Unless you are living under a rock this week, you heard there was a huge new study on life expectancy in America.  It's worth discussing.  This is Healthcare Triage News.

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JAMA, "The association between income and life-expectancy in the United States, 2001-2014".  Okay, get this.  Researchers got ahold of 1.4 billion, with a b, de-identified tax records from 1999-2014.  Then, they got ahold of social security numbers for every single American with a social security number between 1999 and 2014.  Then they linked them together and used social security death records to create life expectancy tables.

So right off, it's hard to imagine that you could ever have more complete data.  This is like, nearly every adult American in the United States from 1999 to 2014.  They had data on 1,408,287,218 person-year observations for people age 40-76 years of age.  The median household earnings among those who worked was just over $61,000.  

Over the study period, there were 4,114,380 deaths among men and 2,694,808 deaths among women.  There were four main findings to this study.  The first was that higher income was associated with a significantly longer life expectancy.  The richest 1% of men lived 87.3 years, compared to 72.7 years for the poorest 1% of men, a 15 year difference.  For women, the richest 1% lived 88.9 years compared to 78.8 for the poorest 1%, a difference of ten years.

The second thing to note is that this gap in life expectancy between the rich and the poor has been increasing over time.  Between 2001 and 2014, life expectancy for the richest 5% of Americans increased 2.3 years for men and 2.9 years for women, but for those in the bottom 5% of income, it only increased 0.3 years for men and 0.04 years for women.

The third finding was that life expectancy really differs among low income individuals, depending on where you live.  In the bottom 25% of earners in the United States, life expectancy differed by as many as 4.5 years depending on local areas.  In some places, life expectancy went up more than four years over the study period.  In other places, it went down more than two years.

The final thing to know is that life expectancy is associated with a number of health behaviors in the lowest quartile of earners.  Smoking, for instance, is a big deal.  What's more surprising, though, is what's not associated with life expectancy.  Acccess to medical care, for instance, was not associated with difference in geographic life expectancy.  How much medicare spent or the proportion of people with health insurance were not associated with differences in life expectancy.  Neither were physical environmental factors, income inequality, or labor market conditions.  

What was associated with improved life expectancy in certain areas: having more immigrants in the area.  Having more college graduates in the area.  Having more government expenditures in the area.  Wealthier, more concentrated urban areas have higher life expectancies, even among the poor.  In New York, where regulation of trans fats and smoking is common and social spending is high, there's a much higher life expectancy among the poor than say, the rural West.

This isn't to say that health insurance and medical care aren't important.  They surely are, but when we're talking about life expectancy and population health, it's important to realize that many other things, more at a public health level, may make a much bigger difference.  Want to make everyone live longer?  Pay attention to those things.

Healthcare Triage is supported in part by viewers like you through patreon.com, a service that allows you to support the show through a monthly donation.  We'd especially like to thank our research associates Joe Sevits and M.T., and our surgeon admiral, Sam.   Thanks, Joe and M.T.  Thanks, Sam.  More information can be found at patreon.com/healthcaretriage.