Inequalities in Life Expectancy Among US Counties, 1980 to 2014 – Temporal Trends and Key Drivers. Laura Dwyer-Lindgren, MPH; Amelia Bertozzi-Villa, MPH; Rebecca W. Stubbs, BA; et al Chloe Morozoff, MPH; Johan P. Mackenbach, MD, PhD2; Frank J. van Lenthe, PhD; Ali H. Mokdad, PhD; Christopher J. L. Murray, MD, DPhil. JAMA Intern Med. Published online May 8, 2017. doi:10.1001/jamainternmed.2017.0918.

“Studies have routinely shown that life expectancy in the United States varies geographically, in some cases dramatically. Counties are the smallest administrative unit routinely available in death registration data and represent an opportunity to explore the extent of geographic inequalities in the United States. In particular, tracking inequality at the county level over time is an important means of assessing progress toward the goal of more equitable health outcomes, as enshrined in the Healthy People 2020 objective: “Achieve health equity, eliminate disparities, and improve the health of all groups.” Moreover, county-level information on basic health outcomes is essential for appropriately targeting resources and designing and implementing health and social welfare policy at both the federal and state level…This analysis has 3 specific aims. First, to generate annual estimates of life expectancy and age-specific mortality risk for each county from 1980 to 2014. Second, to quantify geographic inequalities in life expectancy and age-specific mortality risks and to examine trends in geographic inequality over time. Third, to assess the extent to which variation in life expectancy is explained by variation in socioeconomic and race/ethnicity factors, behavioral and metabolic risk factors, and health care access and quality.”