Life expectancy in the U.S. varies greatly by region | Hacker News Reader

Life expectancy in the U.S. varies greatly by region

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79 pointsbinarynate92 comments

Nobody has explicitly connected the other damning life expectancy visualisation on Twitter yet, so it’s worth linking to it:

https://twitter.com/jburnmurdoch/status/1641799627128143873?...

The difference in life expectancy between the UK and the US is mostly down to young Americans dying from guns, drugs, and cars; my guess is much of the differences within the US are attributable to the same factors.

These sorts of charts are meaningless without being broken down by race.

I did a quick search for "US Mortality Rate by Race" and I found CDC documents showing that African Americans have roughly 35% higher age-adjusted mortality than non-Hispanic Whites [0], and have on average 7 year shorter life expectancy at birth [1].

When people show maps where the American South has seemingly worse outcomes than the rest of the country, it's important to remember that the demographic makeup is totally different.

[0]: https://www.cdc.gov/nchs/data/databriefs/db456.pdf page 2 [1]: https://www.cdc.gov/nchs/data/nvsr/nvsr71/nvsr71-01.pdf page 2

The article explains that the result holds when controlling for race (and income, and education).

Yes, there are racial disparities in life expectancy.

Still, people of all races in the US are behind their European counterparts in life expectancy.

And British people at the same income decile have much longer life expectancies than Americans of the same income decile, despite the fact that Americans at every income decile (except perhaps maybe the very poorest) are richer in absolute terms than Brits.

> These sorts of charts are meaningless without being broken down by race.

I see the exact opposite: the data you showed is meaningless without being broken down by income.

The "life expectancy vs income" chart works similarly in almost all countries, including single-ethnicity countries. So it's clearly something.

But the race one you showed is not income-adjusted. It's well known Black people in the US on average is poorer than, say, White people. It's totally possible (with full data, it's easy to do statistical analysis) their low life expectancy is largely due to poverty.

Why does race need to be brought into it?

From the linked thread[1]:

> One misconception I also want to address: the dreadful US performance does not disappear if you “adjust for race”.

> This is way way overstated.

I wonder where the is? Different data sources?

[1] https://twitter.com/jburnmurdoch/status/1641799890605932544

Combine a map of where African Americans live and where American Natives now live and you pretty much recreate the map in OP. Not exactly though, because you'll still be missing Appalachia. So it really is just a poverty map.

I saw all the doom and gloom tweets, but didn't realize most of the cause boils down to policy decisions. Call your elected officials and tell them you don't want to die an avoidable early death.

I mean, what else could be the cause? One way or another, it'll come down to some insane policy decision or other.

And this "states vs federal" power struggle in America (not my country) basically guarantees that there will be variance across states. The division of powers made sense in the old days, but in today's day and age it's crazy that there are not more standards set across the board at the federal level.

It's not my battle to fight, but it is depressing to see America squander so many opportunities to make things better.

Even though there's definitely a strong state by state correlation, I thought it was interesting that a number of states (like South Dakota and Wyoming) had such a wide range of outcomes. Not sure of that's just randomness due to smaller population sizes or what

Those are reservations. MT, ND, MN, WI too https://en.m.wikipedia.org/wiki/Indian_reservation

Well, that's a very depressing answer to the mystery. Thanks though!

Smaller populations, more rural populations -- see also: rural vs urban divide -- and, as another poster mentioned, Native American reservations, which are often some of the poorest areas in the US.

The problem with federal standards is getting everyone to agree. If state standards aren’t allowed and California wants tougher environmental standards on California land, but Texas doesn’t, you force a showdown, a loser, and simmering resentment for decades.

100% agree with the first sentence.

> If state standards aren’t allowed and California wants tougher environmental standards on California land, but Texas doesn’t, you force a showdown, a loser, and simmering resentment for decades.

Federal standards are in the interest of all citizens, whether or not they frustrate some state politician or not shouldn't even count as an objection.

I don't care if the Texas government is happy, but I do care if the people in Texas are healthy. Maybe that's just me though.

First, I’m sure it’s hard to imagine, but California could lose said showdown and find themselves obstructed from protecting even only California. Second, it’s not just some lone politician that would care. The whole Roe v. Wade thing should have made clear that half of the country had been seething to overturn it for decades. Our whole system is built on consent of the governed; Federal mandate is therefore tricky if one large state is in overwhelming support of an issue while another is overwhelmingly opposed.

What changed between the old days and now to make running many independent(ish) experiments in government stop making sense?

The 13 colonies were not "experiments". They were preexisting local governments that needed to come to agreement on forming a new nation after overthrowing the rule of the British King. The compromises made in the US Constitution were the price for that agreement at the time.

