Understanding the United States Black-White Life Expectancy Gap, 2007-2018

BACKGROUND: Life expectancy is a critical measure of population health. In the U.S., Black Americans have historically experienced lower life expectancy than White Americans due to factors such as health insurance inequities, socioeconomic disparities, and systemic barriers. Though the Black-White life expectancy gap narrowed after 1990, it has fluctuated in recent years, influenced by socioeconomic changes and the COVID-19 pandemic. OBJECTIVE: This study examines how national-level differences in education and income contributed to the Black-White life expectancy gap in the United States from 2007 to 2018. METHODS: Data were analyzed from the National Health and Nutrition Examination Survey (2007-2018) and its Linked Mortality File. Using 3 survival models, this study assessed life expectancy at age 20 for Non-Hispanic Black (NHB) and Non-Hispanic White (NHW) populations. Covariates included education and income. RESULTS: The unadjusted life expectancy gap at age 20 between NHB and NHW individuals averaged 3 years. Adjusting for education using a flexible parametric survival model reduced the gap by 50%, while adjusting for income reduced the gap by 75%. When both factors were adjusted simultaneously, two survival models indicated that NHB life expectancy slightly exceeded NHW life expectancy. Income disparities persisted across educational levels, signifying unequal economic returns to education. CONCLUSIONS: Addressing income disparities is essential for reducing racial inequities in life expectancy. Policies promoting both equitable education access and income equivalence are critical for achieving health equity and improving population health.