Life expectancy by county, race, and ethnicity in the USA 2000-19: a systematic analysis of health disparities GBD US Health Disparities Collaborators

Background There are large and persistent disparities in life expectancy among racial-ethnic groups in the USA, but the extent to which these patterns vary geographically on a local scale is not well understood. This analysis estimated life expectancy for five racial-ethnic groups, in 3110 US counties over 20 years, to describe spatial-temporal variations in life expectancy and disparities between racial-ethnic groups. Methods We applied novel small-area estimation models to death registration data from the US National Vital Statistics System and population data from the US National Center for Health Statistics to estimate annual sex-specific and age-specific mortality rates stratified by county and racial-ethnic group (non-Latino and non-Hispanic White [White], non-Latino and non-Hispanic Black [Black], non-Latino and non-Hispanic American Indian or Alaska Native [AIAN], non-Latino and non-Hispanic Asian or Pacific Islander [API], and Latino or Hispanic [Latino]) from 2000 to 2019. We adjusted these mortality rates to correct for misreporting of race and ethnicity on death certificates and then constructed abridged life tables to estimate life expectancy at birth. Findings Between 2000 and 2019, trends in life expectancy differed among racial-ethnic groups and among counties. Nationally, there was an increase in life expectancy for people who were Black (change 3middot9 years [95% uncertainty interval 3middot8 to 4middot0]; life expectancy in 2019 75middot3 years [75middot2 to 75middot4]), API (2middot9 years [2middot7 to 3middot0]; 85middot7 years [85middot3 to 86middot0]), Latino (2middot7 years [2middot6 to 2middot8]; 82middot2 years [82middot0 to 82middot5]), and White (1middot7 years [1middot6 to 1middot7]; 78middot9 years [78middot9 to 79middot0]), but remained the same for the AIAN population (0middot0 years [-0middot3 to 0middot4]; 73middot1 years [71middot5 to 74middot8]). At the national level, the negative difference in life expectancy for the Black population compared with the White population decreased during this period, whereas the negative difference for the AIAN population compared with the White population increased; in both cases, these patterns were widespread among counties. The positive difference in life expectancy for the API and Latino populations compared with the White population increased at the national level from 2000 to 2019; however, this difference declined in a sizeable minority of counties (615 [42middot0%] of 1465 counties) for the Latino population and in most counties (401 [60middot2%] of 666 counties) for the API population. For all racial- ethnic groups, improvements in life expectancy were more widespread across counties and larger from 2000 to 2010 than from 2010 to 2019. Interpretation Disparities in life expectancy among racial-ethnic groups are widespread and enduring. Local-level data are crucial to address the root causes of poor health and early death among disadvantaged groups in the USA, eliminate health disparities, and increase longevity for all. Funding National Institute on Minority Health and Health Disparities; National Heart, Lung, and Blood Institute; National Cancer Institute; National Institute on Aging; National Institute of Arthritis and Musculoskeletal and Skin Diseases; Office of Disease Prevention; and Office of Behavioral and Social Science Research, US National Institutes of Health. Copyright (c) 2022 Elsevier Ltd. All rights reserved.