Currie and Schwandt: Mortality Inequality - Good News from a County-Level Approach
The Point: This paper looks at the overall gains in life expectancy in the United States and contributes to the discussion of how equally or unequally these gains have been distributed across different segments of the population.
Although, life expectancy in the United States has been growing since the 1990s, quite a bit of recent research has suggested that inequality of life expectancy is increasing. Such findings, however, have been largely based on looking at life expectancy of people in their forties and fifties.
This paper looks at improvements in mortality and life expectancy across American counties. The paper draws attention to mortality rates among infants, children, and young adults, and finds, among other things, that mortality rates for children ages 0-4 has decreased dramatically in the last two decades especially in poorer counties. The paper further find that there have been significant declines in mortality of African Americans in particular among African American men. Such findings push back against recent assertions that inequality of life expectancy in the United States is increasing. The authors conclude by suggesting we need a more 'balanced approach' to studies in mortality inequality. "[E]vidence, which recognizes real progress as well as areas in need of improvement, is more likely to result in sensible policymaking."(26)
"[T]he number of years that one can expect to live is such an important indicator of welfare... Analysts who have concluded that inequality in life expectancy is increasing have generally focused on life expectancy at age 40 to 50. This observation suggests that it is important to examine trends in mortality for younger and older ages separately." (2-3)
"For men, the shift in life expectancy over time is shown by essentially parallel lines, implying that life expectancy increased roughly equally in rich and poor counties and that inequality in life expectancy at birth neither decreased nor increased. For women, increases in life expectancy at birth have been somewhat stronger in the low-poverty county groups resulting in a steepening of the gradient between 1990 and 2010, which illustrates a slight increase in inequality,,,Overall, improvements in life expectancy have been greater for men than for women, implying a strong reduction of the gender gap" (16)
"Figure 3 shows dramatic reductions in mortality among children aged zero to four between 1990 and 2000, with smaller reductions between 2000 and 2010. From 1990 to 2000, the reductions in under-five mortality were much greater in poorer counties than in richer ones, and slightly larger for males than for females." (17)
"Panel A shows mortality rates for children under five. What is most striking in these figures is the truly remarkable reduction in black mortality rates between 1990 and 2000, and the continuing, though smaller, decline for blacks between 2000 and 2010. In 1990, young black male children in the richest counties had mortality rates of 6.2 per 1000, while white male children in the poorest counties had mortality rates of about 4 per 1000. Thus, racial disparities trumped any inequality based on geographic areas. By 2010, the mortality rate for young black male children in the richest counties was still above the mortality rate for young white males in the poorest counties, but the gap had narrowed greatly." (20)
"We believe that a balanced approach to the mortality evidence, which recognizes real progress as well as areas in need of improvement, is more likely to result in sensible policymaking. After all, emphasizing the negative could send the message that “nothing works,” especially in the face of seemingly relentless increases in income inequality. We have emphasized considerable heterogeneity in the evolution of mortality inequality by age, gender, 26 and race. Going forward, identifying social policies that have helped the poor and reduced mortality inequality is an important direction for future research. Similarly, understanding the reasons that some groups and age ranges have seen stagnant mortality rates will be important for mobilizing efforts to reduce inequality in mortality and improve the health of the poor." (25-26)
Method: Currie and Schwandt lay out a nice summary of various existing methods for measuring mortality inequality (p. 6-8). The approach they use is a geographic one. They collect data at the county level and rank each county according to their poverty rates. The counties are then assigned to groups making up roughly 1 percent of the overall U.S. population. For each county data is collected on county characteristics (poverty rate, median income, educational attainment, etc.), life expectancy, and mortality rates. Mortality data comes from Vital Statistics, gender-specific life expectancy is calculated based on mortality rates, and county characteristics are taken from Census data, as well as, the American Community Survey (ACS). To estimate levels of inequality, Currie and Schwandt look at gender-specific life expectancy at birth, mortality by age, and mortality by race and age.
Citation: Currie, Janet and Hannes Schwandt. 2016. "Mortality Inequality: The Good News from a County-Level Approach." Journal of Economic Perspectives, 30(2): 29-52.