Socioeconomic disparities do not explain the US international disadvantage in mortality

Résumé 0

Objectives The paper seeks to examine the contribution of internal socioeconomic disparities in mortality to the United States international disadvantage in life expectancy at birth. Methods Using individual death records from the US national vital statistics system for years 1982 to 2019 and data for other countries from the Human Mortality Database, we compare age-specific death rates and life expectancy between counties classified into ten socioeconomic categories and 20 high-income countries. We also calculate the number of years of life lost in each socioeconomic decile in relation to the comparison set. Results There is a clear and increasing socioeconomic gradient of mortality in the United States but the growing divergence in internal mortality trends does not explain the rising gap between the country and its peers. In 2019, even American women in the most socioeconomically advantaged decile lived shorter lives while only the 10% men in the most affluent decile fared better than their peers. The long-standing US disadvantage in young adult mortality has been growing and the country previous advantage in mortality at ages 75 years and above has virtually disappeared for all but for Americans in the most affluent counties. Discussion The similar age-pattern of differences in mortality rates between socioeconomic deciles and the comparison group suggests that the underlying factors might be the same. The roles of external causes (including drug overdoses) for middle-age adults and a slowing down in progress to control cardiovascular diseases at older ages at the national level are consistent with this pattern.