Life-Expectancy Inequality Grows in America | Hacker News Reader

Life-Expectancy Inequality Grows in America

newyorker.com

60 pointsrafaelc47 comments

“A medical journal article reporting that income is significantly associated with life expectancy is a call to arms,..."

Yet the gender disparity is much greater (and rising), and that is a call to...[crickets]

Here's the worldwide data: http://www.who.int/entity/bulletin/volumes/90/8/BLT-11-09737...

and artile: http://www.who.int/bulletin/volumes/90/8/11-097378/en/

Short version: low income is worse for everyone, but (not surprisingly) more worse for men than women. For high income, men and women have almost achieved parity.

That's interesting. The article talks about "shortfall", not about absolute lifespan. What is the baseline for that shortfall?

It almost looks like it might be the gender-segregated data for "high income", which would explain why those have (a) no shortfall at all and (b) no gender disparity.

Reading the article, it does look like the "shortfall" is gendered, being based on gender-specific maxima.

There may be some reverse causation--in a country where devastating and chronic illness frequently bankrupts people, it's not too surprising that at least this subset of poor people would be living quite a bit shorter than the average citizen.

Status quo bias is a hell of a thing. Imagine if we had firefighter insurance and the most common cause of bankruptcy was their home burning down. That's pretty much where we are with medicine and it's often justified by victim blaming (They shoudn't have eaten that! They should have exercised more!).

You're rhetorically associating systemic injustice against black people with critiquing fat people.

You understand that right? The phrase is from the book Blaming the Victim, about the legacy of slavery.

I'd avoid using that tactic out in the world.

That's a reach. I think the phrase "victim blaming" is mainstream enough to have zero racial connotations (I never knew there was one until I read your claim). Often comes up in discussions of rape/sexual assault where race is not a factor at all.

Okay, then he's comparing fat people with rape victims. Is that better?

The disparity is still significant in countries with state-funded healthcare.

http://www.kingsfund.org.uk/sites/files/kf/field/field_publi...

However the socioeconomic class of the neighborhood as per the linked graphs depend on employment status not hospital bills, and thats constant across US, UK, etc.

For example. Take a senior airline captain. Toward the end of their career they're almost as well paid as us IT people, maybe 90th percentile. That relies on a 1st class med cert, updated every six months. The day after you fail, you're unemployed (more or less). Suddenly his income, and inevitably his neighborhoods social class, starts dropping. Perhaps he works in an office as a clerk. Optimistically maybe 50% percentile income. But he didn't fail that med cert for fun, its because of developing heart disease.

Now you can pretend to be surprised a 50th percentile file clerk has a lower life expectancy (due to his heart disease) than a 90th percentile airline captain. But its not an elaborate conspiracy. Its just that higher income jobs assume health.

Its even worse, in that most employers have low tolerance for employee illness, but even lower tolerance for employee family member illness. A mother who's kid has some terrible disease is much more likely to get poorer and downwardly mobile, than the opposite. Shouldda started that startup, but dad was dying of cancer at that time, and kids of cancer victims tend to become cancer victims, so "mysteriously" lower income people seem to be at higher risk of cancer. Not to forget the destructive effects of mental illness on employability in stereotypical higher income jobs.

Glasgow is notorious when it comes to poor life expectancy:

https://en.wikipedia.org/wiki/Glasgow_effect

"Equally deprived areas of the UK such as Birmingham, Liverpool and Manchester have higher life expectancies, and the wealthiest ten percent of the Glasgow population have a lower life expectancy than the same group in other cities"

Stopped reading here:

A child born in 1900—little more than a century ago—was likely, on average, to die by the age of thirty.

This is so misleading, suggesting that people typically died before they were 30.

The misleading average here is caused by infant mortality. That's the #1 way that life expectancy has risen in the last 116 years.

To illustrate how big we've reduced infant mortality, look at this:

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm4838a2.htm

From 1915 through 1997, the infant mortality rate declined greater than 90% to 7.2 per 1000

This is the same problem with claims that life expectancy in the middle ages was 25 years or so.

"The reasons for the difference are not clear, although the authors point out that cities like New York often have aggressive anti-smoking policies and make it harder for people to eat trans fats, and drink sugary sodas—which are implicated in common diseases like obesity and diabetes"

Anti-smoking in NYC is ~14 years old and the sugary-soda crackdown is less than 4 years old. How can these policies be proven to contribute to life-span data?

While the policies may not be causative, the attitudes which allowed these bills to pass may have been present for much longer.

Gentrification pushes out poor people, therefore you can ban things poor people like without backlash, and naturally fewer poor people means fewer sick people, if most financial problems come from medical expenses and medical expenses mostly come from sickness, then making it hard for poor/bankrupt people to live there will naturally result in the remainder being healthier on average. I would theorize the demographics of NYC are anything but constant.

