
Widening Gap in U.S. Life Expectancy - sciadvance
https://directorsblog.nih.gov/2017/05/16/widening-gap-in-u-s-life-expectancy/
======
jfaucett
"But nearly three-fourths of the variation in longevity is accountable to
behavioral and metabolic risk factors, including obesity, exercise, smoking,
alcohol and drug addiction, blood pressure, and diabetes"

After searching a bit, it seems like there is a lot of overlay with the
obesity maps of the usa here: [https://www.cdc.gov/obesity/data/prevalence-
maps.html](https://www.cdc.gov/obesity/data/prevalence-maps.html)

not as much precision but exercise seems like it could also be a legit factor
according to these maps:
[https://nccd.cdc.gov/dnpao_dtm/rdPage.aspx?rdReport=DNPAO_DT...](https://nccd.cdc.gov/dnpao_dtm/rdPage.aspx?rdReport=DNPAO_DTM.ExploreByTopic&islClass=PA&islTopic=PA1&go=GO)

What would be interesting is to see if there are places where there is perhaps
an inverse relationship and figure out what there the offsetting factors are.

Does anyone have links for maps of the others by any chance?

~~~
flexie
To imagine that a 20 year old college kid from Akron Colorado can reasonably
expect to outlive most people just born a few hours drive away in South
Dakota...

~~~
planteen
Sadly, those low counties in South Dakota line up with reservations.

------
niftich
It's unfortunate that this blog post does not cite another study, the results
of which were published a month prior to the post's publication, which
investigates in detail this issue: The Association Between Income and Life
Expectancy in the United States, 2001–2014 [1].

That study actually offers insight into which particular factors correlate
weakly or strongly with other factors, and offers charts and figures in key
places to illustrate more detail than a mere line that mentions "
_socioeconomic factors, including race, education, and income, and access to
health care_ ".

It's not a long read at all, and highly recommended.

[1] doi:10.1001/jama.2016.4226
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4866586/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4866586/)

------
davidf18
I heard a recent youtube talk by former NYC Mayor Mike Bloomberg in which he
claimed one of the greatest successes of his administration is that the length
of the average NYC life was extended 3 years.

Most of this was accomplished by public health initiatives such as raising the
cost of tobacco to about $12-$14 per pack through NYS and NYC taxes, banning
smoking in public places, hard-hitting anti-smoking ads of about $1 to $2 per
capita per year. Significant efforts were made to reduce air pollution.
Bloomberg is also known in his attempts to limit sugar-sweetened beverages
(SSB) consumption by tax or banning the purchase with food stamp or limiting
the size of fountain "Cokes" to 16 oz. These SSB attempts were unsuccessful,
yet because of all of the publicity, the rate of New Yorkers who consumed at
least 1 SSB per day dropped from 33% to 25%.

The politicians focus on access to care rather than on public health.

------
epmaybe
From the article itself:

"...this study found that socioeconomic and race/ethnicity factors alone
explained 60% of the variation in life expectancy. At the same time, 74% of
the variation was explained by behavioral and metabolic risk factors alone,
while only marginally more variation was explained by socioeconomic and
race/ethnicity factors, behavioral and metabolic risk factors, and health care
factors combined. Furthermore, there was very little additional effect of
socioeconomic and race/ethnicity factors when accounting for all 3 sets of
factors simultaneously, suggesting that the association between life
expectancy and socioeconomic and race/ethnicity factors at the county level is
largely mediated through behavioral and metabolic risk factors."

Maybe I'm misunderstanding how they are controlling here, but don't race,
income, socioeconomic status in general change one's behavioral and metabolic
risk factors (think because I'm poor I don't have access to fresh produce, or
something like that)? If so, the big conclusion gained by controlling for
those factors seem nearly useless to me.

We all know by now that metabolic and behavioral risk factors drive health
outcomes. Are the authors just trying to point out that hope isn't lost
regardless of race or socioeconomic status?

