Abstract
Objectives:Socioeconomic disparities in life expectancy in the United States (US) are marked and have widened over time. However, there is limited research using individual-level socioeconomic variables as such information is generally lacking or unreliable in vital records used for life table construction. Using longitudinal cohort data, we computed life expectancy for US adults by social determinants such as education, income/poverty level, occupation, and housing tenure.Methods:We analyzed the 1997-2014 National Health Interview Survey prospectively linked to mortality records in the National Death Index (N=1,146,271). Standard life table methodologies were used to compute life expectancy and other life table functions at various ages according to socioeconomic variables stratified by sex and race/ethnicity.Results:Adults with at least a Master’s degree had 14.7 years higher life expectancy at age 18 than those with less than a high school education and 8.3 years higher life expectancy than those with a high school education. Poverty was inversely related to life expectancy. Individuals living in poverty had 10.5 years lower life expectancy at age 18 than those with incomes ≥400% of the poverty threshold. Laborers and those employed in craft and repair occupations had, respectively, 10.9 years and 8.6 years lower life expectancy at age 18 than those with professional and managerial occupations. Male and female renters had, respectively, 4.0 years and 4.6 years lower life expectancy at age 18 than homeowners. Women in the most advantaged socioeconomic group outlived men in the most disadvantaged group by 23.5 years at age 18.Conclusions and Global Health Implications:Marked socioeconomic gradients in US life expectancy were found across all sex and racial/ethnic groups. Adults with lower education, higher poverty levels, in manual occupations, and with rental housing had substantially lower life expectancy compared to their counterparts with higher socioeconomic position.
Highlights
Life expectancy has long been considered an important indicator of a nation’s health and wellbeing and human development.[1,2,3] For over three decades, reducing health inequalities and increasing life expectancy among Americans have been the two most important health policy goals for the United States (US).[1,4] life expectancy estimates for the US are routinely reported by sex, race/ethnicity, rural-urban residence, and geographic area,[5,6,7,8] they are not readily available by individual measures of socioeconomic status (SES)
Since the National Health Interview Survey (NHIS)-National Death Index (NDI) file provides only the quarter of death, we assumed that death occurred in the middle month of the quarter, February, May, August, or November.[22]
Educational attainment consisted of five categories: less than high school diploma, high school diploma, some college, Bachelor’s degree, and Master’s degree or higher
Summary
Life expectancy has long been considered an important indicator of a nation’s health and wellbeing and human development.[1,2,3] For over three decades, reducing health inequalities and increasing life expectancy among Americans have been the two most important health policy goals for the United States (US).[1,4] life expectancy estimates for the US are routinely reported by sex, race/ethnicity, rural-urban residence, and geographic area,[5,6,7,8] they are not readily available by individual measures of socioeconomic status (SES). A number of studies have shown persistent or widening socioeconomic disparities in life expectancy over time both in the US and other Western nations such as Canada, the United Kingdom, Australia, and New Zealand.[1,9,10,11,12,13,14] Life expectancy disparities have widened as people in higher SES groups or in more affluent communities have experienced larger gains in life expectancy than their disadvantaged counterparts.[9,10,11]. Many of these studies have used area-based socioeconomic deprivation measures to study disparities in life expectancy in the absence of patientlevel socioeconomic data in administrative databases, including the vital statistics-based national mortality database in the US.[1,6,9,10] Few studies have analyzed variations in life expectancy according to individual SES measures, using longitudinal cohort data for the US.[15,16,17,18] Efforts have been made to estimate life expectancy using educational attainment data on the death certificate, but the quality of education data, especially for decedents aged 65 years and older, remains poor and unreliable.[5,19] Prospective linkages of population surveys and census cohorts with disease registries and mortality records have enabled recent studies to examine differentials in life expectancy by individual or household income, education, and occupation,[15,16,17] but none have tackled the issue of life expectancy disparities using a wide range of individual-level social determinants
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