MSR60 A Comprehensive View on the Geographic Variation in Racial and Ethnic Disparities in Life Expectancy in the United States

Racial and ethnic disparities in health are one of the United States' central challenges. However, a comprehensive view of the geographic variation in disparities in life expectancy has not been studied, partly because of missing and suppressed county-level death data. This study imputes missing and suppressed death data in the CDC WONDER database using Bayesian correlated spatial models and provides a comprehensive view on the geographic variation in disparities in life expectancy in the US in 2016. CDC Wonder data on death counts and population sizes at the county-age-group-sex-race/ethnicity level were used for our analysis, encompassing 3014 counties, 13 age-groups, two sex categories, and five race/ethnicity categories (American Indian/Alaskan Natives (AI/AN), Asians, Non-Hispanic Blacks (NHB), Hispanics, Non-Hispanic Whites (NHW)). A range of spatial models were employed to model deaths, model selection was based on DIC, and predictions were validated by artificially suppressing specific cell data. Following CDC methodology, predicted death probabilities were used to construct life expectancies (LE) at birth. Estimated overall LE in 2016 was 77 years (females: 79; males: 75; AI/AN: 71; Asian: 84; NHB:74 Hispanics: 81; NHW: 77). LE ranged from 61 years among males in Oglala Lakota County, South Dakota, to 85 years among females in Fairfax County, Virginia. Racial/ethnic disparities ranged from a standard deviation of 3.2 years in LE of females in Fairfax County, VA, to 6.1 years in LE of males in Floyd County, KY. A strong negative correlation was observed between county-specific life expectancy and racial/ethnic disparities in LE (Figure 1). A comprehensive view of LE in the US reveals that the largest racial/ethnic disparities in LE tend to concentrate in areas where overall LE is low. This suggests that improving public health, health care delivery, and health care access is critical in overcoming such disparities.