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    Original Investigation
    January 21, 2020

    Association of Social Mobility With the Income-Related Longevity Gap in the United States: A Cross-Sectional, County-Level Study

    Author Affiliations
    • 1Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
    • 2Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
    • 3Center for Demography and Ecology, University of Wisconsin–Madison
    • 4Department of Sociology, University of Wisconsin–Madison
    JAMA Intern Med. Published online January 21, 2020. doi:10.1001/jamainternmed.2019.6532
    Key Points

    Question  Can social mobility—namely, differences in the ability of individuals to exceed the socioeconomic status of their parents—explain why gaps in life expectancy between rich and poor individuals in the United States are larger in some places than others?

    Findings  In this cross-sectional, ecological study of 1559 US counties, higher social mobility was significantly associated with higher life expectancy at age 40 years among men and women in the poorest income quartile and with smaller differences in life expectancy between the lowest and highest income quartiles.

    Meaning  Higher county-level social mobility was associated with smaller county-level longevity gaps between rich and poor individuals in the United States.

    Abstract

    Importance  Despite substantial research, the drivers of the widening gap in life expectancy between rich and poor individuals in the United States—known as the longevity gap—remain unknown. The hypothesis of this study is that social mobility may play an important role in explaining the longevity gap.

    Objective  To assess whether social mobility is associated with income-related differences in life expectancy in the United States.

    Design, Setting, and Participants  This cross-sectional, ecological study used data from 1559 counties in the United States to assess the association of social mobility with average life expectancy at age 40 years by sex and income quartile among adult men and women over the period of January 2000 through December 2014. Bayesian generalized linear multilevel regression models were used to estimate the association, with adjustment for a range of socioeconomic, demographic, and health care system characteristics.

    Exposures  County-level social mobility, here operationalized as the association of the income rank of individuals born during the period of January 1980 through December 1982 (based on tax record data, averaged over the period January 2010 through December 2012) with the income ranks of their parents (averaged over the period January 1996 through December 2000) using the location where the parent first claimed the child as a dependent at age 15 years to identify counties.

    Main Outcomes and Measures  The main outcome was life expectancy at age 40 years by sex and income quartile.

    Results  The sample consisted of 1559 counties, which represented 93% of the US population in 2000. Each 1-SD increase in social mobility—equivalent to the difference between a low-mobility state, such as Alabama (ranked 49th on this measure), and a higher-mobility state, such as Massachusetts (ranked 23rd on this measure)—was associated with a 0.38-year (95% credible interval [CrI], 0.29-0.47) and a 0.29-year (95% CrI, 0.21-0.38) increase in county-level life expectancy among men and women, respectively, in the lowest income quartile. Estimates for life expectancies among county residents in the highest income quartile were smaller in magnitude and not robust to covariate adjustment (men: 0.10-year [95% CrI, −0.02 to 0.22] increase; women: 0.08-year [95% CrI, −0.05 to 0.20] increase). Increasing social mobility in all counties to the value of the highest social mobility county was associated with decreases in the life expectancy gap between the highest and lowest income quartiles by 1.4 (95% CrI, 0.7-2.1) years for men and 1.1 (95% CrI, 0.5-1.6) years for women nationally, representing a 20% decrease.

    Conclusions and Relevance  In this cross-sectional study, higher county-level social mobility was associated with smaller county-level gaps in life expectancy by income. These findings motivate further investigation of causal relationships between policies that shift social mobility and health outcomes.

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