Disparities in Life Expectancy Across US Counties Linked to County Social Factors, 2009 Community Health Status Indicators (CHSI)

Objectives In response to a National Healthy People 2020 goal to create social environments to improve health, we examined US community health status by social factors to identify opportunities for health improvement. County-level relationships between life expectancy and known social determinants of health were assessed. Methods An ecological study of all 3,141 US counties or equivalents using 2009 Community Health Status Indicators dataset was conducted. We examined health status and social indicators across counties and correlation of average life expectancy with educational, income, and racial indicators. Results Life expectancy varied across US counties (median, 77 years; range, 67–81) and was negatively correlated with percentages of residents living below the federal poverty level ( r = −0.65; P < 0.05), of adults aged ≥25 years without a high school diploma ( r = −0.64; P < 0.05), and of African–American residents ( r = −0.56; P < 0.05). By contrast, life expectancy positively correlated with percentage of White-American residents ( r = 0.51; P < 0.05). Correlations persisted across counties with varying poverty and educational attainment; strongest correlations found in counties with largest percentage of residents in poverty or adults with no high school diploma. Conclusions Life expectancy across US counties is moderately to strongly linked with county poverty, educational attainment, and racial composition. Counties with the longest life expectancy need further examination to identify their effective policies, resources, and investments responsible for better health.