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All-Cause Mortality and Life Expectancy by Birth Cohort Across US States
Theodore R Holford1, Lisa McKay1,2, Jamie Tam3
1Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut.
JAMA Network Open
|April 28, 2025
Summary
US mortality rates vary significantly by state and birth cohort, with some states showing minimal life expectancy improvements. Understanding these disparities is crucial for targeted public health interventions and resource allocation.
Area of Science:
- Demography
- Public Health
- Epidemiology
Background:
- Overall US mortality rates have declined, but significant state and generational variations exist.
- Trends in mortality and life expectancy by birth cohort across US states remain undercharacterized.
Purpose of the Study:
- To estimate mortality trends by birth cohort for each US state and Washington, DC.
- To quantify life expectancy at birth and age 40, and the rate of mortality increase after age 35.
Main Methods:
- Utilized an age-period-cohort model with constrained cubic splines for mortality estimation.
- Analyzed all-cause mortality data from 1969-2020 for birth cohorts 1900-2000 across all US states and Washington, DC.
- Included over 179 million deaths in the analysis, estimating life expectancy and mortality rate doubling times.
Main Results:
- Life expectancy improved from 1900-2000 in the West and Northeast, but showed minimal gains in some Southern states.
- Washington, DC, had the lowest 1900 birth cohort life expectancy but experienced substantial increases.
- Identified significant variations in mortality rate doubling times after age 35 across states and sexes.
Conclusions:
- Cohort-specific mortality patterns reveal substantial geographic disparities in the US.
- Certain states exhibit little to no improvement in life expectancy across birth cohorts.
- Understanding state-level cohort mortality variations is essential for informing public health strategies.
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