------
PeterisP
An obvious candidate is the tight coupling between access to medical services
and income. Some link, naturally, exists elsewhere - but it is much higher in
USA than anywhere else in the first world.

~~~
gm-conspiracy
_access to quality medical services_

~~~
PeterisP
My gut feeling is that the average life expectancy is determined less by what
percentage of population has access to top quality medical services and how
good that top quality is, but instead mostly by how many people have to
postpone or limit _basic_ medical services.

------
zajd
Economic inequality, duh

~~~
vorotato
hahah beat me to it I was about to say money.

------
dahart
I'm disappointed by the intentional conflation of life expectancy and
longevity. They are two different things, and the NIH knows it. Life
expectancy has larger and sometimes completely different variations than
longevity. Yet the first and last paragraphs are pretending they're exactly
the same thing, using evidence and variations in expectancy to make statements
about longevity.

~~~
alphaoverlord
For the uninitiated, could you explain the difference?

~~~
dahart
Sure, life expectancy is the average age at death for all people, and
longevity is the average age at which people die of old age.

Death by car crash, for example, affects life expectancy heavily, but doesn't
contribute to longevity at all.

All accidental deaths & infant mortality lower life expectancy but not
longevity.

~~~
LifeExpectancy
I was just a reader so far but I had to register now. As someone who works
full-time in this field: \- You are right about the definition of life
expectancy. \- I have never ever heard this definition of longevity. It is
sometimes used as a synonym for life expectancy. \- No one dies of old age.

~~~
dahart
My sensitivity to the difference between these terms comes from reading Ray
Kurzweil's (and many others') bullshit arguments about how humans will
eventually become immortal through technology. He intentionally conflates
trends in life expectancy with longevity, as do other charlatans who will sell
you a cryogenic chamber or life extending elixir. Having life expectancy
increase _does not mean_ that large numbers of humans are going to start
living to be older than 100 years. The longevity of humans has been around 80
years and barely changing for thousands of years. The life expectancy of
different regions has varied wildly depending on how many people die young.

I'm fairly stunned if you work in this field that you wouldn't have heard of
the concept of longevity, or at least maximum lifespan, as something distinct
and opposed to life expectancy. It's quite important to rule out accidental
causes of death if you want to have any chance of understanding how long
humans can possibly live. Being able to make statements about diet and
exercise requires being able to factor out all car and sports accidents from
the average.

Here's what Wikipedia says: "Longevity, maximum lifespan, and life expectancy
are not synonyms. Life expectancy is defined statistically as the mean number
of years remaining for an individual or a group of people at a given age.
Longevity refers to the characteristics of the relatively long life span of
some members of a population. Maximum lifespan is the age at death for the
longest-lived individual of a species. Moreover, because life expectancy is an
average, a particular person may die many years before or many years after the
"expected" survival. The term "maximum life span" has a quite different
meaning and is more related to longevity."

[https://en.m.wikipedia.org/wiki/Life_expectancy](https://en.m.wikipedia.org/wiki/Life_expectancy)

To be fair, the Longevity entry echoes what you said, that some people use it
as a synonym.

My hope was that the NIH would be more careful, because they're scientists
working in the field, and they know better than to use vague terms that have
easily misunderstood meanings.

> No one dies of old age.

True, but you know exactly what I mean, right? Whatever you want to call it,
natural causes? Ideal conditions? What is the correct term for people who grow
old and don't die of an accident?

~~~
LifeExpectancy
Thank you. I agree with many of your points. Of course, I know about the
discussion of (maximum) life span and also of life expectancy. And, obviously,
the maximum and the expected value (life expectancy) of a random variable is
something different.

I also agree with your statement that life expectancy depended heavily on how
many people die young. Absolutely. But what is not correct is the statement
about the number of centenarians. Please check, for instance, the Human
Mortality Database yourself at www.mortality.org to see how quickly the number
of them is growing. This does not only have something to do with larger birth
cohorts entering those ages but also because of major reductions in mortality
among people aged 80-100. And I would be very curious if you were able to
provide a scientific reference to your statement that human longevity (do you
mean maximum life span?) has been around 80 years for thousands of years. Do
you agree with me (if you refer to maximum life span) that this is different
now?

