全球疾病负担（GBD）美国健康差距协作组Ali H Mokdad团队研究了2000-2019年美国各县、族裔的预期寿命。2022年6月16日出版的《柳叶刀》发表了这项成果。

在美国，不同族裔群体之间的预期寿命存在着巨大而持久的差异，但这些模式在地方范围内的地理差异程度尚不清楚。该分析估计了美国3110个县20年来五个族裔群体的预期寿命，以描述预期寿命的时空变化以及族裔群体之间的差异。

研究组对美国国家人口统计系统的死亡登记数据和美国国家卫生统计中心的人口数据应用了新的小面积估计模型，以估计2000-2019年按县和种族-民族分层（非拉丁裔和非西班牙裔白人[白人]、非拉丁裔和非西班牙裔黑人[黑人]、非拉丁裔和非西班牙裔美国印第安或阿拉斯加土著[AIAN]、非拉丁裔和非西班牙裔亚洲或太平洋岛民[API]、拉丁裔或西班牙裔[拉美裔]）的年度性别和年龄死亡率。研究组校正了这些死亡率，以纠正死亡证明中对种族和族裔的误报，然后构建了简略寿命表，以估计出生时的预期寿命。

2000-2019年期间，各族裔群体和各县的预期寿命趋势有所不同。在全国范围内，黑人（增长3.9岁；2019年预期寿命为75.3岁）、API（2.9岁；85.7岁）、拉美裔（2.7岁；82.2岁）和白人（1.7岁；78.9岁）的预期寿命有所增加，但对于AIAN而言，情况保持不变（0.0岁；73.1岁）。

在全国范围内，在此期间，黑人人口与白人人口的预期寿命负差值有所减少，而AIAN人口与白人人口的预期寿命负差值有所增加；在这两种情况下，这些模式在各县中都很普遍。

2000-2019年，API和拉美裔人口与白人人口在预期寿命方面的正差异在全国范围内有所增加；然而，拉美裔人口在相当少数的县（1465个县中有615个[42.0%]）、API人口在大多数县（666个县中有401个[60.2%]）中这一差异有所下降。对于所有族裔群体来说，预期寿命的改善在各县范围内更为普遍，2000-2010年的改善幅度大于2010-2019年。

研究结果表明，族裔群体之间的预期寿命差异是普遍的和持久的。地方层面的数据对于解决美国弱势群体健康状况不佳和过早死亡的根本原因、消除健康差距和提高所有人的寿命至关重要。

附：英文原文

Title: Life expectancy by county, race, and ethnicity in the USA, 2000–19: a systematic analysis of health disparities

Author: Laura Dwyer-Lindgren, Parkes Kendrick, Yekaterina O Kelly, Dillon O Sylte, Chris Schmidt, Brigette F Blacker, Farah Daoud, Amal A Abdi, Mathew Baumann, Farah Mouhanna, Ethan Kahn, Simon I Hay, George A Mensah, Anna M Nápoles, Eliseo J Pérez-Stable, Meredith Shiels, Neal Freedman, Elizabeth Arias, Stephanie A George, David M Murray, John WR Phillips, Michael L Spittel, Christopher JL Murray, Ali H Mokdad

Issue&Volume: 2022-06-16

Abstract:

Background

There are large and persistent disparities in life expectancy among racial–ethnic groups in the USA, but the extent to which these patterns vary geographically on a local scale is not well understood. This analysis estimated life expectancy for five racial–ethnic groups, in 3110 US counties over 20 years, to describe spatial–temporal variations in life expectancy and disparities between racial–ethnic groups.

Methods

We applied novel small-area estimation models to death registration data from the US National Vital Statistics System and population data from the US National Center for Health Statistics to estimate annual sex-specific and age-specific mortality rates stratified by county and racial–ethnic group (non-Latino and non-Hispanic White [White], non-Latino and non-Hispanic Black [Black], non-Latino and non-Hispanic American Indian or Alaska Native [AIAN], non-Latino and non-Hispanic Asian or Pacific Islander [API], and Latino or Hispanic [Latino]) from 2000 to 2019. We adjusted these mortality rates to correct for misreporting of race and ethnicity on death certificates and then constructed abridged life tables to estimate life expectancy at birth.

Findings

Between 2000 and 2019, trends in life expectancy differed among racial–ethnic groups and among counties. Nationally, there was an increase in life expectancy for people who were Black (change 3·9 years [95% uncertainty interval 3·8 to 4·0]; life expectancy in 2019 75·3 years [75·2 to 75·4]), API (2·9 years [2·7 to 3·0]; 85·7 years [85·3 to 86·0]), Latino (2·7 years [2·6 to 2·8]; 82·2 years [82·0 to 82·5]), and White (1·7 years [1·6 to 1·7]; 78·9 years [78·9 to 79·0]), but remained the same for the AIAN population (0·0 years [–0·3 to 0·4]; 73·1 years [71·5 to 74·8]). At the national level, the negative difference in life expectancy for the Black population compared with the White population decreased during this period, whereas the negative difference for the AIAN population compared with the White population increased; in both cases, these patterns were widespread among counties. The positive difference in life expectancy for the API and Latino populations compared with the White population increased at the national level from 2000 to 2019; however, this difference declined in a sizeable minority of counties (615 [42·0%] of 1465 counties) for the Latino population and in most counties (401 [60·2%] of 666 counties) for the API population. For all racial–ethnic groups, improvements in life expectancy were more widespread across counties and larger from 2000 to 2010 than from 2010 to 2019.

Interpretation

Disparities in life expectancy among racial–ethnic groups are widespread and enduring. Local-level data are crucial to address the root causes of poor health and early death among disadvantaged groups in the USA, eliminate health disparities, and increase longevity for all.

DOI: 10.1016/S0140-6736(22)00876-5

Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)00876-5/fulltext