are right about the definition of life expectancy. - I have never ever heard this definition of longevity. It is sometimes used as a synonym for life expectancy. - No one dies of old age.
      - dahart 9y ago
        My sensitivity to the difference between these terms comes from reading Ray Kurzweil's (and many others') bullshit arguments about how humans will eventually become immortal through technology. He intentionally conflates trends in life expectancy with longevity, as do other charlatans who will sell you a cryogenic chamber or life extending elixir. Having life expectancy increase does not mean that large numbers of humans are going to start living to be older than 100 years. The longevity of humans has been around 80 years and barely changing for thousands of years. The life expectancy of different regions has varied wildly depending on how many people die young. I'm fairly stunned if you work in this field that you wouldn't have heard of the concept of longevity, or at least maximum lifespan, as something distinct and opposed to life expectancy. It's quite important to rule out accidental causes of death if you want to have any chance of understanding how long humans can possibly live. Being able to make statements about diet and exercise requires being able to factor out all car and sports accidents from the average. Here's what Wikipedia says: "Longevity, maximum lifespan, and life expectancy are not synonyms. Life expectancy is defined statistically as the mean number of years remaining for an individual or a group of people at a given age. Longevity refers to the characteristics of the relatively long life span of some members of a population. Maximum lifespan is the age at death for the longest-lived individual of a species. Moreover, because life expectancy is an average, a particular person may die many years before or many years after the "expected" survival. The term "maximum life span" has a quite different meaning and is more related to longevity." https://en.m.wikipedia.org/wiki/Life_expectancy https://en.m.wikipedia.org/wiki/Life_expectancy To be fair, the Longevity entry echoes what you said, that some people use it as a synonym. My hope was that the NIH would be more careful, because they're scientists working in the field, and they know better than to use vague terms that have easily misunderstood meanings. > No one dies of old age. True, but you know exactly what I mean, right? Whatever you want to call it, natural causes? Ideal conditions? What is the correct term for people who grow old and don't die of an accident?
killjoywashere 10y ago
Funny how that map aligns, at least to the a first approximation, with red-blue voting. Of course, voting aligns reasonably with a number of the other variables (obesity, smoking, etc).
- SpartanMindset 10y ago
  Ah someone just had to make it political again, sad to see this on HN, I'm sure you're the same kind of person who wonders why the country is so divided.
  - killjoywashere 9y ago
    From a mathematical perspective: If you can't separate an observation from potential sources of bias, what good is your analysis? The fact that the observation holds despite bias is a strong indicator of its validity. From a business perspective: an informed citizenry makes the best customers. From a leadership perspective: citizens need to engage.
- zzleeper 10y ago
  I think it breaks down when you pay more attention. Using this map: http://www-personal.umich.edu/~mejn/election/2016/countymappurple1024.png http://www-personal.umich.edu/~mejn/election/2016/countymapp... - The Mississippi river is quite blue but has very low life expectancy - Similarly in Montana and the Dakotas, the blue counties are the ones doing poorly - From Alabama to SC, the black belt has low life expectancy and votes blue.
  - killjoywashere 9y ago
    Actually, looking at the coasts and major metro areas (masses of population) it holds quite well. I'd be shocked if there was no variance, particularly in low population areas like the Mississippi floodplain.
- maxerickson 9y ago
  The last map on this page smashes the cartoon: http://gotz.web.unc.edu/2016/12/20/election-maps-representing-area-and-population/ http://gotz.web.unc.edu/2016/12/20/election-maps-representin... (it's the 2016 popular vote)
PeterisP 10y ago
An obvious candidate is the tight coupling between access to medical services and income. Some link, naturally, exists elsewhere - but it is much higher in USA than anywhere else in the first world.
- bkkssnn 9y ago
  Or how much burgers they eat and mountain dew they drink.
  - lithos 9y ago
    Which tends to also be a socioeconomic indicator. Healthy food usually has a cost in time, skill, and/or money.
- gm-conspiracy 9y ago
  access to quality medical services
  - PeterisP 9y ago
    My gut feeling is that the average life expectancy is determined less by what percentage of population has access to top quality medical services and how good that top quality is, but instead mostly by how many people have to postpone or limit basic medical services.
afpx 10y ago
Could someone explain how population migrations work in this model? For instance, if I am born in rust-belt county A but die in technology advanced county B, where is my data placed?
- halestock 10y ago
  From one of the cited papers: "Ezzati et al. used Internal Revenue Service tax records that record movements from county to county to explore how much migration might explain disparities. They found that in general individuals moved from high life expectancy to low life expectancy communities and not the reverse. While their finding suggests migration may not be a major factor in the national patterns, it could be an important factor in selected counties that have experienced substantial in- or out-migration. On the other hand, net immigration of young Hispanic adults with lower mortality could have tended to increase life expectancy at birth for some counties and the nation as a whole."
  - pagnol 9y ago
    > "They found that in general individuals moved from high life expectancy to low life expectancy communities and not the reverse." This sounds interesting. If this is indeed the case, what could be the reason?
    - douche 9y ago
      Lower cost of living and lower property values?
davidf18 10y ago
I heard a recent youtube talk by former NYC Mayor Mike Bloomberg in which he claimed one of the greatest successes of his administration is that the length of the average NYC life was extended 3 years. Most of this was accomplished by public health initiatives such as raising the cost of tobacco to about $12-$14 per pack through NYS and NYC taxes, banning smoking in public places, hard-hitting anti-smoking ads of about $1 to $2 per capita per year. Significant efforts were made to reduce air pollution. Bloomberg is also known in his attempts to limit sugar-sweetened beverages (SSB) consumption by tax or banning the purchase with food stamp or limiting the size of fountain "Cokes" to 16 oz. These SSB attempts were unsuccessful, yet because of all of the publicity, the rate of New Yorkers who consumed at least 1 SSB per day dropped from 33% to 25%. The politicians focus on access to care rather than on public health.
crb002 10y ago
Tobacco and Coca Cola (refined sugar) consumption.
- coldtea 9y ago
  Don't play much of a role. In the South Dacota case, for one, add "alcohol" and you'd be much closer.
epmaybe 9y ago
From the article itself: "...this study found that socioeconomic and race/ethnicity factors alone explained 60% of the variation in life expectancy. At the same time, 74% of the variation was explained by behavioral and metabolic risk factors alone, while only marginally more variation was explained by socioeconomic and race/ethnicity factors, behavioral and metabolic risk factors, and health care factors combined. Furthermore, there was very little additional effect of socioeconomic and race/ethnicity factors when accounting for all 3 sets of factors simultaneously, suggesting that the association between life expectancy and socioeconomic and race/ethnicity factors at the county level is largely mediated through behavioral and metabolic risk factors." Maybe I'm misunderstanding how they are controlling here, but don't race, income, socioeconomic status in general change one's behavioral and metabolic risk factors (think because I'm poor I don't have access to fresh produce, or something like that)? If so, the big conclusion gained by controlling for those factors seem nearly useless to me. We all know by now that metabolic and behavioral risk factors drive health outcomes. Are the authors just trying to point out that hope isn't lost regardless of race or socioeconomic status?