And -- as you say correctly -- I also agree with you that it would be
advisable not to use vague terms. And in my opinion longevity is a vague term
since some people use it for life expectancy others for life span. So it would
be better if people use those clearly defined concepts to avoid confusion.

My comment about "no one dies of old age" refers to the fact that a certain
cause (ICD 10 code) has to be entered on the death certificate. But I also
agree with you here: the precision of this information at very high ages might
be problematic due to multimorbidity. Your question concerning the "correct
term..." I do not want to claim that I know the correct term. In my
experience, people usually differentiate between senescent mortality and non-
senescent mortality.

Final remark: It seems you are familiar with James Fries' influential paper
from 1980 in NEJM [0] since he is talking about "ideal conditions" and
"natural deaths", which is pretty close to what you write in your last
sentence. :-)

[0]
[http://www.nejm.org/doi/full/10.1056/NEJM198007173030304](http://www.nejm.org/doi/full/10.1056/NEJM198007173030304)

~~~
dahart
I'm a bit of a hypocrite demanding clarity from the NIH but not being clear
enough myself. :P I'm in full and complete agreement with you that vague terms
should be avoided. "Mean lifespan" would be better than both life expectancy
and longevity. "Top 10% of lifespan distribution" would be clearer than
longevity, and probably more informative than "maximum lifespan".

Maybe I should have said that the number of people living to be older than 130
isn't going up, instead of 100. Yes, there are more centenarians now. Yes,
there are more people over 80 now. None of that means that we've increased the
maximum possible human lifespan in any way. All it proves is that we've
decreased the number of people who died before they could have, right? Better
medicine, fewer murders, safer cars, cleaner air, less food poisoning. All
these advancements help us "live longer", and yet none of them increase the
maximum lifespan. We are getting asymptotically closer to the maximum
possible, more and more people are approaching the limit, but there is no
evidence yet that the limit is moving or has ever moved, and that's all I want
to be clear about.

I'm mostly making an argument to counter people (not you) who are, for
whatever agenda, intentionally suggesting that increases in life expectancy
are due to increasing maximum lifespan. It's a common tactic, and it's a
falsehood. The problem here is that the NIH is doing it a little bit. They did
paint a picture of huge variability in life expectancy and then conclude that
diet and exercise are the major solution.

"But nearly three-fourths of the variation in longevity is accountable to
behavioral and metabolic risk factors, including obesity..."

I would be willing to bet that this statistic is citing longevity as I've
described it, and not life expectancy. I don't believe it's true that 3/4 of
the variability of life expectancy is due to diet and exercise in combination
with genetics. But "behavioral" risk factors is super duper fudgy, so I have
no idea. Is dying of road rage or a skydiving accident the kind of behavioral
risk factor they're talking about? I don't know, because they quoted a
statistic that you could interpret to mean almost anything.

If that's the case as I suspect, then this article has knowingly and
intentionally mis-used the terms and left a misleading impression without
saying something technically untrue, precisely because the popular lay-
person's understanding is that they're synonymous.

Scientific references for longevity being constant... I don't have a
definitive source, I've mostly had many long discussions about this with my
brother who just finished his PhD in anthropology and told me about longevity
being constant. Before that I was under the mistaken impression that quotes
you get in school about historic people dying at age 35 meant that nobody
lived past 40. Lots and lots of people believe this, and it's not true. Here
are a few things I got poking around just now:

[http://www.livescience.com/10569-human-lifespans-
constant-2-...](http://www.livescience.com/10569-human-lifespans-
constant-2-000-years.html)

[http://www.ancient-origins.net/news-evolution-human-
origins/...](http://www.ancient-origins.net/news-evolution-human-origins/life-
expectancy-myth-and-why-many-ancient-humans-lived-long-077889)

The table in Wikipedia's article gives some indication too (Life expectancy at
older age):

[https://en.wikipedia.org/wiki/Life_expectancy#Variation_over...](https://en.wikipedia.org/wiki/Life_expectancy#Variation_over_time)

The stats about huge increases in life expectancy for people over age 10, 15
or 21 are all trending in the direction of people who make it to 20 can expect
to live to near 80, plus or minus. Much of the "proof" comes from historical
writing, and not from scientific evidence, according to my anthropologist
brother. But it doesn't take an average to prove people were often living to
be four score years old, it just takes a few samples & stories to know it was
somewhat common, right?

------
afpx
Could someone explain how population migrations work in this model? For
instance, if I am born in rust-belt county A but die in technology advanced
county B, where is my data placed?