Or it could be a bias toward authoritarianism naturally results in health, although the cause and effect on that one is a bit fuzzy. The obesity rate in NYC is about 1 in 3 but in Denver its about 1 in 5, and Denver isn't X% more authoritarian than NYC.

In a pay to play healthcare system, those who can pay the most get the best toys. An important study but it shouldn't surprise anyone.

Maybe people with money take care of themselves better? All my lower income acquaintances and friends are fat and never work out. They drive everywhere and are generally very unhealthy. It just blows my mind to see what they eat at restaurants. There's a real issue here about the lack of proper eating and exercise.

The middle class or higher group people in my life often take care of their health, work out, eat right, etc. They ride bikes, stay active, walk a lot, etc.

The idea that its purely healthcare dollars at work here is unrealistic to me. I think there's more at play here and the knee-jerk answers that are political correct is often wrong. Especially post Obamacare, where so many are now insured and go the same doctors and hospitals everyone else goes to.

Think have some strange causation going on here. Have you ever had to figure out how many calories you could get per dollar -- let me tell you it looks a lot more like Taco Bell than grass-fed meat and a kale smoothie. Have you ever had to work 2 terrible mind-numbing boring jobs for 60 hours a week and then threw a couple kids or even grandkids into the mix? Not a lot of spare money or time to get a gym membership. There's also social norms, a lack of future orientation (that is a well known effect of living in poverty), etc. Being poor is unhealthy -- blaming its effects on individual's not "being responsible and eating and exercising right" is an individual cop-out for a structural problems.

When I was poor buying healthy meat and greens at the mexican grocery store cost me very, very little. I don't believe for one second the "the poor must eat big macs and drink full sugar colas or they will die" nonsense.

"we" have lived thru a major cultural shift where 30 years ago when I was a starving student, we didn't have loans (or high tuition) and we did starve. All of us, pretty much. Entire generations went to uni unable to afford junk food because a meal at the restaurant was like one weeks groceries, its unaffordable. I ate a lot of salad. Even pizza delivery was kinda an investment to be budgeted and rarely experienced.

Economic changes over the last couple decades mean college students today are poorer than ever on the balance sheet with $100K of college loans etc, but have wealthy people level cash flows. So when your tuition alone is $30K, you can squeeze the bank for an extra $6 for a big mac at any time. Or all college students today have new iphones, new macbooks, etc. But this is a very new phenomena and has lead to weird cultural beliefs among the very young (say gen Y and younger), like "all poor people pig out on junk food" because modern college students think they experienced real poverty in school when they used the same macbook for two years instead of upgrading every six months like the rich kids (LOL).

There are weird statistic warping exceptions, like homeless people have no where to cook or eat, so they disproportionately eat at McDonalds. Also, for very poor people, an occasional trip to the McDonalds for a value meal is like my occasional trips to the $200/plate steakhouse, so their intake skews junkfood, but its very low. And there are the struggling addict types where the money is getting spent in the next 5 minutes and if its not food in the belly it'll be injected death so they skew toward junk food as a preventative.

There is some truth to poor people are often poor because they find ways to waste money, and junk food being a very expensive way to eat, it is in itself a minor status symbol in that culture. My class level would show off the expensive watch my aunt bought me when I graduated, even though my people never wear watches anymore, but they'd show off they bought an entire 2L bottle of corn syrup soda, because, thats what they can afford and their peers can't afford.

whew! a lot of anecdata in that analysis. Why don't we just look at the evidence? From one quick google.

http://www.washingtonpost.com/wp-dyn/content/article/2008/02...

http://ajcn.nutrition.org/content/79/1/6.short

http://archpedi.jamanetwork.com/data/Journals/INTEMED/12037/...

http://www.sciencedirect.com/science/article/pii/S0002822307...

When you were poor you apparently had time to make a meal with the meat and greens you bought. But llamataboot mentioned time constraints so you must've missed that.

"Especially post Obamacare, where so many are now insured and go the same doctors and hospitals everyone else goes to."

Have you ever had to deal with the healthcare system from the bottom? Even with "Obamacare" it's a nightmare. Unless you have fairly high quality health insurance, you tend to be limited in which doctors you can go to. So, no, the poor aren't suddenly going to the same doctors as the upper middle class. And the doctors that work with those cheaper insurance plans seem to, in my experience, have more patients and less time to spend with each. Quality of care is less, because it's an operation designed around high turnover rather than developing a relationship with each client, as is more common from a 'good' doctor, which tend to only accept better insurance plans.

Also if you gave a chronic condition like asthma you might be on 3 medicines with a 75 dollar copay a month each. Many people have to make due without, that might increase mortality right there.

