State-Level Differences in Life Expectancy Persist Across Generations in the US

Stark disparities in life expectancy across the US over the past century were revealed in new research, with some Southern states seeing little to no improvement in longevity despite major national gains in mortality reduction.¹ Gaps in life expectancy between states grew substantially from 1959 to 2017, especially after the 1980s,² with longer gains in survival often seen in states that implemented stronger public health policies.³

The study, published in JAMA Network Open, which analyzed more than 179 million deaths from 1969 through 2020, suggests geography and public health policy may play a far greater role in determining lifespan than previously understood.¹

Cohort-Based Mortality Study Analyzed 179 Million Deaths

The cohort-based study analyzed approximately 179 million deaths recorded between 1969 and 2020 across all 50 states and Washington, DC. Investigators evaluated mortality patterns among birth cohorts spanning from 1900 through 2000, allowing them to estimate how life expectancy changed across generations rather than examining mortality during a single calendar year.

Researchers found that women born in 1900 had a national life expectancy of approximately 73.9 years, compared with 84.1 years among women born in 2000—an increase of about 10.2 years. For men, life expectancy rose from 58.7 years among the 1900 cohort to 80.7 years among the 2000 cohort, representing a gain of roughly 22 years.

Southern States Lagged in Longevity Improvements

The improvements were not evenly distributed geographically. Among women, life expectancy gains ranged from only 2.2 years in Oklahoma to 20.7 years in Washington, DC. Female life expectancy in Mississippi increased by fewer than 5 years across the century-long period, while states including New York, California, and Massachusetts experienced substantially larger gains.

For men, improvements ranged from 13.2 years in Oklahoma to 38.7 years in Washington, DC. Male life expectancy in the nation’s capital increased from approximately 40 years among the earliest cohort to nearly 79 years among the 2000 cohort.

The authors noted that Southern states such as Mississippi, Alabama, Kentucky, Arkansas, and Oklahoma consistently ranked near the bottom for longevity improvements, while Northeastern and Western states generally experienced more sustained mortality reductions.

Researchers Examined Mortality Acceleration After Age 35

The study also assessed rate-doubling time, a measure of how quickly mortality risk increases with aging after age 35. Longer rate-doubling times indicate slower increases in mortality risk over time.

Among women, New York had the slowest mortality acceleration, with mortality rates doubling every 9.85 years after age 35, compared with 8.39 years in Oklahoma. Among men, Florida had the slowest mortality acceleration at 9.97 years, while Iowa had the fastest at 8.31 years.

Researchers suggested these differences may reflect variation in smoking prevalence, obesity, cardiovascular disease burden, environmental exposures, educational attainment, economic opportunity, and access to preventive care.

Study Highlights Role of Public Health Policy, Social Determinants

The authors emphasized that cohort-based analysis provides a different perspective from traditional life expectancy studies because it follows generations throughout their lifespan. According to the researchers, this method may better capture the long-term effects of public health policies and social conditions on mortality outcomes.

The findings arrive amid growing concern over stagnating US life expectancy and widening health disparities tied to geography and socioeconomic status. National mortality averages may obscure substantial regional inequities, even as overall mortality declined during the twentieth century, the authors emphasized.

Limitations Included Migration, Incomplete Cohort Data

The study had several limitations. Researchers noted that death certificate data may contain inaccuracies in age reporting or cause-of-death classification. Migration between states over a person’s lifetime could also affect the findings because mortality outcomes were analyzed based on the state of death rather than the state of birth or long-term residence.

Additionally, life expectancy estimates for younger birth cohorts remain incomplete because those individuals have not yet lived through their full lifespan. The study also could not fully account for race, ethnicity, socioeconomic status, or other individual-level demographic factors that may influence mortality trends within states.

Despite these limitations, the authors concluded that the findings demonstrate substantial and persistent inequalities in longevity across the US and underscore the importance of targeted public health and policy interventions to improve health equity nationwide.

References

1. Holford TR, McKay L, Tam J, Jeon J, Meza R. All-cause mortality and life expectancy by birth cohort across US states. JAMA Netw Open. 2025;8(4):e257695. doi:10.1001/jamanetworkopen.2025.7695
2. Woolf SH, Schoomaker H. Life Expectancy and mortality rates in the United States, 1959-2017. JAMA. 2019;322(20):1996-2016. doi:10.1001/jama.2019.16932
3. Montez JK, Beckfield J, Cooney JK, et al. US state policies, politics, and life expectancy. Milbank Q. 2020;98(3):668-699. doi:10.1111/1468-0009.12469