~~~
halestock
From one of the cited papers:

"Ezzati et al. used Internal Revenue Service tax records that record movements
from county to county to explore how much migration might explain disparities.
They found that in general individuals moved from high life expectancy to low
life expectancy communities and not the reverse. While their finding suggests
migration may not be a major factor in the national patterns, it could be an
important factor in selected counties that have experienced substantial in- or
out-migration. On the other hand, net immigration of young Hispanic adults
with lower mortality could have tended to increase life expectancy at birth
for some counties and the nation as a whole."

~~~
pagnol
> "They found that in general individuals moved from high life expectancy to
> low life expectancy communities and not the reverse."

This sounds interesting. If this is indeed the case, what could be the reason?

~~~
douche
Lower cost of living and lower property values?

------
crb002
Tobacco and Coca Cola (refined sugar) consumption.

~~~
coldtea
Don't play much of a role. In the South Dacota case, for one, add "alcohol"
and you'd be much closer.

------
frgtpsswrdlame
This is probably as good of a space as any, what do you guys see as
politically feasible solutions to our obesity problem? Politically feasible
would probably entail not angering food lobbies. Or is taxing corn/soda/meat
really the only way?

~~~
overcast
Fat tax, just like Japan. You want to be a fat ass, and drain resources, then
you pay for it. Just like car insurance. You want to drive dangerous sports
cars, then you pay a higher price to cover liability.

~~~
positr0n
The problem with that logic is that people with unhealthy behavior actually
cost the system less. It's way cheaper to be relatively sickly for a few
decades then die of lung cancer or heart disease at 50 than be relatively
healthy and die of cancer or alzheimer's at 90.

Not saying something like that might not be a good idea from a public health
perspective. I'm not educated enough on those issues to have an opinion.

~~~
overcast
Cancer, and Alzheimer's are generally not preventable. Being fat is. If you
want to compare fat people dying of heart disease, and smokers dying of
emphysema, fine. But don't compare an avoidable problem, with an unavoidable
one.

~~~
positr0n
Why not? We're talking about average lifetime medical costs, so who cares if
one is preventable and one isn't?

From a public health perspective yes that absolutely matters, but all I'm
saying is this narrow claim: _You will not save money on medical costs if you
get your population to act healthier and they die of unpreventable diseases
instead of preventable ones._

------
killjoywashere
Funny how that map aligns, at least to the a first approximation, with red-
blue voting. Of course, voting aligns reasonably with a number of the other
variables (obesity, smoking, etc).

~~~
zzleeper
I think it breaks down when you pay more attention. Using this map:
[http://www-personal.umich.edu/~mejn/election/2016/countymapp...](http://www-
personal.umich.edu/~mejn/election/2016/countymappurple1024.png)

\- The Mississippi river is quite blue but has very low life expectancy

\- Similarly in Montana and the Dakotas, the blue counties are the ones doing
poorly

\- From Alabama to SC, the black belt has low life expectancy and votes blue.

~~~
killjoywashere
Actually, looking at the coasts and major metro areas (masses of population)
it holds quite well. I'd be shocked if there was no variance, particularly in
low population areas like the Mississippi floodplain.

