The richest Americans live at least 10 years longer on average than the poorest, but that gap isn't as wide in many communities, especially affluent, highly educated cities, a major study found.

The research emphasizes that where you live and what you earn help determine life expectancy, along with changeable behaviors including smoking and lack of exercise.

stacks of money (Jose Luis Pelaez Inc, ThinkStock)
stacks of money (Jose Luis Pelaez Inc, ThinkStock)

Stanford University economist Raj Chetty and colleagues analyzed more than 1 billion tax records between 1999 and 2014, along with government records on nearly 7 million deaths. They used the data to estimate life expectancy at age 40 by income and geographic area.

Their analysis was published online Monday in the Journal of the American Medical Association. It comes during an election season marked by heated debate about income equality and the endangered middle class.

The report examines the well-known connection between income and longevity, but with more precision and detail than previous research, Princeton University economist Angus Deaton said in a journal editorial.

"The infamous 1 percent is not only richer, but much healthier," Deaton said.


Men with the top 1 percent in income lived 15 years longer than men with the lowest 1 percent in income; for women that gap was 10 years.

Between 2001 and 2014, life expectancy didn't change for people in the lowest 5 percent of income, but it increased by about 3 years for men and women in the top 5 percent. Those changes, and life expectancy in general, varied substantially by region.

The poorest Americans lived the longest in areas where smoking, obesity and inactivity were scarce, and access to medical care had less influence than previous studies have suggested.

The study did not include people with no income.


Data from Dallas, Detroit and New York help illustrate the findings. Among the lowest-income men and women, life expectancy was lowest in Detroit and Dallas and highest in New York. Among men at the lowest income level, life expectancy was 72 in Detroit, but almost 80 years in New York -- a nearly seven-year difference. Among men at the top income level, it was about 86 years in Detroit and 87 years in New York, a difference of just one year. The gap was smaller among women.

The lowest life expectancies for the poorest men and women -- less than 78 years -- were in Indiana, Nevada and Oklahoma. For the richest, the lowest life expectancies -- less than about 85 years -- were in Hawaii, Nevada and Oklahoma.


The poorest Americans fared best in affluent cities with highly educated populations. These tend to be areas with health-related public policies including smoking bans and high levels of funding for public services, the researchers said.

The findings raise the possibility that community-based public health approaches could help address the income-based longevity gap, a journal commentary said.

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