Ranking Age-at-Death Distributions Using Dominance: Robust Evaluation of United States Mortality Trends, 2006-2021

Area of Science:

• Demography
• Public Health
• Biostatistics

Background:

• Mortality trends at different ages necessitate monitoring lifespan inequality alongside life expectancy.
• Ambiguous conclusions arise when life expectancy and lifespan inequality trends are inconsistent.
• Existing inequality measures may not provide robust comparisons of age-at-death distributions.

Purpose of the Study:

• To propose and apply nonparametric dominance analysis for robustly ranking age-at-death distributions.
• To evaluate changes in lifespan inequality in the U.S. from 2006-2021.
• To identify disparities in mortality trends among different racial and ethnic subpopulations.

Main Methods:

• Nonparametric dominance analysis applied to U.S. period life tables (2006-2021).
• Comparison of age-at-death distributions across different years and subpopulations.
• Assessment of trends in lifespan inequality and its intersection with life expectancy.

Main Results:

• From 2006-2014, recent years generally dominated earlier years, indicating improvements in lifespan distribution, particularly for non-Hispanic Black and Hispanic individuals.
• Post-2014, earlier years often dominated more recent years across all subpopulations, especially Hispanics, suggesting worsening lifespan distributions.
• The COVID-19 pandemic (2020-2021) showed a dramatic deterioration in age-at-death distributions, most pronounced for Hispanic individuals.

Conclusions:

• Nonparametric dominance analysis offers a robust method for assessing lifespan inequality trends.
• U.S. lifespan inequality showed improvements until 2014, followed by a concerning reversal, particularly impacting Hispanic populations.
• The findings highlight the need for targeted public health interventions to address worsening mortality distributions and pandemic impacts.