59 points by sciadvance 10y ago

zajd 10y ago

Economic inequality, duh

vorotato 10y ago
hahah beat me to it I was about to say money.

jfaucett 10y ago

"But nearly three-fourths of the variation in longevity is accountable to behavioral and metabolic risk factors, including obesity, exercise, smoking, alcohol and drug addiction, blood pressure, and diabetes" After searching a bit, it seems like there is a lot of overlay with the obesity maps of the usa here: https://www.cdc.gov/obesity/data/prevalence-maps.html https://www.cdc.gov/obesity/data/prevalence-maps.html not as much precision but exercise seems like it could also be a legit factor according to these maps: https://nccd.cdc.gov/dnpao_dtm/rdPage.aspx?rdReport=DNPAO_DTM.ExploreByTopic&islClass=PA&islTopic=PA1&go=GO https://nccd.cdc.gov/dnpao_dtm/rdPage.aspx?rdReport=DNPAO_DT... What would be interesting is to see if there are places where there is perhaps an inverse relationship and figure out what there the offsetting factors are. Does anyone have links for maps of the others by any chance?

flexie 9y ago
To imagine that a 20 year old college kid from Akron Colorado can reasonably expect to outlive most people just born a few hours drive away in South Dakota...
- planteen 9y ago
  Sadly, those low counties in South Dakota line up with reservations.
JBReefer 9y ago
Walkability and density is a giant, giant factor, and no one seems to want change the status quo. Anecdata, but most of the 60+ year olds I know that spent their lives in the suburbs can barely walk, all of the 60+ year olds that live in my city walk faster than I do.
Balgair 9y ago
It would be nice to see these maps in a population adjustment way, like the last map here: http://www.businessinsider.com/2016-election-results-maps-population-adjusted-cartogram-2016-11/#counties-themselves-arent-uniformly-blue-or-red-looking-at-a-color-gradient-using-varying-shades-of-purple-we-can-see-most-counties-had-a-tight-split-between-republican-and-democratic-voters-although-a-few-islands-of-deep-red-and-blue-still-remain-6 http://www.businessinsider.com/2016-election-results-maps-po...

frgtpsswrdlame 10y ago

This is probably as good of a space as any, what do you guys see as politically feasible solutions to our obesity problem? Politically feasible would probably entail not angering food lobbies. Or is taxing corn/soda/meat really the only way?

