Early death

How long lives last, and the deaths that end them early, have more than one geography. This part asks how life expectancy differs across neighborhoods, where people die young, from what, and how concentrated those deaths are in particular neighborhoods and counties. Violence, overdose, alcohol and suicide each have a map of their own, and the part sets each against the deprivation gradient and against one another. Counts below a privacy threshold are withheld by CDC, so some counties appear as no data, and how that withholding biases a comparison is the subject of Chapter 10.5, Suppressed counties in death data.

Chapter 6.1, Place and the length of a life begins with life expectancy at birth across tenths of neighborhood deprivation, lower in every tenth than in the one before. It then asks what a county average leaves out, how far apart nearby neighborhoods are under a stated rule, whether the ordering repeats inside metros and counties, and what a randomized housing-voucher experiment adds about moving. The estimates are modeled for deaths in 2010 to 2015, and the chapter separates the spread of places from the uncertainty of an average.

Chapter 6.2, Gun homicide and the causes of early death then moves to the smallest grain. Firearm homicide deaths concentrate in a small share of tract clusters, the unit in which CDC publishes neighborhood death rates, and the chapter follows that concentration into Cook County, where the clusters with the highest rates are also the most deprived and the shortest-lived. It then widens to counties. Premature mortality rises with county deprivation, the mix of deaths differs between the least and the most deprived counties, and the kind of death with the highest rate differs from county to county. Homicide and suicide rates differ by race in opposite directions among the counties that report both groups. A box reports a trial that assigned vacant lots to remediation at random, and nothing else in the chapter supports a claim about what changes violence.

Chapter 6.3, Overdose, alcohol and suicide maps overdose, alcohol-induced deaths and suicide by county, with homicide as a comparison. Suicide, overdose and homicide rates are highest in different counties, and suicide is the most separate of them. Among the larger counties where CDC WONDER publishes a count every year, overdose deaths exceed alcohol-induced deaths in most of those where both can be mapped, and deprivation is more closely related to suicide and overdose rates than to alcohol-induced rates. The chapter counts deaths and does not measure despair. Whether the people who live in a county feel despair is a question about persons, and it belongs to the survey chapters in the next part. Some results depend on the weighting, and the chapter reports which ones change when each county counts once.

Chapter 6.4, Mortality trends, 2018 to 2024 follows overdose, alcohol-induced, suicide and homicide deaths from 2018 to 2024, nationally and by county deprivation. The causes keep different schedules. Overdose and alcohol-induced deaths rose above their earlier levels and stayed above them through the last year of data, suicide stayed near its earlier level, and homicide rose and then came back to it. The two sources give different sizes for the rise in overdose, and the chapter finds that the difference tracks deaths that only CDC WONDER counts, which fits the definitions but cannot be proved from the files. In the same counties the two sources agree on how the changes differed by county deprivation; a larger rise in the most deprived counties appears only among the counties whose counts CDC WONDER withholds, which only the modeled panel covers. The latest values in one source are provisional, and the chapter says what that allows.

Chapter 6.5, Violence and the life-expectancy gap makes a rough accounting of how much of the life-expectancy gap between the most and the least deprived tracts homicide accounts for. Under its stated assumptions homicide accounts for a small part of the gap across deprivation tenths and a larger part in the clusters with the highest homicide rates, and most of the gap belongs to other causes of death.