KEY FINDINGS

• Where you are born and where you are living at age 50 both matter

  New research highlighted in this report suggests that geographical disparities impact people not just at birth, but across the course of a lifetime. It is therefore critical to work to change the impact of geography and economic inequality on life expectancy in mid-adulthood, in addition to childhood.
  
  Successful solutions addressing both the challenges and opportunities of aging societies—including local geographic, economic, and racial disparities, which are increasingly limiting healthy longevity—will likely require interventions at the national, state, and local levels.
  
  Life Expectancy at age 50 may be a better measure of the impact of the COVID-19 pandemic on U.S. life expectancy than life expectancy at birth, because it measures mortality in people at higher risk for serious illness and death.
  
  

• Geographic disparities in life expectancy grew across the U.S. from 1980 to 2014.

  While life expectancy rose in most U.S. counties from 1980 to 2014, the gap between the best-and worst-performing counties widened.
  
  Between 1980 and 2014, life expectancy at age 50 only increased in the worst performing county by 2.4 years, as compared to 5.6 in the best performing county—an increase in geographic disparity of 3.2 years.
  
  This increase in geographic disparity means that residents in the best-performing counties are benefiting from increasing longevity while the residents in the worst-performing counties are not given the same opportunity.
  
  The rising inequality in life expectancy observed at the county level between 1980 and 2014 may have laid the groundwork for subsequent decreases in overall life expectancy in the U.S. between 2015 and 2017. [i]
  
  
  

• Geographic disparities between counties reflect economic and racial disparities.

  Racial disparities underlie many of the geographic disparities we find between counties.
  - Improvements in life expectancy at age 50 in counties in which the majority of residents are Black lag almost three decades behind the improvements in life expectancy at age 50 experienced by residents of counties with less than 5% Black residents.
  
  In 1980, residents in majority Black counties had a lower life expectancy at age 50 than residents in counties with less than 5% Black residents. It took Black counties until 2008, or 28 years, to catch up and have the same life expectancy at age 50 as counties with less than 5% Black residents back in 1980.
  
  The major economic shock in the U.S. that has resulted from the global COVID-19 pandemic could potentially widen existing economic and racial inequities. Black workers also suffered from a weak job recovery after the Great Recession.[ii]
  
  
  

• While the data from this analysis predates COVID-19, rising geographic disparities may share common root causes with today’s dramatic disparities in mortality during the pandemic.

  Disparities matter more than ever at a time when U.S. counties with a higher percentage of Black residents have accounted for more than half of coronavirus cases and deaths. [iii]
  
  As the U.S. seeks to rebound from the pandemic, we as a nation need to address the underlying systemic causes of the growing inequity in in longevity, such as disparities in access to quality health care, housing, work and transportation.