Blockbuster research just published in the Journal of the American Medical Association makes two major points regarding longevity - how long we live. The first conclusion: the rich live longer. The second: where you live can give, or take, years from your life - but differences in access to health care are not a factor.
The differences in life expectancy also can be immense. According to the research, here is how profoundly income shapes longevity: men in the bottom 1% at age 40 had an expected death of 72.7 years. Men in the top 1% were projected to live until 87.3 -- that is, 14.6 years longer. Women in the bottom 1% had expected longevity of 78.8. Women in the top 1% were expected to live until 88.9, 10.1 years longer.
Why? Nobody precisely knows but guesses from experts are that the wealthy have a keener sense of self-preservation and also they have the means and knowhow to seek out appropriate medical treatment.
No real surprise on those scores, just as it is unsurprising that the poor - whether they have Medicaid or not - may put off seeking care and may also lack the knowhow to source the best options.
The rich live longer, and you would have guessed that on your own. “That’s unsurprising,” said Dr. Stephen Schimpff, retired chief executive officer of the University Medical Center in Maryland and author of Fixing the Primary Care Crisis. "Populations with less income smoke more. They tend not to eat as good a diet and tend to have more obesity which leads to diabetes. If you are less well off you have greater stress."
But the research's kicker is that lives are longer in particular states, and this is especially true for low-income residents but it is also true for the rich.
The states with the lowest life expectancy probably aren’t the ones you expected. Here they are: Nevada, Indiana, and Oklahoma, where those in the bottom income quartile had life expectancy of 77.8 years.
The longest lived states are California, New York, and Vermont, where those in the bottom income quarter are expected to live to 80.6, almost three years more.
Curiously, those in the top income quartile had the lowest life expectancy - 85.3 years - in Nevada, Hawaii, and Oklahoma. The highest life expectancy among the wealthy is in Utah, Washington DC, and Vermont -- 87.6 years.
Some cities do especially badly, some well. Gary, Ind. was singled out as especially bad for life expectancy for the poor - 74.2 years for men and 80.7 years for women. New York City was particularly good for longevity for the poor - 79.5 years for men and 84 years for women.
The researchers stressed that access to health care did not appear to figure in as a determinant.
What did? Bad lifestyle choices, said Dr. Schimpff.
Cono Badalamenti, a physician in Riverside, Calif. elaborated: “Lifestyle medicine experts have known that your life expectancy and quality of life has much more to do with lifestyle and environment then the underlying genome for most people," he said. "It is not surprising that where you live and how much money you make can drive health outcomes. It doesn't take a strong imagination to recognize the likely possibility that populations of people with access to a safe environment, affordable high-quality plant-based, whole foods and a cultural connection to healthful activities of daily living would achieve statistical advantages in health outcomes.”
But some of this - in ways not quite understood by researchers - also seems to be geographically influenced. That is, why do the poor in Gary, Ind. appear to weigh more and smoke more than the poor in California? A guess - put out by some experts - is peer pressures. In some cities, smoking and obesity are more tolerated than in others. But those two factors in particular clearly correlate with lower life expectancy.
The good news in this: it may not so much be where you live that shapes life expectancy, so much as what you do wherever you live. And that means even in you live in Gary, Ind. there is no urgent reason to call U-Haul. Don’t smoke, eat healthy, exercise and your life expectancy will reflect those lifestyle choices. No matter where you live.
At least that is what the experts are saying.
This article is commentary by an independent contributor. At the time of publication, the author held TK positions in the stocks mentioned.