overcast 10y ago
Fat tax, just like Japan. You want to be a fat ass, and drain resources, then you pay for it. Just like car insurance. You want to drive dangerous sports cars, then you pay a higher price to cover liability.
- frankc 10y ago
  Well, I don't think that is going to "solve" the underlying problem. It might help the government pay for things, but it's not going to solve the obesity epidemic. There are already huge intrinsic and extrinsic negative impacts to your life if you are obese. One more negative impact is not likely to suddenly make you thin. What we need to do is figure out why people are getting fatter despite how much they don't want to be fat.
  - NikolaeVarius 10y ago
    Sedentary lifestyle, cheap food (and not just junk food, calories in general are insanely cheap), eating too much of said cheap food.
    - frankc 10y ago
      Those are hypothetical causes but they don't actually line up with all the observations. For instances, poor people are fatter than rich people. Shouldn't rich people be fatter since they 1) don't have to work as much manual labor 2) have more access to food. You can try complicate the explanations to account for this but the fact is that it shows that the 'obvious' reasons most people surmise are not so clear cut and need to be tested like any hypothesis. It's a hard problem to test and there are several other competing hypothesis. The best I can say for my own beliefs is that we need to have more studies that need to be done before I'm convinced of any of them.

niftich 10y ago

It's unfortunate that this blog post does not cite another study, the results of which were published a month prior to the post's publication, which investigates in detail this issue: The Association Between Income and Life Expectancy in the United States, 2001–2014 [1]. That study actually offers insight into which particular factors correlate weakly or strongly with other factors, and offers charts and figures in key places to illustrate more detail than a mere line that mentions "socioeconomic factors, including race, education, and income, and access to health care". It's not a long read at all, and highly recommended. [1] doi:10.1001/jama.2016.4226 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4866586/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4866586/

dahart 10y ago

I'm disappointed by the intentional conflation of life expectancy and longevity. They are two different things, and the NIH knows it. Life expectancy has larger and sometimes completely different variations than longevity. Yet the first and last paragraphs are pretending they're exactly the same thing, using evidence and variations in expectancy to make statements about longevity.

alphaoverlord 10y ago
For the uninitiated, could you explain the difference?
- dahart 10y ago
  Sure, life expectancy is the average age at death for all people, and longevity is the average age at which people die of old age. Death by car crash, for example, affects life expectancy heavily, but doesn't contribute to longevity at all. All accidental deaths & infant mortality lower life expectancy but not longevity.
  - LifeExpectancy 9y ago
    I was just a reader so far but I had to register now. As someone who works full-time in this field: - You are right about the definition of life expectancy. - I have never ever heard this definition of longevity. It is sometimes used as a synonym for life expectancy. - No one dies of old age.
    - dahart 9y ago
      My sensitivity to the difference between these terms comes from reading Ray Kurzweil's (and many others') bullshit arguments about how humans will eventually become immortal through technology. He intentionally conflates trends in life expectancy with longevity, as do other charlatans who will sell you a cryogenic chamber or life extending elixir. Having life expectancy increase does not mean that large numbers of humans are going to start living to be older than 100 years. The longevity of humans has been around 80 years and barely changing for thousands of years. The life expectancy of different regions has varied wildly depending on how many people die young. I'm fairly stunned if you work in this field that you wouldn't have heard of the concept of longevity, or at least maximum lifespan, as something distinct and opposed to life expectancy. It's quite important to rule out accidental causes of death if you want to have any chance of understanding how long humans can possibly live. Being able to make statements about diet and exercise requires being able to factor out all car and sports accidents from the average. Here's what Wikipedia says: "Longevity, maximum lifespan, and life expectancy are not synonyms. Life expectancy is defined statistically as the mean number of years remaining for an individual or a group of people at a given age. Longevity refers to the characteristics of the relatively long life span of some members of a population. Maximum lifespan is the age at death for the longest-lived individual of a species. Moreover, because life expectancy is an average, a particular person may die many years before or many years after the "expected" survival. The term "maximum life span" has a quite different meaning and is more related to longevity." https://en.m.wikipedia.org/wiki/Life_expectancy https://en.m.wikipedia.org/wiki/Life_expectancy To be fair, the Longevity entry echoes what you said, that some people use it as a synonym. My hope was that the NIH would be more careful, because they're scientists working in the field, and they know better than to use vague terms that have easily misunderstood meanings. > No one dies of old age. True, but you know exactly what I mean, right? Whatever you want to call it, natural causes? Ideal conditions? What is the correct term for people who grow old and don't die of an accident?

killjoywashere 10y ago

Funny how that map aligns, at least to the a first approximation, with red-blue voting. Of course, voting aligns reasonably with a number of the other variables (obesity, smoking, etc).

