Abstract
BACKGROUND: Longevity has stagnated during the last decade in the United States, but this stagnation has not been homogeneous. We aimed to explore the spatial variation of life expectancy by sex across commuting zones in the contiguous United States from 1990 to 2019. METHODS: We computed sex-specific life expectancy at birth for US commuting zones across six 5-year periods (1990-1994 to 2015-2019) and examined the spatial variability of life expectancy and clustering of baseline and changes in life expectancy during the study period. RESULTS: Overall life expectancy increased over time for both males and females and recently stagnated, while variability has increased for females. Regardless of sex, commuting zones with low baseline life expectancy that worsened over time were concentrated in the Appalachian region and Deep South. Areas with high baseline life expectancy and improved the most over time were scattered throughout the Midwest, Northwest, and West. CONCLUSION: The recent stagnation in life expectancy reflects wide spatial heterogeneity in changes in longevity. Growing spatial differences in longevity render males and females in the South, specifically the Appalachia and along the Mississippi River, to consistently live disproportionate short lives. Further studies should explore the contribution of different causes of death and the potential contextual drivers of these patterns.