Social Inequality and the Future of US Life Expectancy

Gutin, Iliya; Hummer, Robert A.

doi:10.1146/annurev-soc-072320-100249

Cited by 37 publications

(26 citation statements)

References 127 publications

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“…The report noted the “limited political support among both the public and policymakers to enact the policies and commit the necessary resources” as important reasons for the steady decline in U.S. health rankings. These policies and resources span not only health care and biomedical research, but also social, economic, and environmental spheres, which shape the nonmedical or social determinants of health and the risk factors related to disease and injury ( Berkman, 2009 ; Braveman & Gottlieb, 2014 ; Gutin & Hummer, 2021 ; Link & Phelan, 1995 ; Phelan et al, 2010 ; Pickett & Wilkinson, 2015 ; Schoeni et al, 2008 ; Williams et al, 2019 ).…”

Section: Discussionmentioning

confidence: 99%

Age-Specific Mortality During the 2020 COVID-19 Pandemic and Life Expectancy Changes in the United States and Peer Countries, 1980–2020

Masters

Woolf

Aron

2022

The Journals of Gerontology: Series B

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OBJECTIVES Since the 1980s, life expectancy at birth (e0) in the United States (U.S.) has fallen steadily behind that of other high-income countries, widening the U.S. e0 disadvantage. We estimate how that disadvantage was affected by high mortality rates in 2020, the first full year of the COVID-19 pandemic. METHODS We contrast male and female e0 in the U.S. and 18 peer countries for years 1980, 1995, 2010, 2019 and 2020. Using Arriaga decomposition, we show how differences in age-specific death rates have contributed to U.S. e0 disadvantages. RESULTS In 2020, U.S. male and female e0 declined by 2.33 years (-2.50, -2.15) and 1.69 years (-1.85, -1.53) years, respectively, whereas corresponding changes in peer countries averaged -.67 (-.82 -.51) years and -.50 (-.65, -.35) years, respectively. This accelerated a longstanding and widening U.S. e0 disadvantage relative to its peers, which increased from 3.49 to 5.15 years in males and from 2.78 to 3.97 years in females between 2019 and 2020. Whereas deaths before age 65 accounted for 55% and 40% of declines in US male and female life expectancy, respectively, they accounted for only 24% and 11% of the respective declines in peer countries. DISCUSSION U.S. life expectancy declines in 2020 were larger than in peer countries and involved deaths across a broader age range, particularly among young and middle-aged adults. Both the longstanding U.S. e0 disadvantage and acute losses of life in 2020 signal the need for systemic policy changes in the United States.

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Section: Discussionmentioning

confidence: 99%

Age-Specific Mortality During the 2020 COVID-19 Pandemic and Life Expectancy Changes in the United States and Peer Countries, 1980–2020

Masters

Woolf

Aron

2022

The Journals of Gerontology: Series B

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“…Yet from 2000 to 2019, life expectancy increased by 1.9 years, while overall health equity remained unchanged, and even declined by about 3 points for those ages 25–64. Results such as these suggest that efforts to combat individual health disparities without addressing larger social forces may not succeed in advancing health equity ( Gutin & Hummer, 2021 ).…”

Section: Discussionmentioning

confidence: 99%

Trends in health equity in mortality in the United States, 1969–2019

Anderson

Zimmerman

2021

SSM - Population Health

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: Rationale Health equity is a significant concern of public health, yet a comprehensive assessment of health equity in the United States over time is lacking. While one might presume that overall health will improve with rising living standards, no such presumption is warranted for health equity, which may decline even as average health improves. Objectives To assess trends in national and state-level health equity in mortality for people up to age 25, ages 25–64 and aged 65 and older. Methods A health equity metric was calculated as the weighted mean life expectancy relative to a benchmark level, defined as the life expectancy of the most socially-privileged subpopulation (white, non-Latinx males with a college education or higher). We analyzed 114,558,346 death records from the National Center for Health Statistics, from January 1, 1969 to December 31, 2019 to estimate health equity annually at the national and state-level. Using ICD-9/ICD-10 classification codes, inequities in health were decomposed by major causes of death. Results From 1969 to 2019, health equity in the United States improved (+0.36 points annually [95% CI 0.31–0.41]), albeit at a slower rate over the last two decades (+0.08 points annually [95% CI 0.03–0.14] from 2000 to 2019, compared to +0.57 points annually from 1969 to 2000 [95% CI 0.50–0.65]). Health equity among those under 25 improved substantially (+0.82 points annually [95% CI 0.75–0.89]) but remained flat for adults 25–64 (−0.01 points annually [95% CI -0.03-0.003]) For those over 65, health equity displayed a downward trend (−0.08 points annually [95% CI -0.09 to −0.07]). Gains in equity from reduced unintentional injuries and homicides have been largely offset by rising mortality attributable to drug overdoses. Conclusions The US is failing to advance health equity, especially for adults. Keeping policy-makers accountable to a summary measure of health equity may help coordinate efforts at improving population health.

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“…The strength of critique within US-based studies stems in part from the role of crowdfunding as a last, desperate course of action in a system which remains an outlier among high income countries for both its health spending, and its entrenched inequalities in access ( Gutin and Hummer, 2021 ; Michener, 2018 ). By contrast, while still highly critical of the demands of “entrepreneurial patienthood” ( Kerr et al, 2021 ) and the risks of commodifying healthcare ( Dressler and Kelly, 2018 ), studies in more equitable systems have tended to depict healthcare crowdfunding as one tactic alongside other activism.…”

Section: Background: Crowdfunding Charity and The Nhsmentioning

confidence: 99%