Disparities in Life Expectancy Across US States Over the Past Century

A comprehensive study conducted by researchers at Yale School of Public Health has uncovered significant disparities in longevity among US states and the District of Columbia over the last hundred years. Published in JAMA Network Open, the research analyzed over 179 million deaths from 1969 to 2020, highlighting how public health policies, social conditions, and environmental factors have shaped life expectancy across different regions.

The findings reveal a mixed picture: while some states, mainly in the Northeast and West, experienced substantial gains—up to 30 years for females and 38 years for males—others, particularly in the South, saw minimal or no improvement. For example, women born in certain Southern states from 1900 to 2000 gained less than three years in life expectancy, whereas states like New York and California saw increases of over 20 years.

Urban centers like Washington D.C. made remarkable advances, emerging from low starting points in 1900 and narrowing the gap dramatically by 2000. Conversely, states such as Mississippi, Alabama, and Kentucky lagged behind, with systemic issues like socioeconomic disadvantages and limited healthcare access contributing to persistently lower health outcomes.

The researchers employed sophisticated models considering age, historical timeline, and generational influences to understand long-term health patterns. These models demonstrated how early-life conditions, such as sanitation, vaccinations, and tobacco use, significantly impacted health trajectories and mortality risks later in life.

Disparities are also evident in aging patterns. States like Hawaii and Massachusetts showed slower increases in mortality risk after age 35, indicating healthier aging, while others like Oklahoma and Iowa experienced faster declines. The study emphasizes that these patterns result from decades of cumulative effects—including public health initiatives, socioeconomic factors, and environmental exposures—and that without targeted policy efforts, these gaps will likely persist.

The research underscores the importance of viewing health through a generational lens, recognizing that early prevention and policy interventions can have long-lasting benefits. For instance, early adoption of smoking bans and public health programs in some states contributed to better health outcomes, while delayed measures in others continue to elevate mortality risks.

Overall, this study highlights critical areas for health policy focus and equity reforms to improve longevity across all regions of the United States. Refocusing efforts on conditions that influence health from early life can help close these persistent gaps in life expectancy.