A study published today shows that Americans have shorter lives than similarly situated Europeans, and that is true even in the richest areas. At the same time, longevity of Black Americans has been catching up, and the life expectancy gap between Black and white Americans fell by 48.9%.
The paper, “Inequality in Mortality between Black and White Americans by Age, Place and Cause, and in Comparison to Europe, 1990-2018,” is published today in the Proceedings of the National Academy of Sciences (PNAS). It examines age-specific mortality trends and racial gaps in life expectancy in rich and poor U.S. areas and compared them with mortality in six European countries between 1990 and 2018 using Vital Statistics data on each single death occurring across all country during this time period.
“It is astonishing how much stronger longevity gains were in European countries since 1990, and that is true even if we focus on the richest U.S. areas,” said economist Hannes Schwandt, assistant professor in Northwestern University’s School of Education and Social Policy and a fellow in the University’s Institute for Policy Research. Together with Princeton University economist Janet Currie, Schwandt lead the research, which involved 26 coauthors from 15 research institutions across the U.S. and Europe.
The study found inequalities in life expectancy are starker in the U.S. than in Europe.
In 1990, white Americans and Europeans in rich areas had similar overall life expectancy, while life expectancy for white Americans in poor areas was lower. But since then, even rich white Americans have lost ground relative to Europeans. Meanwhile, the gap in life expectancy between Black Americans and Europeans decreased by 8.3%.
Within the United States, the racial longevity gap strongly declined. Black Americans lived seven years fewer than whites in 1990. But by 2018, that number dropped to 3.6 years. “This is a great success story, even though a dramatic and unacceptable life expectancy gap remains,” Schwandt says. “We have to make sure to understand better what has been driving the mortality improvements among Black Americans in order to further narrow, and ultimately fully close, the longevity gap.”
Black life expectancy increased more than white life expectancy in all U.S. areas and among all age groups, however improvements in poorer areas were the most dramatic. The causes that contributed most to the mortality improvements were cancer, homicide, HIV and causes originating in the fetal or infant period, all of which disproportionally affect disadvantaged Black Americans.
Interestingly, there have been significant health improvements for infants and children, in all three groups since 1990, though especially among Black Americans. Safety-net programs such as Medicaid, the Supplemental Nutrition Assistance Program (SNAP), and the Earned Income Tax Credit, as well as lower levels of pollution in poor areas, are all important contributors to reduced mortality. There also is potential for the U.S. to catch up to Europe by investing in maternal and child health.
If improvements had continued at the 1990-2012 rate, the racial gap in life expectancy would have closed by 2036. But life expectancy for both Black and white Americans plateaued or slightly declined after 2012. Still, even prior to the COVID-19 pandemic, this stalling was most evident among Black Americans. European life expectancy also has stalled after 2014, suggesting that there may be a common element.
“What the data tells us is that mortality rates of both Black and white Americans could fall much further across all ages and in both rich and poor areas,” Schwandt said.
The researchers’ goal was to see whether racial differences in life expectancy have evolved differently in richer and poorer parts of the United States using Europe as a benchmark. They ranked American counties based on their poverty rates and placed them into groups of fixed population size. This allowed them to analyze trends across ages and race in places with the same relative poverty rates. Factoring in age is important in order to account for whether changes in life expectancy are based on a person’s stage of life. For example, people older than 65 qualify for Medicare, which could play a role in extending life expectancy.
They also wanted to understand how the United States compared to Europe to determine whether mortality in richer parts of the country is more similar to that of European countries, or whether both rich and poor Americans tend to lag behind. They collaborated with researchers in nine European countries, including Czech Republic, England, Finland, France, Germany, Netherlands, Norway, Portugal and Spain in order to analyze all of the data in a similar framework. These countries represent a range of economic conditions.
Co-authors of the study are from Northwestern, Erasmus School of Economics, University of Manchester, University of Verona, Norwegian School of Economics, Institute for Fiscal Studies London, University of Coimbra, Universitat Pompeu Fabra, University of Milan, Aalto University, VATT Institute for Economic Research Helsinki, University of Munich, Lund University, Université Paris 1, and University of Halle-Wittenberg.