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Northeast, West Coast residents gain decades of life over century, especially women
In a nutshell
- Southern states like Oklahoma, Mississippi, and West Virginia have seen minimal improvements in life expectancy over the past century, with some showing less than three years of gain since 1900.
- Northeastern and Western states have experienced dramatic improvements, with Washington, D.C. seeing the most striking increase—female life expectancy rose from 63.9 to 93 years.
- State policies on issues like tobacco control, healthcare access, and environmental protections likely contribute to these persistent geographic health disparities.
NEW HAVEN, Conn. — For those living in Southern states like Mississippi and Oklahoma, a century of medical advances has barely moved the needle on life expectancy, according to a new study. Meanwhile, residents in Northeast and West Coast states have gained decades of extra life over the same period.
Researchers analyzing mortality data across America report that a baby girl born in Oklahoma today might live only a few months longer than one born in 1900 – a shocking contrast to places like New York, where female life expectancy jumped 20 years over the same timeframe.
The study, which examined a massive dataset of 179 million deaths across the United States from 1969 to 2020, reveals how deeply geography determines health trajectories in America. While we often think of medical advances benefiting everyone equally, the paper, published in JAMA Network Open, demonstrates that reality is far more complex and uneven.
Regional Health Disparities Persist Across Generations
Researchers from Yale, the University of Michigan, and the University of British Columbia tracked mortality not just by calendar year but by birth cohort—following groups born in the same year throughout their lives. This approach reveals how early-life conditions and public policies affect entire generations.
“The birth cohort perspective is particularly important for capturing potential changes in mortality that would otherwise be masked in cross-sectional analyses,” the researchers explain.
The findings paint a troubling picture: eight Southern states (Oklahoma, Arkansas, Kentucky, Tennessee, Louisiana, Alabama, West Virginia, and Mississippi) consistently show the weakest improvements in life expectancy. In some, female life expectancy improved less than three years over an entire century, while male life expectancy gained less than two years since 1950.
“Cohort-specific patterns across states reveal wide disparities in mortality,” the researchers write. “Some states have experienced little or no improvements in life expectancy from the 1900 to 2000 birth cohorts.”
Florida, on the other hand, bucks the trend, with male residents especially seeing remarkable life expectancy gains. Female Floridians born in 2000 are expected to live about a decade longer than those born in 1900, while males will live nearly 20 years longer.
By contrast, a child born in Washington, D.C. in 2000 could expect to live to 93—nearly 30 years longer than one born in 1900. New York and California residents also saw dramatic improvements, with female life expectancy increasing about 20 years over the century.
How Quickly We Age: The ‘Doubling Time’ Factor
Beyond life expectancy, the study measured how rapidly mortality rates accelerate with age after 35—what researchers call “doubling time.” This metric reveals how quickly a population is aging.
Women in Oklahoma had the fastest mortality acceleration, with death rates doubling every 7.96 years, while New York women enjoyed a slower pace at 9.39 years. For men, Iowa had the fastest acceleration at 8.95 years, while Florida had the slowest at 11.47 years.
These differences correlate with overall life expectancy: states with longer doubling times (slower aging) generally show better life expectancy outcomes.
Policy Choices Shape Health Outcomes
The regional variations likely reflect different state-level approaches to public health issues like tobacco control, healthcare access, and environmental protections. California’s early adoption of workplace smoking restrictions in 1995, for example, helped reduce smoking rates and improved mortality outcomes compared to states like Kentucky that implemented few tobacco controls.
Washington, D.C.’s dramatic improvement stands as an outlier, possibly reflecting demographic shifts as more affluent residents with better healthcare access moved into the capital over time.
Study authors suggest that understanding these historically entrenched patterns could help policymakers target resources to regions that have benefited least from a century of medical progress.
“Without conscious policy changes, these gaps will likely persist or even widen,” says lead author Theodore Holford, of the Yale School of Public Health. “Where you are born shouldn’t determine how long you live. But in America, it still does.”
