How long you live depends on where you live, new research suggests.
Americans’ life expectancy increased throughout the 20th century, although in some states, particularly in the South, people aren’t living much longer than they were 100 years ago. It’s worse among women.
Researchers at the Yale School of Public Health analyzed the death data of 77 million women and 102 million men born from 1900 through 2000. The findings, published Monday in the journal JAMA Network Open, showed that nationwide life expectancy for women increased from 73.8 to 84.1 in that time frame, while it jumped from 62.8 to 80.3 for men.
Scientists and health officials calculate life expectancy at birth as a way of understanding a country’s health over time. How long people in the United States lived since the last century varied drastically by state.
“What was surprising to me was that for some states, especially for women, there’s basically no change,” said study co-author Theodore Holford, a senior research scientist in biostatistics at Yale University. “Over 100 years, in some of these Southern states, they improved less than two years in the framework of all of the medical advances that we have seen during the 20th century.”
The bottom five states for life expectancy among women born in 2000, compared to women born in 1900, are:
- West Virginia, 75.3, up from 74.3.
- Oklahoma, 76, down from 76.7.
- Kentucky, 76.5, up from 74.9.
- Mississippi, 76.6, up from 73.2.
- Arkansas, 76.6, up from 75.7.
Southern men born in 2000 also tended to have lower life expectancies, though they showed greater improvements than women since 1900:
- Mississippi, 71.8, up from 62.3.
- West Virginia, 72.6, up from 63.7.
- Alabama, 72.6, up from 62.5.
- Louisiana, 72.9, up from 61.5.
- Tennessee 73.4, up from 63.6.
Not all Southern states show lower or stalled life expectancies for people born in 2000.
Florida, Texas and Virginia are among the Southern states featured in the top 20 of life expectancy for both men and women born in 2000.
States outside the South that ranked in the bottom 10 for both sexes include Ohio and Indiana.
The study also highlights life expectancy by state and sex at the midway point of 1950.
Men in particular showed greater improvement during the first half of the century. In North Dakota, for example, male life expectancy jumped 10 years from 66.4 in 1900 to 76.5 in 1950, but only one year, 77.8, from 1950 to 2000.
Data reflects the state in which a person died, not where they were born.
It’s well-established that women live longer than men, but this latest research unveils geographic disparities in life expectancy at a turning point in federal public health administration. Health and Human Services Secretary Robert F. Kennedy Jr. lamented the state of the nation’s health care system in an April 10 statement that was also published in the New York Post.
“Our country’s health is declining. America has the highest rates of chronic disease in the world,” Kennedy said. “We rank last in terms of health among developed nations. And life expectancy is declining for many groups of Americans.”
Why is life expectancy lower in the South?
The Yale study claims to be the first to analyze historic state mortality trends by birth cohort, meaning entire generations are tracked.
Population health research more commonly involves a metric called period life expectancy, which estimates influences on mortality over a select year, such as during a pandemic.
“The idea here is to try to pick up on generational factors,” Holford said. “There are lots of factors related to health that are more closely tied to generations than a calendar year.”
Cindy Prins, an associate professor in the department of population health sciences at the University of Central Florida College of Medicine, who wasn’t involved in the study, said, “This is a unique and important approach to examining life expectancies.”
That doesn’t make the data any less alarming.
“It’s concerning to know that cohort life expectancies in many Southern states, which have the lowest overall life expectancies, haven’t changed much over time,” Prins said.
Overall, Americans are living longer, thanks to improvements in health care, sanitation, tobacco control, and the prevention of cancer, heart disease and other diseases, the study said. Previous research indicates that states with progressive public health policies are more likely to have higher life expectancies. Socioeconomic differences among states also impact longevity.
Dr. Marc Gourevitch, a professor in the department of population health at New York University’s Grossman School of Medicine, said research shows that states with policies that support a more livable minimum wage and paid sick leave, as well as access to affordable medical care, are more likely to show significant life expectancy gains over time.
“Focusing on policies that help people better meet their everyday needs promises to go a long way in improving life expectancy and, with it, giving more people a chance at getting to watch their grandchildren grow,” said Gourevitch, who wasn’t involved in the Yale study.
Women born in 2000 in the District of Columbia have both the highest life expectancy, 93 years, and the biggest improvement since 1900, when life expectancy was 63.9. Similarly, D.C. men born in 2000 have the third-highest life expectancy of 86.5 years, up from 48.7 at the start of the century.
“Urban areas tend to do a lot better than rural areas, presumably because of differences in access to health care,” Holford said of people living longer in the nation’s capital.
Another change is the mix of the population in the District of Columbia.
“Many more people moving into the area who would have a lot of the monetary advantages that would give them better access to things affecting their health,” Holford said.
Which states have the highest life expectancy?
States with the longest life expectancies for women born in 2000 spanned both coasts and beyond the continental U.S.:
- In New York, 91.9, up from 71.2.
- California, 91.3, up from 73.6.
- Massachusetts, 88.8, up from 74.2
- Hawaii, 88.7, up from 75.6 .
Other than D.C., these states show the longest life expectancy among men born in 2000:
- New York, 87.8, up from 60.1.
- California, 86.8, up from 62.7.
- Massachusetts, 84.8, up from 63.4.
- Washington, 84.3, up from 63.7.
Holford said the Yale study is part of his work with the National Cancer Institute’s Cancer Intervention and Surveillance Modeling Network (CISNET). A goal of this and other CISNET research is to help health departments address state-specific disparities.
One downside to implementing promising public health policies, Holford said, is that it can take years — even generations — to measure their effects.
“Nevertheless, it’s important to start it so that you put these things in place.”