The problem is that people in the 21st century still feel bound by an 18th century agreement. I guess the alternative is another civil war, so that might be why the agreement lasts, no matter how shaky and dubious.

Many US states are size equivalent to entire EU countries. There’s no need to let the EU control those countries directly, same goes for states.

Going one level higher up the chain doesn’t gain anything other than further separating people from policy makers.

However, US states are vastly more interconnected than EU countries. We all (well, mostly) speak the same language, we all use the same currency and always have used the same currency, you can walk or drive across the borders of any states with nobody checking or caring, and indeed states don't need to take individual responsibility for protecting their borders militarily. You can live and work in any state you want and move to or work in a different state at any time. The US military is mostly nationalized. The state-based National Guard does exist, but it's quite small and weak compared to the Army, Navy, Air Force, Marines. And the National Guard doesn't have nuclear weapons! Imagine if individual US states controlled nukes...

Sure seems to me like any time the technocrat/commentariat/coastal crowd point out the various problems with the American South, it's always with this patronizing schadenfreude vibe.

"Haha guys look at the poor dumb hicks who don't know what's best for them"

I had a co-worker whose neighbor died recently not all that much after his 40th birthday from some combination of smoking, occupational exposure to construction debris/chemicals, and long covid. He was on the list for a lung transplant for a bit, but no one seemed to believe that gave him any chance, and it did not. Perhaps if he had not smoked, worn proper PPE when needed, and gotten a covid vaccine, he would be alive today. It seems that his downwardly mobile southern culture failed him quite completely, but I do agree that if you had told him that, you'd probably be thought of as a patronizing.

When everyone sh*ts on your culture 24/7/365 for decades and decades, it gets pretty hard to separate the condescension from the genuinely good advice.

Consider what are the predominant themes were in white southern culture 60 years ago. They never really let go of it.

I guess they’re getting what they deserve then, eh?

Certainly not. I think they have cynically manipulated by politicians taking advantage of some amount of real cultural disapproval. They cultivate the grievances and push them even more extremes.

Politicians are just people. They're not space aliens like Kang and Kodos. Politicians are citizens and came from the same place as everyone else. They're just as much a product of the local culture as everyone else in their locality.

Sure. Politics is a group dynamic. And in this case it has a clear tendency towards an extreme that is self harming. But almost none of the individuals are driving towards that intentionally.

> But almost none of the individuals are driving towards that intentionally.

I disagree with that.

Indeed, when their own TV network calls them "dumb, cousin-fucking terrorists"[0], you'd think they'd have a hard time trusting them, but it doesn't seem that way. Still, I'd think don't smoke and take your vaccines would be relatively uncontroversial basic public health information these days, but I guess not.

[0]https://twitter.com/Eric_Alterman/status/1634971075334508544

“Their own TV network”

I don’t know many Louisianans working at FOX NEWS HQ in NYC…

Yes, they'd never be allowed to work there for reasons mentioned in my previous comment. However, you may find that they view it as their side in opposition to the mainstream media. But of course you know that and are simply playing a game of your own (and I suppose I'm indulging in it a bit myself).

What’s the other explanation? I presume it’s not the enormous amount of asymmetric financial assistance that pours into the south every single year from the “patronizing” coastal elites?

The South ties its wagon to the wrong horse year in and year out. No one forces them to do that.

Fixating on the patronizing tone is exactly the type of error that gets these outcomes.

QED

Is your claim that the patronizing tone is the source of or a possible solution to the South’s problems?

Or is this a, “because the coasts are patronizing, we don’t need to discuss these issues.”

Seems like the latter to me but I’d be interested to hear if it’s the former.

“You made your bed, now lay in it” is neither constructive nor effective in changing minds.

No one is saying that. This would be a good retort if anyone was proposing that the South actually lay in its own bed.

I have never heard any proposal from the patronizing coastal elites to cut off funding for Southern welfare states.

“The South ties its wagon to the wrong horse year in and year out. No one forces them to do that.”

. . .

True. What is effective, though?

Cultures do change themselves over time, but it may be painfully slow, and sometimes they don't change.

I'm not condescending or judging. We're all human biologically, and culture is not a simple matter of individual responsibility, it's a collective and historical phenomenon. Individuals may be able to rise above their culture, but in some cases the path can be longer and steeper. Would I be the same person if I were born in a different place? If I were born in a different time? Of course not. We've all been shaped by our culture.

