Understanding Geographic Disparities in Mortality

A rich literature shows that early life conditions shape later life outcomes, including health and migration events. However, analyses of geographic disparities in mortality outcomes focus almost exclusively on contemporaneously measured geographic place (e.g., state of residence at death), thereby potentially conflating the role of early life conditions, migration patterns, and effects of destinations. We use the newly available Mortality Disparities in American Communities (MDAC) dataset, which links respondents in the 2008 ACS to official death records and estimate consequential differences by method of aggregation; the mean absolute deviation of the difference in life expectancy at age 50 measured by state of birth versus state of residence is 0.58 (0.50) years for men and 0.40 (0.29) years for women. These differences are also spatially clustered, and we show that regional inequality in life expectancy is higher based on life expectancies by state of birth, implying that interstate migration mitigates baseline geographical inequality in mortality outcomes. Finally, we assess how state-specific features of in-migration, out-migration, and non-migration together shape measures of mortality disparities by state (of residence), further demonstrating the difficulty of clearly interpreting these widely used measures.