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The Poor Still Die Young, but Their Kids Have Hope

The mortality gap between rich and poor narrows for America's youth.

In America, the rich live longer, the poor die younger and the overall gap between the two is widening. But it's not the case for everyone—particularly among those under 30, which may bode well for the future.

A new analysis published on Thursday in the journal Science shows the gap narrowing in that demographic, led by a dramatic decrease in infant mortality since 1990. It's an unexpected bit of good news after the recent drumbeat of grim reports about life expectancy, most prominently one that revealed a startling reversal in gains among white Americans

The new data may reflect investments in health targeted at poor populations, such as Medicaid coverage for children and pregnant women, social programs like Head Start, "and reductions in pollution, which tend to have disproportionate effects on the poor," the authors wrote. The chart below shows infant mortality rates for males, with the richest counties at the left and the poorest at the right. A steeper line going up and to the right means death inequality is greater. If everyone died at the same rate regardless of income, the line would be flat. The slopes here represent, from top to bottom, 1990, 2000, and 2010. 

male infant mortality
Source: Currie et al., Science (2016)

The researchers first ranked U.S. counties by poverty level. Then they looked at how mortality rates changed from 1990 to 2010. They broke the analysis down by gender and age group to see trends for specific ages. The authors, from Princeton University and the University of Zurich, uncovered that infant mortality has decreased across the board, which is good news. More of a surprise was that the slope is flattening, meaning that poorer counties saw greater improvement than rich ones, reducing the death gap.

When they did this analysis for all age groups, the authors found the slope flattening for both sexes up to age 30 and for men up to age 50. For a big part of the U.S. population, the difference in death rates between rich and poor is getting smaller.

How does the finding square with recent research that shows the difference between rich and poor is increasing overall? Most people die at older ages. The researchers found that "among older adults, mortality has continued to decline, though declines are generally greatest in the richest counties."

It's also important to note that the authors are talking about death rates by county, not individual deaths (they also re-order the county groups by poverty level for each year analyzed). Larger gaps between individuals based on income may be occurring inside counties, the authors concede.

One question is whether this is the beginning of something bigger: will these younger Americans have better health, and health equality, as they get older? Based on prior evidence, the authors concluded, there’s “good reason to hope that today’s young will also be healthier when they reach old age and that inequality in mortality will decrease among these elderly in the future."

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