Subnational life expectancy disparities in low and middle-income countries: measurement and determinants

Relatively little is known about subnational life expectancy disparities in low and middle-income countries (LMICs). We construct indicators of subnational disparities in life expectancy, offering critical insights into health inequalities within countries. Moreover, we investigate the factors that account for cross-country and over-time variations in subnational life expectancy in less developed countries.

We measure subnational disparities in life expectancy within a country by way of a population-weighted coefficient of variation indicator. Our sample covers 101 LMICs during the period 2000-2021 and we consider overall, male and female health disparities. We employ regression analysis to identify important drivers of subnational disparities in life expectancy and focus on the role of subnational disparities in income and education.

The findings reveal that subnational disparities in life expectancy are markedly higher in Sub-Saharan Africa compared to other LMIC world regions. Moreover, while subnational disparities in life expectancy have decreased in most regions, Sub-Saharan Africa stands out as an exception, with persistently high disparities alongside rising average life expectancy. A gender-specific analysis highlights that, while women generally live longer than men, subnational disparities are greater for women. Regression analysis identifies a range of factors influencing life expectancy disparities. Variables such as good governance and public health spending help reduce subnational disparities, while decentralization, country size, geographic diversity and ethnic fractionalization tend to increase them. Subnational disparities in income and education emerge as the most significant drivers, with disparities in female education playing a particularly critical role.

Subnational life expectancy disparities in some LMICs, especially in Sub-Saharan Africa, are high and persistent. Reducing subnational disparities in female education emerges as a key strategy.