Same Country, Different Worlds: Understanding the Ten Americas – Life Expectancy Inequalities in the USA

Introduction

A recent study published in The Lancet titled “Ten Americas: A Systematic Analysis of Life Expectancy Disparities in the USA” revisits and expands the seminal “Eight Americas” framework to examine life expectancy trends from 2000 to 2021. Researchers Laura Dwyer-Lindgren and colleagues partitioned the U.S. population into ten groups (“Americas”) based on race, ethnicity, geography, income, and segregation to analyze disparities in longevity. These findings underscore how life expectancy in the U.S. is profoundly shaped by social and structural determinants, with the COVID-19 pandemic further amplifying these disparities.

Study Framework and Methods

The study defines the ten Americas as mutually exclusive groups reflecting unique combinations of race and ethnicity, geographic location, income levels, and urban or segregated environments. Examples include America 1 (Asian Americans), America 6 (Black Americans in low-segregation areas), and America 10 (American Indian and Alaska Native individuals in the West).

Using death records from the National Vital Statistics System and census data, researchers calculated life expectancy and its variations by age, sex, and time. Adjustments for misclassification of race and ethnicity on death certificates were integrated, ensuring accuracy.

Key Findings

1. Widening Gaps Over Time:
   • In 2000, the life expectancy difference between the highest (America 1) and lowest groups (America 9) was 12.6 years. By 2021, this gap had grown to 20.4 years.
   • COVID-19 exacerbated these disparities, with severe declines in life expectancy for the most disadvantaged groups, including America 10 (AIAN in the West).
2. Geographical and Racial Dynamics:
   • America 10 experienced the most substantial life expectancy declines from 2000 to 2019 and faced the sharpest reductions during the pandemic, reflecting systemic neglect.
   • Black Americans (Americas 6, 7, and 9) saw relative improvements from 2000 to 2019 but still trailed other groups significantly in 2021.
3. Socioeconomic Paradoxes:
   • Higher income and education levels were generally associated with better life expectancy but did not uniformly predict outcomes.
   • Latino Americans (Americas 2 and 5) exhibited relatively high life expectancy despite lower socioeconomic status, highlighting the “Latino Paradox.”

Implications for Public Health

1. Strengthen Community-Based Interventions

AIAN and Black communities should be prioritized for culturally sensitive health initiatives that address unique needs.

2. Policy Reforms

Policies addressing economic disparities, improving access to healthcare, and combatting systemic racism are crucial for narrowing gaps.

3. Pandemic Resilience

Future public health responses must ensure equitable resource distribution to minimize disproportionate impacts on vulnerable groups.

Conclusion

The “Ten Americas” framework reveals that despite decades of progress in medical science, life expectancy remains a marker of profound inequality in the U.S. By acknowledging and addressing the systemic factors that create and perpetuate these disparities, public health professionals and policymakers can foster a more equitable society where everyone has the opportunity to live a long and healthy life.