Genetic codes play a highly influential role in human morbidity and mortality, while a case can be made that zip codes also must be taken into account. Where individuals reside has important consequences for their health and well-being. Geographic areas of the U.S. vary on several social, economic, and political dimensions associated with mortality risk. According to an article published in the February 2023 issue of the journal Demography, states are of particular interest because they are semiautonomous units whose governments exert considerable influence over the implementation of policies regarding social service programs and healthcare delivery. Compositional and contextual differences by state contribute to geographic disparities in mortality risk in the United States that are wide, persistent, and potentially growing. For example, life expectancy in 2019 ranged from a high of 80.9 years in Hawaii to a low of 74.4 years in Mississippi. This wide discrepancy among U.S. states exceeds the range in life expectancy among high-income nations. The extent to which differences in lifespan variability by state have changed over time, however, is unclear.
The study referred to in the aforementioned journal article indicates that lifespan variability declined over time for all states, but sizable disparities remain between states. These differences generally align with states' varied demographic, cultural, and socioeconomic contexts. For instance, southern and Appalachian states experience higher levels of poverty and poor health than other parts of the country. These states exhibit persistently higher levels of lifespan variability. Additionally, states vastly differ in their policy contexts regarding social inequality, such as Medicaid expansion, Earned Income Tax Credit, tobacco control, and setting a minimum wage above the federal level. Policies that alleviate poverty and promote educational and occupational opportunities may be especially effective for averting preventable, early-life deaths that contribute disproportionately to lifespan variability. State policies that curtail early-life mortality would have the dual benefit of increasing life expectancy while simultaneously decreasing lifespan inequality. By adopting more progressive policies found in most low-variability states, high-variability states have the potential to extend the lives of their most vulnerable residents, reduce lifespan variability, and close the population health gaps between the leading and lagging states. Although more research is needed to identify the reasons behind increases in lifespan variability, evidence suggests that rising accidental poisoning and suicide deaths among younger adults are contributing factors.