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Life expectancy gains across US states between 1941 and 2000: a cohort study
Héctor Pifarré I Arolas1,2,3, José Andrade4, Jason Fletcher5,2
1University of Wisconsin-Madison, Madison, Wisconsin, USA hparolas@lafollette.wisc.edu.
BMJ Open
|April 8, 2026
Summary
US states saw significant gains in cohort life expectancy for all birth cohorts from 1941-2000. Robust methods and new data confirm improvements, refuting claims of stagnation or loss.
Area of Science:
- Demography
- Public Health
- Epidemiology
Background:
- Estimating US state-level mortality trends and life expectancy is crucial for public health policy.
- Previous studies have yielded conflicting results regarding life expectancy gains across different US states and birth cohorts.
- Understanding geographical variations in life expectancy is essential for targeted interventions.
Purpose of the Study:
- To estimate mortality levels and trends for US states and Washington DC.
- To quantify cohort life expectancy for birth cohorts born between 1941 and 2000.
- To analyze convergence trends in cohort life expectancy across US states.
Main Methods:
- Observational retrospective cohort study utilizing new data and robust methods.
- Analysis of mortality data and population estimates from the US Mortality Database for cohorts born 1941-2000.
- Estimation of cohort life expectancy at birth by sex and geographical level, using coefficient of variation for convergence analysis.
Main Results:
- All US states and regions showed cohort life expectancy gains for both sexes between 1941 and 2000, often exceeding 5 years.
- Significant gains were observed, with some states like Arizona, New Mexico, and South Carolina showing over 14 years increase for men.
- States converged in the 1940s due to reduced under-five mortality in the South; stability in variation observed since the 1960s.
Conclusions:
- New estimates demonstrate substantial cohort life expectancy gains across all US states and regions for birth cohorts 1941-2000.
- Contrary to some recent findings, no US state showed cohort life expectancy losses with improved data and methods.
- Early life interventions likely drove regional convergence around 1950, with limited additional convergence thereafter.
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