In any case, it's difficult to help when relevant help is rejected, e.g., ACA subsidies. Moreover, there's an underlying conflict of values and even religion that pervades the politics, seeping into seemingly unrelated issues such as health and economics, and undermining the possibility of agreement or compromise. It's difficult to be kind, sympathetic, understanding, patient with someone when that someone goes out of their way to try to take away civil rights that you care deeply about. At a certain point, you need to fall back to self-preservation.

And that isn’t being said here. Frustration with a person’s family is one comment, discussions of the cultural problems on the south in another (denial/defiance), but regardless of someone’s tone thousands of miles away the problem is still there and the source of it is not the tone or words used by individuals from far away.

> I presume it’s not the enormous amount of asymmetric financial assistance that pours into the south every single year from the “patronizing” coastal elites?

No, this is largely a myth. [0]

[0]: https://mises.org/wire/no-red-state-economies-dont-depend-gr...

It is interesting that so many states are tagged blue when I would have tagged them red or purple at most. According to Wikipedia (https://en.wikipedia.org/wiki/List_of_United_States_state_le...) there are 19 democratic states and 28 republican states. Your source almost splits the country into two halves which is misleading.

I believe "red state" and "blue state" is commonly referring to which party's candidate won the state in the last presidential election.

Having half my extended family in the rural South, they don't often do much to offset that impression. There are nice ones and mean ones, but none of them really have their lives together and there's obvious stuff they could be doing, like cutting sugar consumption in half (so many diabetics). One of my uncles died of complications from willfully unmanaged diabetes. His foot was literally rotting off one toe at a time, he was in direct pain and he still pounded can after can of Mountain Dew and ignored anyone who tried to advise him otherwise, including his own wife and son. My nicer uncle is half-functional due to neck injuries he sustained in a car crash, but he just pushes through things and doesn't look after his health, and just makes things worse for himself despite his good intentions.

That seems to be the identity of the modern south, various flavors of denial and defiance. Those who defy the stereotype tend to leave, or cluster in/around the better developed urban areas. I've met a lot of awesome people who immigrated from the south, but not many living there outside of a major metro.

Thank you for illustrating my point. Yeesh.

How so? Is it patronizing to say the Bears had the worst record in the NFL last season? The proof is in the pudding.

My experiences are just anecdotal evidence that supports the objective stats.

Respect is earned, and sometimes, when lots of people tell you you're wrong, it's useful to have the humility to consider they might be right.

I am from the South and I concur with that poster, I’m not sure why takes like these are invalid due to having left. If a place has a lot of problems, you would expect people to leave it and then freely tell other people about the problems after getting more exposure to the world outside of it.

The South has educational problems, lack of opportunities, a lot of poverty, health problems, and different cultural values when compared with the rest of the country. This is a fact, it’s not a “yikes” to state this.

It’s not entirely willful, but it’s also not a completely unavoidable state of affairs either. A lot of it is cultural - when you’re in that environment, it’s normal to you. But at the same time, the people making up the culture as a whole are not helpless individuals incapable of understanding things like diabetes or obesity

The biggest problem with the American south: https://www.pbs.org/wgbh/nova/article/how-a-worm-gave-the-so...

I more or less agree... But, does it make it any less true?

No it absolutely does not change the facts - but I’d be willing to bet people are more likely to change their minds (about policy, politics, their way of life) if folks didn’t look down their noses at them.

Of course everyone knows this, but grace and empathy is much harder than condescension and schadenfreude.

It goes both ways though. "Woke" has now become almost exclusively pejorative. And they're pulling "Communist" out of retirement lately, despite the fact that Russia and China are both capitalist now. What about the contempt for gay people? The contempt for "hippies" in 1960s?

I doubt that anyone is innocent of condescension.

Here's an article about "No-Respect Politics" from 20 years ago: https://www.washingtonpost.com/archive/opinions/2002/07/26/n...

Evidently you missed the part about grace and empathy?

"But they started it" "They do it too" "They are meaner"

'They they they' is the problem.

Grace and empathy only go so long. You cannot be tolerant of the intolerant over and over again. There needs to be some amount of reciprocity.

> "But they started it" "They do it too" "They are meaner"

You're using quotes, but I said none of those things.

> 'They they they' is the problem.

The problem is as vaidhy suggested. You said grace and empathy is much harder than condescension and schadenfreude, but it becomes even harder when grace and empathy are met in return with condescension and schadenfreude. If you're acting in good faith, how much can you stand to be humiliated? It takes two sides to come to the table. Trust must be built mutually. Otherwise it's like talking to a brick wall.

I’m not really sure how this relates to the problem. People may be awful or cruel sometimes, but that doesn’t force civic leaders or individuals into making bad policy/personal decisions.

