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Health disparities are associated with low life expectancy

Lee Seachrest points to an article, “Life expectancy and disparity: an international comparison of life table data,” by James Vaupel, Zhen Zhang, and Alyson van Raalte. This paper has killer graphs. Here are their results:

In 89 of the 170 years from 1840 to 2009, the country with the highest male life expectancy also had the lowest male life disparity. This was true in 86 years for female life expectancy and disparity. In all years, the top several life expectancy leaders were also the top life disparity leaders. Although only 38% of deaths were premature, fully 84% of the increase in life expectancy resulted from averting premature deaths. The reduction in life disparity resulted from reductions in early-life disparity, that is, disparity caused by premature deaths; late-life disparity levels remained roughly constant.

The authors also note:

Reducing early-life disparities helps people plan their less-uncertain lifetimes. A higher likelihood of surviving to old age makes savings more worthwhile, raises the value of individual and public investments in education and training, and increases the prevalence of long-term relationships. Hence, healthy longevity is a prime driver of a country’s wealth and well-being. While some degree of income inequality might create incentives to work harder, premature deaths bring little benefit and impose major costs.

They also write something that puzzles me:

Russia, the USA and other laggards can learn much from research on the reasons why various countries (including Japan, France, Italy, Spain, Sweden and Switzerland) have been more successful in reducing premature deaths. The reasons involve healthcare, social policies, personal behaviour (especially cigarette smoking and alcohol abuse), and the safety and salubriousness of the environment.

I don’t know much about salubriousness, but I thought the smoking rate among men is lower in the U.S. than in Japan and much of Europe, and maybe we have less alcohol abuse here too. So I’m not sure how the above paragraph can make sense.

Sechrest also sent along this article, “Differences in life expectancy due to race and educational differences are widening, and many may not catch up,” by S. Jay Olshansky and 14 (!) others:

It has long been known that despite well-documented improvements in longevity for most Americans, alarming disparities persist among racial groups and between the well-educated and those with less education. . . . in 2008 US adult men and women with fewer than twelve years of education had life expectancies not much better than those of all adults in the 1950s and 1960s. When race and education are combined, the disparity is even more striking. In 2008 white US men and women with 16 years or more of schooling had life expectancies far greater than black Americans with fewer than 12 years of education—14.2 years more for white men than black men, and 10.3 years more for white women than black women. These gaps have widened over time and have led to at least two “Americas,” if not multiple others, in terms of life expectancy, demarcated by level of education and racial-group membership.

That’s pretty scary! But I’m suspicious of the causal reasoning that leads to the final sentence in their abstract:

The message for policy makers is clear: implement educational enhancements at young, middle, and older ages for people of all races, to reduce the large gap in health and longevity that persists today.

12 Comments

  1. Veronica says:

    There is a huge problem with the casual reasoning in the second paper, because it compares different values/quantiles/proportions of population over time, as per numbers quoted in the NYT “Americans without a high school diploma — about 12 percent of the population, down from about 22 percent in 1990″
    So yes, if you compare bottom 12% quantile with bottom 22% quantile… (given that poverty, educational level, longevity etc are all correlated)

    (the article is behind the paywall, but I assume it’s the same one NYT wrote about amonth ago:
    http://www.nytimes.com/2012/09/21/us/life-expectancy-for-less-educated-whites-in-us-is-shrinking.html?ref=global-home&_r=0)

  2. R Segurado says:


    They also write something that puzzles me:

    Russia, the USA and other laggards can learn much from research on the reasons why
    various countries (including Japan, France, Italy, Spain, Sweden and Switzerland)
    have been more successful in reducing premature deaths. The reasons involve healthcare,
    social policies, personal behaviour (especially cigarette smoking and alcohol abuse),
    and the safety and salubriousness of the environment.

    Learning much from the reasons would include, presumably, discerning the relative impact of those reasons. E.g. perhaps discovering that tobacco and alcohol may not be too important. Or at least that other factors explain much more of the lag in US/Russia relative to the other countries. I admit, it’s poorly phrased if that is their message.

  3. Anonymous says:

    The second article is a classic instance of the public health malaise: “correlation implies causation”. That 14 people signed off on it shows how contagious this malaise is. That’s what happens when you put values and advocacy before science.

    http://aidwatchers.com/2011/05/from-shaky-research-into-solid-headlines-via-medical-journals/

    Race and education are correlated with a whole bunch of things, including income, single parent families, etc… Hard to tell what is cause and effect.

    But no worries. The solution is more education even if in the US the education system fails precisely the poorest people. Perhaps US teachers’ unions have something to learn…

  4. Phil says:

    Smoking in the U.S. is lower than in Europe, but that wasn’t true twenty years ago and earlier. Not sure how relevant that is here.

  5. Mike says:

    At a quick glance, the first paper seems like it has ‘nation-state bias’ pretty bad. Yes, the US and Russia have more health disparities than a place like France, but the US and Russia are also much bigger than France. Is my life expectancy here in California affected by the poor life expectancy of people in Alabama? It seems likely to have little more effect on my life than poor life expectancy in Canada off-hand… And I’m about equally likely to end up in either place (i.e. very unlikely) so they probably affect my saving behavior, etc. about the same amount.

    If you’re going to use big areas like the US and Russia, you probably need to keep using big areas like the EU (which has quite a bit of health disparity), not the individual countries of the EU. If you’re going to use small areas like individual countries of the EU, you probably want to compare to US and Russian regions in some way. I mean, the underlying point might still stand if you did that, I have no idea, but the use of the US and Russia as the primary examples everywhere is a problem, it seems to me.

    • Fr. says:

      Trying to derive your own life expectancy of aggregate measures is not a reasonable way to doubt the granularity of the data. Health inequalities exist at the regional level in all European countries for which I have seen the data, and their relative differences reach similar orders of magnitude than state averages.

  6. Steve Sailer says:

    The big news lately is that life expectancies are declining for poorly educated white people.

  7. Jason Kerwin says:

    If there’s an upper bound to life expectancy (which is approximately true) then to some extent there is a mechanical relationship between the range of the data and the mean. This result would be more interesting if it corrected for that issue – is there still a link between the mean and dispersion of LE if the data is not close to the maximum value?

  8. [...] good posts from statistician Andrew Gelman: 1) health disparities are associated with low life expectancy; 2) researcher “degrees of freedom” (ie, how many ways can you fiddle with the data [...]

  9. [...] “Life expectancy and disparity: an international comparison of life table data” http://bmjopen.bmj.com/content/1/1/e000128.full.pdf … with discussion http://andrewgelman.com/2012/10/health-disparities-are-associated-with-low-life-expectancy/ … [...]