Understanding the Regional Divergence in Adult Mortality in the United States Andrew Fenelon, PhD University of Maryland, College Park
American Life Expectancy 77 76 75 Life Expectancy in Years 74 73 72 71 70 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Source: US Vital Statistics, National Center for Health Statistics
American Life Expectancy 77 76 75 Life Expectancy in Years 74 73 72 71 70 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Source: US Vital Statistics, National Center for Health Statistics
American Life Expectancy is in Peril 77 76 75 Life Expectancy in Years 74 73 72 71 70 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Source: US Vital Statistics, National Center for Health Statistics
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
Some Context for the Problem
Adult Mortality by State Source: Fenelon (2013) Population and Development Review
Adult Mortality by State Source: Fenelon (2013) Population and Development Review
Adult Mortality by State 2015 Source: CDC Wonder
Regional Divergence The regional divergence in American adult death rates has two major components
Regional Divergence The regional divergence in American adult death rates has two major components 1. The Southern Disadvantage
Regional Divergence The regional divergence in American adult death rates has two major components 1. The Southern Disadvantage 2. Exceptional East Coast improvements
The Southern Disadvantage A growing gap between the southern states and other US regions Particularly the Central South Kentucky Tennessee Mississippi Alabama
The Southern Disadvantage, Men 0.055 0.05 0.045 ASDR 0.04 ages 50+ 0.035 0.03 0.025 1965 1970 1975 1980 1985 1990 1995 2000 Source: Fenelon (2013) Population and Development Review Central South Upper Midwest Middle Atlantic New England Mountain West Pacific
The Southern Disadvantage, Women 0.04 0.03 ASDR ages 50+ 0.02 Central South Middle Atlantic Upper Midwest New England Mountain West Pacific 0.01 1965 1970 1975 1980 1985 1990 1995 2000 Source: Fenelon (2013) Population and Development Review
Data Visualization of Regional Divergence Population Reference Bureau Funded by the National Institute on Aging Michigan Center on the Demography of Aging https://assets.prb.org/prb17/mortality/index.html
The Southern Disadvantage Source: Population Reference Bureau Declines in Adult Death Rates Lag in the South
The Southern Disadvantage Source: Population Reference Bureau Declines in Adult Death Rates Lag in the South
The Southern Disadvantage Source: Population Reference Bureau Declines in Adult Death Rates Lag in the South
The Southern Disadvantage Source: Population Reference Bureau Declines in Adult Death Rates Lag in the South
Tennessee Source: Population Reference Bureau Declines in Adult Death Rates Lag in the South
Arkansas Source: Population Reference Bureau Declines in Adult Death Rates Lag in the South
East Coast Improvement Source: Population Reference Bureau Declines in Adult Death Rates Lag in the South
East Coast Improvement Source: Population Reference Bureau Declines in Adult Death Rates Lag in the South
East Coast Improvement Source: Population Reference Bureau Declines in Adult Death Rates Lag in the South
East Coast Improvement Source: Population Reference Bureau Declines in Adult Death Rates Lag in the South
Maryland Source: Population Reference Bureau Declines in Adult Death Rates Lag in the South
New York Source: Population Reference Bureau Declines in Adult Death Rates Lag in the South
Explaining the Divergence The Role of Cigarette Smoking
Smoking-attributable mortality, men 350 300 250 Smoking-200 Attributable death rate per 150 50 Central South 100,000 Upper Midwest Middle Atlantic 100 New England Pacific Mountain West 0 1965 1970 1975 1980 1985 1990 1995 2000 Source: Fenelon (2013) Population and Development Review
Smoking-attributable mortality, women 80 70 Central South 60 50 Smoking- Attributable death 40 rate per 100,000 30 Middle Atlantic Pacific New England Mountain West Upper Midwest 20 10 0 1965 1970 1975 1980 1985 1990 1995 2000 Source: Fenelon (2013) Population and Development Review
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
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
Understanding the Regional Divergence in Adult Mortality in the United States Andrew Fenelon afenelon@umd.edu
State Mortality 1965 and 2004 Mortality Rank 2000-2004 50 45 40 35 30 25 20 15 10 5 0 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 0 5 10 15 20 25 30 35 40 45 50 Mortality Rank 1965-69 MI WV RI VT ME GA PA MS MD NH SC DE
State Mortality 1965 and 2004 Mortality Rank 2000-2004 50 45 40 35 30 25 20 15 10 5 0 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 0 5 10 15 20 25 30 35 40 45 50 Mortality Rank 1965-69 MI WV RI VT ME GA PA MS MD NH SC DE
State Mortality 1965-2004 50 45 40 35 30 Mortality Rank 25 2000-2004 20 15 10 5 0 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 0 5 10 15 20 25 30 35 40 45 50 Mortality Rank 1965-69 MD
State Mortality 1965-2004 50 45 40 35 30 Mortality Rank 25 2000-2004 20 15 10 5 0 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 0 5 10 15 20 25 30 35 40 45 50 Mortality Rank 1965-69 MD