Background

There are large and persistent disparities in life expectancy among racial–ethnic groups in the USA, but the extent to which these patterns vary geographically on a local scale is not well understood. This analysis estimated life expectancy for five racial–ethnic groups, in 3110 US counties over 20 years, to describe spatial–temporal variations in life expectancy and disparities between racial–ethnic groups.

Methods

We applied novel small-area estimation models to death registration data from the US National Vital Statistics System and population data from the US National Center for Health Statistics to estimate annual sex-specific and age-specific mortality rates stratified by county and racial–ethnic group (non-Latino and non-Hispanic White [White], non-Latino and non-Hispanic Black [Black], non-Latino and non-Hispanic American Indian or Alaska Native [AIAN], non-Latino and non-Hispanic Asian or Pacific Islander [API], and Latino or Hispanic [Latino]) from 2000 to 2019. We adjusted these mortality rates to correct for misreporting of race and ethnicity on death certificates and then constructed abridged life tables to estimate life expectancy at birth.

Findings

Between 2000 and 2019, trends in life expectancy differed among racial–ethnic groups and among counties. Nationally, there was an increase in life expectancy for people who were Black (change 3·9 years [95% uncertainty interval 3·8 to 4·0]; life expectancy in 2019 75·3 years [75·2 to 75·4]), API (2·9 years [2·7 to 3·0]; 85·7 years [85·3 to 86·0]), Latino (2·7 years [2·6 to 2·8]; 82·2 years [82·0 to 82·5]), and White (1·7 years [1·6 to 1·7]; 78·9 years [78·9 to 79·0]), but remained the same for the AIAN population (0·0 years [–0·3 to 0·4]; 73·1 years [71·5 to 74·8]). At the national level, the negative difference in life expectancy for the Black population compared with the White population decreased during this period, whereas the negative difference for the AIAN population compared with the White population increased; in both cases, these patterns were widespread among counties. The positive difference in life expectancy for the API and Latino populations compared with the White population increased at the national level from 2000 to 2019; however, this difference declined in a sizeable minority of counties (615 [42·0%] of 1465 counties) for the Latino population and in most counties (401 [60·2%] of 666 counties) for the API population. For all racial–ethnic groups, improvements in life expectancy were more widespread across counties and larger from 2000 to 2010 than from 2010 to 2019.

Interpretation

Disparities in life expectancy among racial–ethnic groups are widespread and enduring. Local-level data are crucial to address the root causes of poor health and early death among disadvantaged groups in the USA, eliminate health disparities, and increase longevity for all.

Funding

National Institute on Minority Health and Health Disparities; National Heart, Lung, and Blood Institute; National Cancer Institute; National Institute on Aging; National Institute of Arthritis and Musculoskeletal and Skin Diseases; Office of Disease Prevention; and Office of Behavioral and Social Science Research, US National Institutes of Health.

中文翻译：

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美国各县、种族和族裔的预期寿命，2000-19 年：健康差异的系统分析

背景

美国不同种族群体之间的预期寿命存在巨大且持续的差异，但这些模式在当地范围内的地理差异程度尚不清楚。该分析估计了美国 3110 个县 20 年来五个种族群体的预期寿命，以描述预期寿命的时空变化以及种族群体之间的差异。

方法

我们将新颖的小区域估计模型应用于美国国家生命统计系统的死亡登记数据和美国国家卫生统计中心的人口数据，以估计按县和种族群体分层的年度特定性别和特定年龄死亡率（非拉丁裔和非西班牙裔白人 [白人]、非拉丁裔和非西班牙裔黑人 [黑人]、非拉丁裔和非西班牙裔美洲印第安人或阿拉斯加原住民 [AIAN]、非拉丁裔和非西班牙裔亚洲人或从 2000 年到 2019 年，太平洋岛民 [API] 和拉丁裔或西班牙裔 [拉丁裔]）。我们调整了这些死亡率，以纠正死​​亡证明上种族和民族的误报，然后构建了简略生命表来估计出生时的预期寿命。

发现

2000 年至 2019 年间，不同种族群体和县之间的预期寿命趋势有所不同。在全国范围内，黑人的预期寿命有所增加（变化 3·9 年 [95% 不确定性区间 3·8 至 4·0]；2019 年预期寿命为 75·3 年 [75·2 至 75·4] ])、API（2·9 年 [2·7 至 3·0]；85·7 年 [85·3 至 86·0]）、拉丁裔（2·7 年 [2·6 至 2·8]； 82·2年[82·0至82·5]）和怀特（1·7年[1·6至1·7]；78·9年[78·9至79·0]），但仍然是AIAN 人群也是如此（0·0 岁 [–0·3 至 0·4]；73·1 岁 [71·5 至 74·8]）。在全国范围内，这一时期黑人人口与白人人口预期寿命的负差异有所缩小，而AIAN人口与白人人口相比的预期寿命负差异有所增加；在这两种情况下，这些模式在各县中很普遍。2000 年至 2019 年，全国范围内，API 和拉美裔人口与白人人口的预期寿命差异有所扩大；然而，在拉丁裔人口的相当少数县（1465 个县中的 615 个 [42·0%]）和 API 人口的大多数县（666 个县中的 401 [60·2%]）中，这种差异有所下降。对于所有种族群体来说，2000 年至 2010 年预期寿命的改善在各县范围内更为普遍，且比 2010 年至 2019 年更大。在拉丁裔人口的相当少数县（1465 个县中的 615 个 [42·0%]）和 API 人口的大多数县（666 个县中的 401 [60·2%]）中，这种差异有所下降。对于所有种族群体来说，2000 年至 2010 年预期寿命的改善在各县范围内更为普遍，且比 2010 年至 2019 年更大。在拉丁裔人口的相当少数县（1465 个县中的 615 个 [42·0%]）和 API 人口的大多数县（666 个县中的 401 [60·2%]）中，这种差异有所下降。对于所有种族群体来说，2000 年至 2010 年预期寿命的改善在各县范围内更为普遍，且比 2010 年至 2019 年更大。

解释

种族群体之间的预期寿命差异广泛且持久。地方数据对于解决美国弱势群体健康状况不佳和过早死亡的根本原因、消除健康差距和延长所有人的寿命至关重要。

资金

国家少数民族健康和健康差异研究所；国家心肺血液研究所；国家癌症研究所；国家老龄化研究所；国家关节炎、肌肉骨骼和皮肤疾病研究所；疾病预防控制办公室；和美国国立卫生研究院行为和社会科学研究办公室。