Trends in Non-Hispanic White Mortality in the United States by Metropolitan-Nonmetropolitan Status and Region, 1990-2016

Recent decades have witnessed growing geographic divergence in mortality in the United States alongside national-level stagnation in life expectancy, particularly among non-Hispanic whites. We examine changes in non-Hispanic white life expectancy between 1990 and 2016 in 40 areas, 10 regions cross-classified by 4 metropolitan-nonmetropolitan categories. Large central metros, which had the lowest life expectancy in the early 1990s, have experienced large gains in life expectancy (5.09 years for men and 2.98 years for women). By 2014-2016, large central metros had the highest life expectancy for men and women. In contrast, nonmetropolitan areas have experienced smaller gains (2.25 years for men and 0.20 years for women). This pattern is evident throughout the nine Census divisions and Appalachia. Since 2010, trends mortality at the working ages (25 to 64 years) have been particularly adverse contributing to stagnating or declining life expectancy. Drug overdose, mental and nervous system disorders (including Alzheimer's disease), and respiratory diseases (women only) were key contributors to reductions in life expectancy across most regions and metro/nonmetro categories. Cardiovascular disease was the primary cause of death generating divergence across the 40 geographic areas. We discuss potential explanations for the life expectancy declines and geographic divergence.