Health Equity

A growing health disparity: Life expectancy for richest, poorest Americans

Michael Winters , Contributing News Writer

The poorest American men at age 40 have a life expectancy similar to men in Pakistan and Sudan, according to a major study appearing in the Journal of the American Medical Association (JAMA). Meanwhile, the richest Americans continue to add years to their lives.

That widening gap is the subject of a report JAMA published online April 10. Using tax and Social Security records, eight researchers examined how income correlates with longevity—and how that correlation is changing.

In addition, researchers uncovered something they said should be a key area for further research: The poor live longer in cities such as San Francisco and New York, cities that have higher average incomes and levels of education.

The report found that the gap in life expectancy between the richest 1 percent and the poorest 1 percent was 10 years for women and nearly 15 years for men. Men at the age of 40 in the bottom 1 percent of the income distribution had a life expectancy of almost 73 years, women 79 years. Men in the top 1 percent of the income distribution had a life expectancy of 87 years, women 89 years.

That gap widened between 2001 and 2014, the period examined in the study. Life expectancy increased by about three years for men and women in the top 5 percent of the income distribution but showed no increase for those in the bottom 5 percent.

The researchers put their data in perspective by comparing life expectancies at selected percentiles of the income distribution in the United States with mean life expectancies in other countries. “For example,” the report said, “men in the bottom 1 percent of the income distribution at the age of 40 years in the United States have life expectancies similar to the mean life expectancy for 40-year-old men in Sudan and Pakistan.”

The study confirmed that life expectancy follows income and that most of the variation in life expectancy was related to differences in health behaviors, including smoking, exercise and obesity. But those behaviors and corresponding life expectancy for the poorest individuals correlate with the areas in which people live.

The strongest pattern in the data showed that persons in the lowest-income quartile live the longest, and have more healthful behaviors, in cities with high incomes, high education and high levels of government spending, such as New York and San Francisco. In these cities, life expectancy for the bottom 5 percent in income was about 80 years, compared to about 75 in years in cities such as Gary, Ind., and Detroit.

Researchers suggested the longer lives of the poor in cities such as San Francisco and New York could be explained by public policy in those cities, such as smoking bans and higher spending for public services. Also, those with lower incomes may benefit from the influence of others who follow healthy behaviors.

The variations in cities suggest that reducing gaps in longevity may require local policy changes, the researchers concluded. Health professionals could target low-income communities with interventions intended to change health behaviors, the study found, while taxing and other local polices may play a role in encouraging behavior changes.