Life expectancy in America depends on where you are born  

Life expectancy in the United States reveals a deeply fractured landscape. Yale School of Public Health researchers examined records of 179 million deaths between 1969 and 2020, and traced how generational health patterns diverged across regions.

The team chose an unconventional approach – analyzing life expectancy by birth cohort instead of by year – to uncover hidden disparities missed by standard mortality reports.

The findings, published in JAMA Network Open, tell a compelling story of a nation where regional policies, economic conditions, and public health initiatives shape life trajectories in dramatically different ways.

Life expectancy gains in some states

California and New York surged ahead in terms of extending lifespans significantly. In contrast, many Southern states struggled to keep pace. This result indicates that the U.S. is a country where the place of birth remains a potent predictor of lifespan.

“For females born in some Southern states, life expectancy increased by less than three years from 1900 to 2000,” said Theodore R. Holford, lead author and professor emeritus at Yale.

“That’s a staggering contrast when you consider that in states like New York and California, life expectancy rose by more than 20 years over the same period.”

Washington, D.C., a region once synonymous with low life expectancy, now exemplifies transformative progress. Between 1900 and 2000, the life expectancy of women in the capital increased by almost 30 years, while the life expectancy of men leapt by 38 years.

What fueled such a stark contrast?

Public health policies, economic revitalization, and aggressive tobacco control campaigns reshaped the region.

California, banned workplace smoking in 1995, slashed smoking rates among workers and teens, and lowered smoking-related deaths. Kentucky, by contrast, chose a different path by resisting tobacco control efforts and continuing to grapple with high mortality rates from smoking.

“These trends in mortality and life expectancy reflect not only each state’s policy environment but also their underlying demographics as well,” said Jamie Tam, assistant professor at Yale.

“It’s not surprising that states with fewer improvements to life expectancy also have higher rates of poverty, for example.”

Life expectancy trends by generation

The study’s approach of using an age-period-cohort model allowed the researchers to isolate the impact of generational experiences.

Instead of year-by-year comparisons, the team followed birth cohorts from 1900 to 2000, revealing how early-life conditions like disease exposure, sanitation, and vaccine access shaped lifespans.

“Looking at mortality trends by cohort gives us a more accurate reflection of the lived experiences of populations,” noted Holford.

“It shows the long-term impact of policies and social conditions affecting the life course of populations, that might otherwise be invisible in year-by-year comparisons of mortality rates from different generations.”

A child born in Mississippi in 1900 faced vastly different health risks than one born in California in 1950. The study’s cohort analysis illuminated how those risks compounded over time, creating distinct health outcomes across states.

Aging rapidly or aging well

States varied not only in life expectancy gains but also in how quickly health declined after age 35. Oklahoma and Iowa showed rapid rises in mortality risk, with mortality doubling in less than eight years.

New York and Florida, in contrast, experienced slower rates of increase, suggesting healthier aging populations.

Among women, the slowest mortality increase occurred in New York, where it took 9.39 years for mortality risk to double.

For men, Florida recorded the longest doubling time at 11.47 years. Oklahoma’s women faced the fastest decline, with mortality risk doubling in just 7.96 years – a rate that suggests rapid health deterioration.

“The disparities we see today are the result of decades of cumulative effects on smoking rates, health care access, environmental exposures, and public health investments,” Holford emphasized. “Without conscious policy changes, these gaps will likely persist or even widen.”

Reinvention in Washington, D.C.

Washington, D.C., a region once plagued by poor health outcomes, now serves as a case study in urban transformation.

At the dawn of the 20th century, women in the capital could expect to live just 63.9 years. By 2000, life expectancy had soared to 93 years – the highest gain recorded nationwide. Male life expectancy jumped from 48.7 years to 86.5 years over the same period.

What drove this metamorphosis? Improved healthcare infrastructure, urban policy changes, and robust public health initiatives fueled the gains.

Yet, for rural Southern states, the story remained grim. In Kentucky and Alabama, policymakers resisted public health reforms, leaving residents trapped in cycles of poverty and poor health outcomes.

Poverty’s impact on life expectancy

While Washington, D.C., and California leveraged economic growth to implement effective health policies, states like Mississippi and Kentucky remained mired in economic hardship.

Poverty compounded existing health risks, leaving residents more vulnerable to chronic diseases and less likely to access preventive care.

California’s tobacco control measures slashed smoking rates, particularly among younger cohorts. In Kentucky, however, the absence of similar policies allowed smoking rates to persist, resulting in higher smoking-related death rates.

The data illustrate a stark divide: states with strong economies and progressive health policies saw life expectancy gains, while poorer states stagnated.

Interventions to bridge the gap

Targeted public health interventions offer a path forward. Researchers recommend that states with lower cohort life expectancy consider comprehensive tobacco regulations, expanded healthcare access, and environmental health initiatives.

“This research highlights the importance of viewing health through a generational lens,” Tam said. “The benefits of health interventions ripple across lifetimes.”

For Southern states, reversing the stagnation will require targeted investments in public health infrastructure, disease prevention, and health education.

Without such efforts, the study warns, the gap between states with high and low life expectancy will only widen, locking future generations into predetermined health outcomes.

“Where you are born shouldn’t determine how long you live,” Holford concluded. “But in America, it still does.”

The study is published in the journal JAMA Network Open.

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