SpartanMindset 10y ago
Ah someone just had to make it political again, sad to see this on HN, I'm sure you're the same kind of person who wonders why the country is so divided.
- killjoywashere 9y ago
  From a mathematical perspective: If you can't separate an observation from potential sources of bias, what good is your analysis? The fact that the observation holds despite bias is a strong indicator of its validity. From a business perspective: an informed citizenry makes the best customers. From a leadership perspective: citizens need to engage.
zzleeper 10y ago
I think it breaks down when you pay more attention. Using this map: http://www-personal.umich.edu/~mejn/election/2016/countymappurple1024.png http://www-personal.umich.edu/~mejn/election/2016/countymapp... - The Mississippi river is quite blue but has very low life expectancy - Similarly in Montana and the Dakotas, the blue counties are the ones doing poorly - From Alabama to SC, the black belt has low life expectancy and votes blue.
- killjoywashere 9y ago
  Actually, looking at the coasts and major metro areas (masses of population) it holds quite well. I'd be shocked if there was no variance, particularly in low population areas like the Mississippi floodplain.
maxerickson 9y ago
The last map on this page smashes the cartoon: http://gotz.web.unc.edu/2016/12/20/election-maps-representing-area-and-population/ http://gotz.web.unc.edu/2016/12/20/election-maps-representin... (it's the 2016 popular vote)

PeterisP 10y ago

An obvious candidate is the tight coupling between access to medical services and income. Some link, naturally, exists elsewhere - but it is much higher in USA than anywhere else in the first world.

bkkssnn 9y ago
Or how much burgers they eat and mountain dew they drink.
- lithos 9y ago
  Which tends to also be a socioeconomic indicator. Healthy food usually has a cost in time, skill, and/or money.
gm-conspiracy 9y ago
access to quality medical services
- PeterisP 9y ago
  My gut feeling is that the average life expectancy is determined less by what percentage of population has access to top quality medical services and how good that top quality is, but instead mostly by how many people have to postpone or limit basic medical services.

afpx 10y ago

Could someone explain how population migrations work in this model? For instance, if I am born in rust-belt county A but die in technology advanced county B, where is my data placed?

halestock 10y ago
From one of the cited papers: "Ezzati et al. used Internal Revenue Service tax records that record movements from county to county to explore how much migration might explain disparities. They found that in general individuals moved from high life expectancy to low life expectancy communities and not the reverse. While their finding suggests migration may not be a major factor in the national patterns, it could be an important factor in selected counties that have experienced substantial in- or out-migration. On the other hand, net immigration of young Hispanic adults with lower mortality could have tended to increase life expectancy at birth for some counties and the nation as a whole."
- pagnol 9y ago
  > "They found that in general individuals moved from high life expectancy to low life expectancy communities and not the reverse." This sounds interesting. If this is indeed the case, what could be the reason?
  - douche 9y ago
    Lower cost of living and lower property values?

davidf18 10y ago

I heard a recent youtube talk by former NYC Mayor Mike Bloomberg in which he claimed one of the greatest successes of his administration is that the length of the average NYC life was extended 3 years. Most of this was accomplished by public health initiatives such as raising the cost of tobacco to about $12-$14 per pack through NYS and NYC taxes, banning smoking in public places, hard-hitting anti-smoking ads of about $1 to $2 per capita per year. Significant efforts were made to reduce air pollution. Bloomberg is also known in his attempts to limit sugar-sweetened beverages (SSB) consumption by tax or banning the purchase with food stamp or limiting the size of fountain "Cokes" to 16 oz. These SSB attempts were unsuccessful, yet because of all of the publicity, the rate of New Yorkers who consumed at least 1 SSB per day dropped from 33% to 25%. The politicians focus on access to care rather than on public health.

crb002 10y ago

Tobacco and Coca Cola (refined sugar) consumption.

coldtea 9y ago
Don't play much of a role. In the South Dacota case, for one, add "alcohol" and you'd be much closer.

epmaybe 9y ago

From the article itself: "...this study found that socioeconomic and race/ethnicity factors alone explained 60% of the variation in life expectancy. At the same time, 74% of the variation was explained by behavioral and metabolic risk factors alone, while only marginally more variation was explained by socioeconomic and race/ethnicity factors, behavioral and metabolic risk factors, and health care factors combined. Furthermore, there was very little additional effect of socioeconomic and race/ethnicity factors when accounting for all 3 sets of factors simultaneously, suggesting that the association between life expectancy and socioeconomic and race/ethnicity factors at the county level is largely mediated through behavioral and metabolic risk factors." Maybe I'm misunderstanding how they are controlling here, but don't race, income, socioeconomic status in general change one's behavioral and metabolic risk factors (think because I'm poor I don't have access to fresh produce, or something like that)? If so, the big conclusion gained by controlling for those factors seem nearly useless to me. We all know by now that metabolic and behavioral risk factors drive health outcomes. Are the authors just trying to point out that hope isn't lost regardless of race or socioeconomic status?