The 21st century has been a period of rising inequality in both income and health. In this paper, we find that geographic inequality in mortality for midlife Americans increased by about 70 percent between 1992 and 2016. This was not simply because states like New York or California benefited from having a high fraction of college-educated residents who enjoyed the largest health gains during the last several decades. Nor was higher dispersion in mortality caused entirely by the increasing importance of "deaths of despair," or by rising spatial income inequality during the same period. Instead, over time, state-level mortality has become increasingly correlated with state-level income; in 1992 income explained only 3 percent of mortality inequality, but by 2016 state-level income explained 58 percent. These mortality patterns are consistent with the view that high-income states in 1992 were better able to enact public health strategies and adopt behaviors that, over the next quarter-century, resulted in pronounced relative declines in mortality. The substantial longevity gains in high-income states led to greater cross-state inequality in mortality.

中文翻译：

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美国死亡率的地理差异不断扩大。

21 世纪是收入和健康方面不平等加剧的时期。在本文中，我们发现，在 1992 年至 2016 年间，美国中年人死亡率的地域不平等增加了约 70%。这不仅仅是因为纽约或加利福尼亚等州受益于高比例的受过大学教育的居民，他们享有最大的过去几十年的健康收益。死亡率的更高分散也不是完全由“绝望死亡”的重要性增加或同期空间收入不平等加剧造成的。相反，随着时间的推移，州级死亡率与州级收入的相关性越来越高。1992 年，收入仅解释了死亡率不平等的 3%，但到 2016 年，州级收入解释了 58%。这些死亡率模式与以下观点一致，即 1992 年的高收入州能够更好地制定公共卫生战略并采取在接下来的 25 年中导致死亡率相对显着下降的行为。高收入州大幅延长寿命导致跨州死亡率不平等加剧。