Top US cities where financial setbacks shorten your life expectancy

It’s well established that earning a higher income is associated with living longer. Wealthy individuals work in healthier environments, have better job security, and can afford better healthcare than people who make less money.

The findings of a sweeping study shed light on yet another element of the relationship between income and life expectancy: For poor Americans, geography matters. Individuals with low-paying jobs are better off in some states than others, according to the study.

But in which cities and states are financial setbacks more likely to lead to serious health problems or death? And what might explain the differences between each region?

Understanding the lifespan gap

The study, published in JAMA, analyzed income and mortality data for the US population over more than a decade. The authors—economic researchers from Massachusetts Institute of Technology, Stanford, Harvard, and even the US Treasury—concluded that from 2001 through 2014 (the duration of the study), the lifespan gap between rich and poor Americans grew wider.

Individuals in the top 1% income bracket gained 3 years of life expectancy, while individuals in the bottom 1% experienced no gains at all. This disconnect has amounted to a staggering difference between rich and poor Americans. Wealthy men live nearly 15 years longer than poor men, for instance, and wealthy women live 10 years longer than poor women.

“As you go up in the income distribution, life expectancy continues to increase, at every point,” said study coauthor Michael Stepner, PhD, currently a postdoctoral fellow in economics at Harvard.

High-income earners—who have access to better healthcare, education, and food—generally live longer no matter where they are, but lower-income Americans show big differences in life expectancy depending on their geographic location. The poorest men in the US have life expectancies comparable to those in Sudan and Pakistan, while the richest men in the US have the highest life expectancies on Earth. 

What do the data mean?

The study supported a common belief that healthy behaviors strongly influenced longevity, as researchers found that life expectancy correlated negatively with rates of smoking, obesity, and lack of exercise.

That lifestyle impacts mortality is not surprising. Many of the states that ranked lowest in life expectancy are areas where the nation’s opioid epidemic is most concentrated. The CDC considers people on Medicaid and other low-income individuals to be at high risk for prescription drug overdose.

Perhaps surprisingly, the study found that access to healthcare, residential segregation, and unemployment weren’t strong indicators of life expectancy. There was a much stronger relationship between life expectancy and behavioral factors.

The cities where low-income individuals tend to live the longest—including San Diego, New York, Miami, and San Francisco, where life expectancy averages around 81 years old for lower income individuals—have higher population densities, more educated residents, and higher local government spending. These cities provide greater funding for public services and enforce policies that benefit public health, like restricting smoking. Not to mention, living in an affluent city might influence a low-income individual to exhibit healthier behaviors modeled by their wealthier neighbors.

While the study dismissed unemployment as a factor influencing life expectancy, individuals who find themselves without work—whether from layoffs, furloughs, business closures, or other causes—are still more at risk in certain states.

Lowest life expectancy states

In descending order, here are the cities and high-population areas whose poorest Americans have the lowest life expectancies, along with factors that jeopardize the health of their residents.

10. Des Moines, IA

Life expectancy among poorest citizens: 76.7 years

A metro with many poor smokers (28.7%), Des Moines’ local government spending ($2,500 per capita) is just slightly less than the national average ($2,600 dollars).

9. Las Vegas, NV

Life expectancy among poorest citizens: 76.6 years

Sin City contains about 7% more poor smokers than most places in the country. There are also considerably fewer college graduates (16.4%) than the national average (24.4%).

8. Little Rock, AR

Life expectancy among poorest citizens: 76.5 years

Again, this city houses a higher percentage of poor people who smoke (29.7%) than the national average (27%). Local government spending in Little Rock ($1,700 per capita) is also well below the national average ($2,600).

7. Detroit, MI

Life expectancy among poorest citizens: 76.4 years

Detroit’s poor residents are more likely to obese (31.5%) than their counterparts in other cities in the nation (28%). The city also has about 3% more poor smokers than the US average.

6. Knoxville, TN

Life expectancy among poorest citizens: 76.3 years

More poor people smoke here (32.4%) than on average elsewhere in the US (27%). Knoxville is also home to fewer college graduates (22.5%) than the national average (24.4%).

5. Toledo, OH

Life expectancy among poorest citizens: 76.2 years

Obesity among Toledo’s poor residents (32.6%) outpaces the national average (28%), while the percentage of poor people who smoke (34.4%) also surpasses the national average by more than 7%. Finally, local government spending falls $500 below the national average.

4. Oklahoma City, OK

Life expectancy among poorest citizens: 76.0 years

The percentage of poor people who smoke (32.8%) exceeds the national average. At $1,800 per capita, local government spending in Oklahoma City is well below the national average ($2,600 per capita).

3. Topeka, KS

Life expectancy among poorest citizens: 75.8 years

Local government spending in Topeka is $2,000 per capita, which is below the national average by about $600.  

2. Louisville, KY

Life expectancy among poorest citizens: 75.7 years

This city’s percentage of low-income earners who smoke (34.8%) is higher than the national average (27%), while its number of college graduates is lower (21.5%) than the national average (24.4%).

1. Gary, IN

Life expectancy among poorest citizens: 75.7 years

The poor in Gary have the shortest lifespan among all the high-population areas in this study. Plus, at nearly 35%, obesity among Gary’s poor residents exceeds the national average of 28%. The percentage of poor people who smoke (31.8%) is also above the national average (27%), and there are fewer college graduates (17.3%) than the national average (24.4%).

The problem for poor patients

If there’s anything to take from this study, it’s that geography matters for the poor.

“But it is not inevitable. There are things we can do to change the life trajectory of people,” said former director of the CDC Thomas R. Frieden, MD, to The New York Times. “What improves health in a community? It includes wide access to social, educational and economic opportunity.”

Within the JAMA study is a hopeful message that echoes this sentiment. Steps to improve behavioral habits and public health—replicating the successes of cities where gaps in life expectancy are relatively small among socioeconomic groups—can help people live longer, healthier lives, regardless of their income.