New paper in PNAS

19 October 2021 13:53

New paper in PNAS

Together with a team of international researchers, Kjell Gunnar Salvanes, Aline Bütikofer and René Karadakic have published a new paper in the scientific journal PNAS. The paper is entitled “Inequality in mortality between Black and White Americans by age, place, and cause and in comparison to Europe, 1990 to 2018”.

Recent events, notably the Black Lives Matter movement and the disproportionate impact of the COVID-19 pandemic on the Black population, have highlighted the persistent gap in life expectancy between Black Americans and other Americans (1, 2). In 2018, the gap in life expectancy between Black and White Americans was 3.6 y. However, there have also been tremendous improvements in life expectancy among Black Americans relative to White Americans over time and especially since 1990 (3–7). Much of the highly publicized recent research investigating changes in inequality in life expectancy and mortality in the United States over the past 30 y highlights inequalities in adult mortality across educational and income groups (8–23).


This paper discusses the evolution of inequalities in mortality between Black and White Americans from 1990 to 2018 through the lens of place. There are two innovations: First, following several recent studies (1, 6, 24–31), we examine the evolution of mortality rates among Black and White Americans by age and county poverty rates. This analysis allows us to see whether racial gaps have evolved differently in higher- and lower-income parts of the United States. Trends in age-specific mortality rates provide insights into whether changes in life expectancy are specific to certain age groups, for example, people over 65 who qualify for Medicare, which in turn may provide additional insight into possible mechanisms.


Second, we benchmark these developments against trends in mortality inequality across high- and low-income places in a set of six prosperous European countries. This comparison offers several potential insights, such as whether mortality in higher-income parts of the United States is more similar to that of European countries or whether both high- and low-income US places tend to lag behind. It also provides additional perspective on the gaps between Black and White Americans, allowing us to ask, for example, if only Black Americans fall short of a European benchmark or if the mechanisms driving lower life expectancy in the United States also affect White Americans.


Our analysis proceeds by first ranking counties by their poverty rate in each year and then grouping counties into clusters that each account for about 5% of the population (Materials and Methods). A key advantage of this approach is that we can examine all deaths, whereas information on income and completed education is not available for every person. We also avoid problems due to changes in the education distribution over time. For example, high school dropouts in the United States have become an increasingly small and more negatively selected group as high school completion and college attendance have become more normative (32–35). A limitation of our approach is that we cannot examine inequalities within small areas. Set against this limitation is evidence that low-income Americans live longer in high-income areas than in low-income ones (12), so that mortality across geographic areas is of independent interest. Our approach allows us to see whether changes in mortality occur in both high- and low-income areas or are driven largely by improvements in lower-income areas.


A second advantage of this geographical approach is that it can be easily adapted to examine mortality inequality in other countries using a similar framework. We examine trends in mortality inequality in six wealthy European countries using methods identical to the US analysis. Mortality inequality in these countries is of interest in its own right but also serves as a useful baseline for considering developments in the United States, contributing to a growing body of comparative literature on mortality differentials (6–39). Our main analysis focuses on six countries (England, France, Germany, the Netherlands, Norway, and Spain) for which consistent mortality data by geographic areas exist for the entire time period. All six are prosperous countries with well-developed health care and social welfare systems. The experience of these countries provides some insight into questions such as how low US mortality rates could fall given current medical standards; whether increasing gaps in life expectancy between the United States and Europe are driven only by lower-income areas or whether higher-income areas are also falling behind; and finally, whether mortality among Black Americans declined only relative to White Americans or whether it also declined relative to a European life expectancy benchmark.


Kjell G. Salvanes is a professor in labor economics at NHH, research director at CELE since 2012, and deputy director of the Centre of Excellence FAIR (Centre for Experimental Research on Fairness, Inequality and Rationality) since 2017.

Aline Bütikofer is a Professor of Economics at the Norwegian School of Economics. She received her PhD from the Department of Economics at the University of Bern in 2011. She is a co-founder of the Center for Empirical Labor Economics and since 2017 a faculty affiliate at the Centre of Excellence FAIR (Centre for Experimental Research on Fairness, Inequality and Rationality). Since 2020, she is a co-editor for the Journal of Human Resources.

René Karadakic is a PhD candidate at the Department of Economics at the Norwegian School of Economics and is affiliated to the Center for Experimental Research on Fairness, Inequality and Rationality (FAIR). He joined the Department in August 2018.

See the full article here 


Photo: Aaron Burden