Understanding the Regional Divergence in Adult Mortality in the United States

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1 Understanding the Regional Divergence in Adult Mortality in the United States Andrew Fenelon, PhD University of Maryland, College Park

2 American Life Expectancy Life Expectancy in Years Source: US Vital Statistics, National Center for Health Statistics

3 American Life Expectancy Life Expectancy in Years Source: US Vital Statistics, National Center for Health Statistics

4 American Life Expectancy is in Peril Life Expectancy in Years Source: US Vital Statistics, National Center for Health Statistics

5 A Problem The United States ranks 26 th of 35 high-income countries with an average life expectancy of just 78.8 years Source: WHO Life Expectancy estimates from America s Health Rankings, 2015

6 Some Context for the Problem

7 Adult Mortality by State Source: Fenelon (2013) Population and Development Review

8 Adult Mortality by State Source: Fenelon (2013) Population and Development Review

9 Adult Mortality by State 2015 Source: CDC Wonder

10 Regional Divergence The regional divergence in American adult death rates has two major components

11 Regional Divergence The regional divergence in American adult death rates has two major components 1. The Southern Disadvantage

12 Regional Divergence The regional divergence in American adult death rates has two major components 1. The Southern Disadvantage 2. Exceptional East Coast improvements

13 The Southern Disadvantage A growing gap between the southern states and other US regions Particularly the Central South Kentucky Tennessee Mississippi Alabama

14 The Southern Disadvantage, Men ASDR 0.04 ages Source: Fenelon (2013) Population and Development Review Central South Upper Midwest Middle Atlantic New England Mountain West Pacific

15 The Southern Disadvantage, Women ASDR ages Central South Middle Atlantic Upper Midwest New England Mountain West Pacific Source: Fenelon (2013) Population and Development Review

16 Data Visualization of Regional Divergence Population Reference Bureau Funded by the National Institute on Aging Michigan Center on the Demography of Aging

17 The Southern Disadvantage Source: Population Reference Bureau Declines in Adult Death Rates Lag in the South

18 The Southern Disadvantage Source: Population Reference Bureau Declines in Adult Death Rates Lag in the South

19 The Southern Disadvantage Source: Population Reference Bureau Declines in Adult Death Rates Lag in the South

20 The Southern Disadvantage Source: Population Reference Bureau Declines in Adult Death Rates Lag in the South

21 Tennessee Source: Population Reference Bureau Declines in Adult Death Rates Lag in the South

22 Arkansas Source: Population Reference Bureau Declines in Adult Death Rates Lag in the South

23 East Coast Improvement Source: Population Reference Bureau Declines in Adult Death Rates Lag in the South

24 East Coast Improvement Source: Population Reference Bureau Declines in Adult Death Rates Lag in the South

25 East Coast Improvement Source: Population Reference Bureau Declines in Adult Death Rates Lag in the South

26 East Coast Improvement Source: Population Reference Bureau Declines in Adult Death Rates Lag in the South

27 Maryland Source: Population Reference Bureau Declines in Adult Death Rates Lag in the South

28 New York Source: Population Reference Bureau Declines in Adult Death Rates Lag in the South

29 Explaining the Divergence The Role of Cigarette Smoking

30 Smoking-attributable mortality, men Smoking-200 Attributable death rate per Central South 100,000 Upper Midwest Middle Atlantic 100 New England Pacific Mountain West Source: Fenelon (2013) Population and Development Review

31 Smoking-attributable mortality, women Central South Smoking- Attributable death 40 rate per 100, Middle Atlantic Pacific New England Mountain West Upper Midwest Source: Fenelon (2013) Population and Development Review

32 A Caution about the Role of Smoking Cigarette smoking behavior is not just an individual decision Smoking Prevalence by State We should avoid blaming the victim, and instead seek to understand the underlying factors that contribute to smoking

33 Summary The states with the highest adult mortality are largely in the South This pattern is relatively recent, and has occurred largely since 1980 Mid-Atlantic states on the East Coast have seen exceptional mortality improvements

34 Understanding the Regional Divergence in Adult Mortality in the United States Andrew Fenelon

35 State Mortality 1965 and 2004 Mortality Rank NM NE AK CO FL MN UT AR KS CA ID ND TX OR MT WI HI AZ OK WA KY AL IA SD TN NV NY NJ VA NC MO CT IL WY LA MA IN OH Mortality Rank MI WV RI VT ME GA PA MS MD NH SC DE

36 State Mortality 1965 and 2004 Mortality Rank NM NE AK CO FL MN UT AR KS CA ID ND TX OR MT WI HI AZ OK WA KY AL IA SD TN NV NY NJ VA NC MO CT IL WY LA MA IN OH Mortality Rank MI WV RI VT ME GA PA MS MD NH SC DE

37 State Mortality Mortality Rank KY MS TN AR AL WV NC IN OK MO OH ME IL AK KS IA PA NH WA MA OR VT SD MT WI NE CT WY AZ ND MN CA ID CO NM HI UT SC GA VA TX MI NV RI FL NJ NY LA DE Mortality Rank MD

38 State Mortality Mortality Rank KY MS TN AR AL WV NC IN OK MO OH ME IL AK KS IA PA NH WA MA OR VT SD MT WI NE CT WY AZ ND MN CA ID CO NM HI UT SC GA VA TX MI NV RI FL NJ NY LA DE Mortality Rank MD

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