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Life and Death in the American City: Men’s Life Expectancy in 25 Major American Cities From 1990 to 2015

Abstract

The past several decades have witnessed growing geographic disparities in life expectancy within the United States, yet the mortality experience of U.S. cities has received little attention. We examine changes in men’s life expectancy at birth for the 25 largest U.S. cities from 1990 to 2015, using mortality data with city of residence identifiers. We reveal remarkable increases in life expectancy for several U.S. cities. Men’s life expectancy increased by 13.7 years in San Francisco and Washington, DC, and by 11.8 years in New York between 1990 and 2015, during which overall U.S. life expectancy increased by just 4.8 years. A significant fraction of gains in the top-performing cities relative to the U.S. average is explained by reductions in HIV/AIDS and homicide during the 1990s and 2000s. Although black men tended to see larger life expectancy gains than white men in most cities, changes in socioeconomic and racial population composition also contributed to these trends.

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Notes

  1. Data for state, county, and city of residence were public use for units with more than 100,000 residents in the MCD file from 1959–2004 and were removed in 2005 at the request of state vital statistics agencies. We requested geographic identifiers for the years 2005–2015 from NAPHSIS and received data from NCHS through a data use agreement.

  2. Residential change among older adults prior to death could bias estimates of mortality risk for central cities, particularly if long-term care institutions are differentially located inside or outside central cities, and if these location patterns have changed over time. However, this is unlikely to substantively impact our results, largely because old-age mortality makes little contribution to gains in life expectancy over this period in cities relative to the United States as a whole.

  3. Table B3 in the online appendix lists the ICD codes used for each cause of death.

  4. The starting year of 1990 was chosen to reflect the beginning of sociodemographic changes in many large cities. In Tables A8 (men) and A9 (women) of the online appendix, we present life expectancy estimates for 1979–1981 (centered on 1980) as well.

  5. It is likely that deaths from HIV/AIDS were underenumerated during the early period given the relative recency of the epidemic (Preston and Elo 2014). Evidence for this is that “Other Infectious Diseases” also make significant contributions to the gains in life expectancy for many of the cities with high mortality from AIDS. As a result, the total contributions of HIV/AIDS in Table 3 likely understate the total contribution. It is unclear whether the undercounting of HIV/AIDS deaths varies across cities.

  6. A more formal assessment of the role of cigarette smoking in Table A12 (online appendix) supports the finding that smoking’s contribution to city-specific gains was likely small.

  7. U.S. death certificates added indicators of educational attainment until 1989, but data were reported from only 21 states. By 2015, still only 49 states were reporting educational attainment information on death certificates. Furthermore, population denominators by age, sex, and education are estimated using the ACS and are subject to large sampling error. As a result, we are unable to directly calculate life expectancy by educational group within cities.

  8. For consistency over time, we calculate life expectancy for whites and blacks, including Hispanics. Changes over time in the identification of Hispanic origin may make it difficult to obtain comparable estimates of life expectancy for non-Hispanic whites and non-Hispanic blacks for cities in 1988–1992 and 2011–2015.

  9. The life expectancy of white men and women in Washington, DC, in the late period is particularly notable. Whites in Washington, DC, outlive U.S. white men by 6.8 years and U.S. white women by 5.8 years. In fact, in Washington, DC, life expectancy among white men is 2.5 years above the leading country globally (Iceland, at 80.9 years) for white men, and that among white women is 0.7 years above the leading country (Japan, at 86.7 years).

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Acknowledgments

We acknowledge infrastructure support from the Maryland Population Research Center P2C Award (P2C-HD041041). We are grateful to Isaac Sasson for helpful comments.

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Fenelon, A., Boudreaux, M. Life and Death in the American City: Men’s Life Expectancy in 25 Major American Cities From 1990 to 2015. Demography 56, 2349–2375 (2019). https://doi.org/10.1007/s13524-019-00821-2

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Keywords

  • Cities
  • Life expectancy
  • United States
  • HIV/AIDS
  • Homicide