Furthermore, a lot of this is an explicit problem. Poverty is high in the south and poverty correlates strongly with less access to healthcare, or healthcare avoidance to avoid the cost.

I have direct experience with non-coastal people doing things bad for their health because somebody told them it was bad for their health, not because they think the person who told them was wrong, but because they want to show that they can exercise their right to be stupid anyway. Everything from eating things they didn't really like just because they were unhealthy to modifying their cars to be dirtier. This was a frequent enough occurrence to be noticeable.

Viewing every woe as a policy issue is actually very technologist/authoritarian.

The South obviously has a unhealthy diet, but the inner cities are dramatically poorer than blue state cities with even more crime to match (St. Louis in particular). It's not a blue/red thing. It's more income and culture driven.

> "Haha guys look at the poor dumb hicks who don't know what's best for them"

We can factually and objectively demonstrate how the south is lagging. This isn't some moralistic "lol those dumb hayseeds wear shitty clothes", there is a measurable, concrete divide in things like healthcare and scholastic outcomes.

People are dying early, considerably so. dying Child mortality is notable higher. Standardized test scores are just lower, and by non-trivial numbers.

> Call your elected officials and tell them you don't want to die an avoidable early death.

I'm pretty sure they know that already.

Exactly, I'll tell them I want restrictions on guns, more speed limit enforcement, universal healthcar....oh you were trying to be sarcastic

I don't think you have noticed. But politics has devolved into being anti-woke rather than making adult policy decisions.

One thing that also should be pointed out is the race gap in medical outcomes. When you look at the statistics Black Americans face a higher risk of stroke, heart attacks, cancer mortality, infant mortality, maternal mortality, HIV/AIDS, diabetes, pneumonia, etc. In almost every leading cause of mortality in the United States there is a significant gap between Native Americans and Black Americans and the rest of the population.

My sense is that there is a combination of culture and poverty that is causing this gap to occur. Poverty doesn't seem to be the sole cause IMO (although it's probably the biggest factor) because white people and asian people experience similar levels of poverty but asians live way longer.

The article explains that the gap still exists, even after controlling for race.

Yes, white women in the US will live (much) longer than black men on average. Yet their UK counterparts will live longer still.

Take a look at the data in the commonwealth fund report for comparison. It’s not culture and poverty per se, it’s that unlike every modern and industrialized country in the world, the US lacks a universal healthcare system that serves all of its citizens fairly and proportionally regardless of race or culture. That’s the missing factor.

https://www.commonwealthfund.org/publications/issue-briefs/2...

Correlation with obesity rate seems stronger than anything else.

And alcoholism in certain counties.

It also looks like it correlates to state or local tax rate. But as the old chestnut goes, correlation isn't causation.

Besides, which came first, the chicken or the chestnut?

Seems to be a lot of correlation to voting patterns as well.

> Seems to be a lot of correlation to voting patterns as well.

No it doesn't: https://en.wikipedia.org/wiki/File:2020_United_States_presid...

It appears to be much more strongly correlated with poverty rate: https://www.census.gov/library/visualizations/2018/comm/acs-...

Rio Grande Valley (one of poor regions in US) has similar life expectancy as Northern Burbs of DFW while beating Dallas and Tarrant county. Need to take a deeper look at the data.

Could be access to medical facilities in Mexico border towns - that would be some fascinating data.

Looks like the data is pulled from here - https://ghdx.healthdata.org/about-ghdx/ghdx-records-explaine...

Hispanics live longer than white people, who live longer than black people (look at the Black Belt).

It's hard to simply blame economics when some very poor Hispanic regions outlive some wealthy black/white ones.

I'm not versed enough to know whether race itself plays any significant roles, or if it's more cultural, but it's certainly eye opening as a factor.

> Hispanics live longer than white people, who live longer than black people (look at the Black Belt).

There is a glaring counterexample:

Atlanta, a prosperous majority black city, has very high life expectancy, but the surrounding rural areas in Georgia, majority white and poor, have low life expectancy.

Birmingham Alabama is another similar example.

Wow. I knew of course that there was a spread to the average, but I never imagined there were such large swaths of the country that never even make it to full retirement age.

Remember this when they say they want to raise the retirement age.

Is it reasonable to raise the retirement age in California (where people live longer) and lower it in Texas where they don’t live quite such a long life? It feels off, I think, people will then move to Texas because they can retire earlier.

My guess would be no. Since social security is federally accessible, so I could easily see people just move to Texas a few years earlier from California to get around the age difference.

“Every man dies. Not every man truly experiences sweet tea.” - Southern Braveheart (probably)

1 generous cup of sugar per half gallon of tea was my old recipe. I was merely a Virginian so I think it could be increased even more a state or two south

As a South Carolinian, that recipes is accurate.

