Inequality in Survivorship in Midlife in the US

Sanderson, W. & Scherbov, S. ORCID: https://orcid.org/0000-0002-0881-1073 (2026). Inequality in Survivorship in Midlife in the US. Trends in Public Health 1 (1) e3. 10.3390/tph1010003.

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Abstract

Background/Objectives: Inequality in survival across socioeconomic strata has been growing in the US for decades. Traditional measures of this inequality increasingly fail to capture the heterogeneous biological realities of the US population. Using new measures, this study provides a fresh perspective on the dynamics of mortality inequality across ten socioeconomic deciles in the United States from 1982 to 2019. Methods: The data come from annual life tables from US counties, aggregated according to their socioeconomic characteristics. Measures of Inequality: Three measures of inequality are used, capturing survival inequality from different perspectives, inequality in ages of death over the lifecycle, inequality in survival at older ages, and inequality in survival in midlife. For the latter, the equal survivorship age (ESA)—a metric defined as the age at which a specific subgroup’s survival probability from age 20 matches the survival probability from age 20 to 65 of the total population—is used. Results: We find consistently growing inequality, largely unaffected by economic circumstances such as the Great Recession. By 2019, the ESA for the lowest socioeconomic decile was nearly 11 years lower than the ESA of the highest decile. Conclusions: This “survival gap” in the ESA suggests that low-socioeconomic status (SES) populations effectively exhaust their survival reserves a decade earlier than their high SES counterparts. These findings challenge the equity of the use of universal chronological ages in public policies and underscore the need for “Social-Determinant-Adjusted” geriatric policy models. The growing inequality in the ESA suggests the importance of cohort-based influences.

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