New research shows wide variation in life expectancy across different parts of the country, including five states in which the probability of death actually increased more than 10% over the last 26 years.
The U.S. Burden of Disease Collaborators, a group made up of dozens of doctors from some of the country's biggest research institutes, released its latest report on the state of health in the U.S. in the Journal of the American Medical Association this week.
The study dives into death rates, life expectancy and years lived with a disability based on 333 causes and 84 risk factors, measuring changes in those metrics from 1990 to 2016. Overall, mortality rates declined by about 32% during that time frame, and the probability of death for people aged 20 to 55 declined in 31 states and the District of Columbia.
But pockets of the country are seeing significantly poorer outcomes. Despite decades of declining mortality rates for 20- to 55-year-olds, the probability of death actually reversed in 21 states, and increased by more than 10% in five states: West Virginia, New Mexico, Wyoming, Kentucky and Oklahoma. Mortality rate reversals were strongly linked to the burden of substance abuse, cirrhosis and self-harm.
Researchers also found significant gaps between states. Hawaii, for example, has the highest life expectancy at 81.3 years, while life expectancy in Mississippi is the lowest at 74.7 years.
"The findings … indicate that while the United States overall is experiencing improvements in health outcomes, the patterns of health at the state level vary across geography," the researchers said. "Routinely monitoring the trend of burden of disease is essential given the vital role of states in many aspects of health and social policy."
The study also found that though, overall, states have made strides in reducing mortality risk, there is still work to be done in addressing disability risk. This is especially true for drug addiction disorders, according to the study, which accounted for a large portion of the disability burden.
These findings can drive policy and clinical change, and put a focus on areas for improvement, said Howard K. Koh, M.D., of the Harvard T.H. Chan School of Public Health, and Anand K. Parekh, M.D., of the D.C.-based Bipartisan Policy Center, in an accompanying editorial.
The research drives home the importance of investing in preventive care, the pair wrote, especially in specialties like behavioral health, where access has lagged considerably.
Policymakers can also use this evidence to rethink the "current dismal national stance toward disease prevention," according to the editorial. Public health agencies should be a funding priority, and health policy should account for the need to address the social determinants of health, they said.
"Clinicians and policymakers can use these analyses and rankings to reexamine why so many individuals still experience preventable injury, disease and death," they wrote. "Doing so could move the entire nation closer toward a United States of health."