Paper Summary
Methodology
The researchers analyzed all-cause mortality rates for each U.S. state and Washington, D.C., by single years of age (0-119) and birth cohort (1900-2000). They obtained mortality data from the National Center for Health Statistics, the CDC, and the Surveillance, Epidemiology, and End Results database, covering calendar years 1969-2020 and ages 0-84. The team employed an age-period-cohort model with constrained cubic splines to estimate mortality trends, allowing them to calculate life expectancy at birth and at 40 years of age for each cohort. They also determined the doubling time for death rates after age 35, which measures how quickly mortality increases with age. This comprehensive approach enabled them to track how mortality patterns evolved across different generations in each state.
Results
The study analyzed 179 million deaths (77 million female and 102 million male) across the United States. Researchers found dramatic differences in life expectancy trends between states. While states in the West and Northeast showed substantial improvements in cohort life expectancy from 1900 to 2000, many Southern states experienced minimal gains or even declines. For females in states like Oklahoma, life expectancy actually decreased by 0.7 years over the century studied. Washington, D.C. showed the most dramatic improvement, with female life expectancy rising from 63.9 to 93.0 years across the century. After age 35, mortality doubling times varied significantly by state, with New York having the highest (slowest mortality acceleration) at 9.39 years for females and Florida at 11.47 years for males. The shortest doubling times were 7.96 years for females in Oklahoma and 8.95 years for males in Iowa.
Limitations
The researchers note several limitations to their approach. While their model performed well with available data, predictions extending to 2119 (for the 2000 cohort) should be used cautiously as they cannot account for future events or healthcare changes. The study also does not explicitly control for demographic shifts and migration patterns within states, though the underlying data reflect those population changes. The researchers did not report results by race or ethnicity in order to maximize precision in estimates for all states. Additionally, data from after 2020 was not included, meaning the impact of COVID-19 and related policies on state mortality disparities was not fully captured in the analysis.
Funding
This research was supported by grant U01CA253858 from the National Cancer Institute of the National Institutes of Health. The funding organization had no role in the design and conduct of the study, data analysis, manuscript preparation, or the decision to publish.
Publication Information
The study, titled “All-Cause Mortality and Life Expectancy by Birth Cohort Across US States,” was published in JAMA Network Open on April 28, 2025. It was authored by Theodore R. Holford, Lisa McKay, Jamie Tam, Jihyoun Jeon, and Rafael Meza from Yale School of Public Health, University of Michigan, and University of British Columbia. The study was approved by the Institutional Review Board of Yale University School of Medicine and complies with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline for cohort studies.
These are garbage people, the only ones that live there that are worth anything are the ones that move there from somewhere else. The ones born and raised there are the children of bigots slave owners and trailer trash, lazy under educated over fed…
Confederate losers that should have been plowed under after the Civil War.
This is because most people in the South moved here from a 3rd world country, such as California.
Wrong choices of what and how much one consumes. Insufficient exercise. The worse those choices, the sooner one dies.
I would like to see the raw data broken down by urban versus rural and level of education attainment. I think rural parts of Texas would rank similar to the surrounding states while the gains would be found in high income parts of the larger cities such as Dallas and Houston.
I believe you’re correct. I live in a suburban relatively affluent part of the south. Our life expectancies seem quite extended, compared to the rural parts of the state. It’s seemingly down to embracing healthier life styles and having better health care. Yes, it’s largely down to which area has higher income and better education. That’s in the urban areas. Fewer people in rural areas have those advantages.
This is why all vices should end at 35 and a serious life extension program should begin.I did so 40 years ago,a time when the medical community was still haranguing people that vitamins were a waste of money.Those who put their money into 401K’s,mostly did not make it to retirement.I bought vitamins and the like.Who is better off today?Most of these people are barely existing,while I’ll be at the gym shortly.