Good point. I know someone who was born with HIV. They can maintain the condition indefinitely, but the combination of drugs comes to over $200 per month in just co-pays. This person was born to it, and you can blame the parents for being irresponsible, but this person had no input. Now this person has to consistently maintain insurance and a steady income significantly above what most people need or risk being unable to afford medication and face terminal illness. Fortunately this person was raised by people capable of meeting her needs, has worked consistently since adulthood, and is working toward future security, but if things had been stacked the other way, this person could easily have not reached adulthood, or not survived much beyond that.

So, certainly being poor vs being rich makes a difference beyond individual habits.

Offense intended. You sound like you hate poor people and you every obviously do not understand what it means to be poor.

It doesn't seem so obvious to me, e.g. in Cuba much less money is spent, but results are similar.

http://www.forbes.com/sites/judystone/2014/12/22/cuba-cost-e...

> In a pay to play healthcare system...

I love how every reporter writing about this study implies that these gaps are somehow related to income inequality and health care. It makes so much sense, right?

In fact, the study directly contradicts this. See figure 8 - both income inequality and health care were not shown to have a significant effect.

https://jama.jamanetwork.com/article.aspx?articleid=2513561

This study does not show what you suggest. The problem is when you have several causes for the same effect some of all of them can fall below the noise floor. Being poor means slightly worse health care, worse food, increased risk of violence, etc etc. Trying to seperate each of them out in a statistically meaningful way is difficult and expencive.

One might even say, "separating them out" uses fancy regression models to obscure rather than explain the data. Being poor DOES mean all those things and likely health outcomes are overdetermined. We know that reducing inequality reduces all of these things - so let's just reduce inequality!

Yes, the effects could be small rather than zero. Either way, why are reporters implying (while being careful not to explicitly state) that inequality and health care are significant?

Essentially your complaint is that NHST could be more realistic and doesn't deal well with tiny effect sizes.

There is a staggering degree of beating-around-the-bush in these articles we've been seeing.

I feel that you are misrepresenting the study here.

The conclusions from the abstract:

In the United States between 2001 and 2014, higher income was associated with greater longevity, and differences in life expectancy across income groups increased over time. However, the association between life expectancy and income varied substantially across areas; differences in longevity across income groups decreased in some areas and increased in others. The differences in life expectancy were correlated with health behaviors and local area characteristics.

The figure you point to absolutely does not say that income inequality does not have a significant effect. Figure 8 shows that the association between life expectancy and income varied substantially across areas; differences in longevity across income groups decreased in some areas and increased in others.

So yes, the differences in life expectancy are definitely related to income inequality. But the strength of that correlation varies depending on region.

The pieces of the study you quote don't disagree with me.

Read figure 8. The correlation between various local area characteristics (which include health care and income inequality) were correlated with bottom income quartile life expectancy. The confidence intervals for this do not exclude zero.

What part of the study do you believe shows a statistically significant relationship between income inequality or health care and life expectancy?

Thats the name of the game now. Class warfare and racism get clicks.

If there is no graph in an article about research it cant have my respect.

Would you prefer USA Today, the "Cat In The Hat" of news sources because they sprinkle pictures everywhere so you don't have to read so many words?

http://www.salon.com/2015/04/10/7_remarkably_cruel_instances...

> The researchers, led by Raj Chetty, a professor of economics at Stanford University, analyzed more than 1.4 billion federal tax returns, as well as mortality data from the Social Security Administration, from the years 2001 to 2014. In that period, the life expectancy of the richest five per cent of Americans increased by roughly three years. For the poorest five per cent, there was no increase.

I find it hard to believe that over a period of 13 years a particular group of Americans lived three years longer on average because they could afford more and better healthcare. That's a very significant jump, and to me it seems more likely to be explained by differences in the composition of the top 5 percent. Did it become more white, more educated, more urban, etc.?

Can anyone who read the original paper comment on whether that was explored at all?

when you think about medical advances in the next 20-40 years, especially the custom ones which would require money, one would be wondering how much a today's healthy person with a lot of money, like Zuck, would live... Probably as long as they want :)

Medical advances have greatly increased the average life span, and are likely to continue to do so. However, there has been very little change in the maximum lifespan, and there is not really any good reason to believe that this will change over the next 20-40 years.

Similar dynamics arose in late 60s in the USSR and 20 years later it disintegrated.

Fortunately, since then, someone spotted that causation and correlation occasionally differ. Phew. Bullet dodged.

I was actually implying two non-interrelated casuations of same trend.

Similar dynamics in what way? Certainly there was no nominal wealth inequality in the USSR (there were of course people with wads of illegally obtained cash, and there were classes of people with access to a lot of things [which money couldn't legally buy] that the majority could not access, but officially wealth and income were very similar for everyone, in particular you couldn't legally own most sorts of assets traditionally held by investors, including real estate. So I wonder what sort of inequality correlated with life expectancy inequality in the USSR in the late 60s.)

Inequality of education, inequality of place of living (city vs town vs village, different republics)

Reply on news.ycombinator.com