One thing that was stark and unbelievable to me is that the sheer number of medical providers in New England, Western and Upper midwestern states are so much higher than the south.

If one were to live in rural America, rural coasts are so much better than rural south, from a medical perspective.

Pretty messed up you can see where the reservations are.

Scroll down and compare the maps https://en.m.wikipedia.org/wiki/Indian_reservation

For those who are immediately thinking of the political angle, compare Utah and Oregon.

Umm... There is a strong political correlation here. Even the one exception you're thinking of, doesn't buck the trend, as all the Democrat/Blue parts of Oregon and Utah are high life-expectancy and the Republican/Red rural parts are not.

> Umm... There is a strong political correlation here.

Umm... No, there isn't. Look at the entire midwest/central US. See these two maps:

* From the OP: https://pbs.twimg.com/media/FsuBjJeaQAAv8EE?format=jpg&name=...

* 2020 presidential: https://upload.wikimedia.org/wikipedia/commons/thumb/f/fb/20...

It's much more correlated with:

* Poverty rate: https://www.census.gov/library/visualizations/2018/comm/acs-...

The color choices of the original map appear to have intended to lead you into thinking a certain way, which appears to have worked.

While it looks like poverty rate is more correlated, idk how you look at those maps and see anything but an obvious political correlation, albeit not perfect. What do the stats say?

"Among 3110 U.S counties and Washington, D.C., change in life expectancy at the county level was negatively associated with Republican share of the vote in the 2020 Presidential election"

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8209240/

>What do the stats say?

How about: a relatively large portion of the country is left behind by federal policies and are willing to support whatever crackpot promises good things?

> idk how you look at those maps and see anything but an obvious political correlation

Because I have eyes and a brain. In the first map (life expectancy), almost the entire north half of the US is marked as "high", and the "low" is almost entirely clustered in the south east. When I look at the political map, the blue parts are almost entirely on the coasts with some scattering in metros and a deep blue clump right in the middle of the south east again. In what universe would that be a political correlation? The maps are entirely different.

Also your stats are not very convincing, considering they are measuring something entirely different. Comparing the percent change in life expectancy from 1980 - 2014 to the 2020 election results seems pretty useless. Look at how vastly different the presidential voting map is since 1980: https://upload.wikimedia.org/wikipedia/commons/thumb/b/b9/19...

A better correlation might be percent change in party voting vs percent change in life expectancy. And even then, how long does it take for policy to affect life expectancy numbers?

Politics doesn't directly kill people earlier (usually), but policy can either tamp down or exacerbate other problems.

Utah and Oregon both have large urban prosperous populations who can afford healthcare and these areas are known for outdoor healthy lifestyles. SLC is loaded with fitness oriented businesses. They are socioeconomically very similar.

In contrast, many of the worst outcomes are in places that are poor, have major drug or violence epidemics, and also have little in the way of public support for healthcare.

Bad policy can make a bad situation worse more than good policy can improve an already pretty good situation.

I'm surprised this shitty visualization made it here out of all places.

The colorbar is "clearly" picked to make things more dramatic: the "middle" isn't centered (red part is longer), each end has a sizable chunk that basically has the same dark color.

Also isn't the dominant factors simply poverty? One of course can go further and discuss why these regions are poorer (which IMO is history), but the direct cause of low life expectancy variation in the US is pretty clear to me to be poverty than secondary things like life choices and/or policies.

OTOH, the fact the US as a whole is significantly lower than many other developed countries is something more interesting.

Interesting choice of Blue and Red there.

It's really depressing that, given the good data that we have available and the different compared experienced from other countries and public policy research efforts from our academics that the political system is simply incapable of producing the right policies to remedy these situations.

I mean, it seems to me like there's so much that gets confused in the public debate that most people voting for their representative have actually no idea what they're actually voting for. The political stage is filled with so much misinformation (which includes lies and omissions) that it has become very difficult for people to make the little decision power they have a good decision.

In many ways, I think the political system encourage a sort of "package deal" policy making. When in reality people will have positions all over the political spectrum. And most importantly, I think people are not even given the opportunity to change their minds to begin with. Misinformation and lack of opportunity to deliberate is really hurting the policies that are being adopted by most states and this is very concerning.

Of course, we shouldn't expect people to be concerned about everything at all times and be completely immersed in every issue out there. But there are plenty of ideas out there that seek to find middle of the ground solutions between engagement and influence. It just feels really bad that people are so concerned about closing the holes made by the faulty system that they don't stop and wonder that maybe a lot of these holes are natural consequences of the system's design to begin with.

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