JAMA：想要长寿？多赚点钱吧！
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近日，刊登在国际杂志Journal of the American Medical Association上的一项研究论文中，来自斯坦福大学的研究人员通过研究发现，美国人居住的地方和其所赚钱的多少会明显影响个体的平均寿命，而相比居住位置而言，收入是一个更加重要的因素。
作者Raj Chetty说道，我们在美国贫穷区域发现了较大的差异，而在富裕的地区却发现了较小的差异。文章中研究人员追踪了1999年至2014年美国的联邦数据，结果发现，人们越富裕，其寿命趋向于越长久；比如富有的40岁男性个体的预期寿命可以达到87岁，而贫穷个体的预期寿命仅仅会到72岁，而且较高收入的女性个体的预期寿命会达到89岁，而较低收入的个体则只会到79岁。
同时研究者还发现，富裕和贫穷在预期寿命上的差异还会不断拉大，在2001至2014年期间，高收入的美国个体的平均预期寿命会提高3年，而低收入个体的预期寿命则没有明显变化。同时收入对预期寿命的影响还取决于个体所居住的地方，比如在伯明翰居住的富裕和贫穷的个体在预期寿命上都会获取类似的收益，从另外一方面来讲，居住在佛罗里达州坦帕的个体的预期寿命从2000年开始就开始下降了。举另外一个例子，在纽约居住的收入最底层5%的男性个体的预期寿命要比居住在印第安纳州加里收入相当个体的预期寿命长5年。
研究者Chetty指出，相比医疗保险和医疗保健而言，生活方式还会对个体的预期寿命产生重要的影响，拥有较短预期寿命的个体所居住的地方更易于是高比率吸烟、肥胖及低频率锻炼的区域。然而在某些地区贫穷个体的寿命相比其他个体更长一些，这就表明收入和健康之间的关联或许并不是非常严格的，而且还可以通过重点关注地方区域层面上的问题来改善贫穷个体的健康状况。
最后研究者说道，如果我们考虑买一份从退休一直到预期寿命之间的保险的话，我们或许就需要考虑我们的预期寿命是否实际可以达到，如果在美国利用平均预期寿命的相关数据来讲，我们或许就会开始对伤害那些贫困个体，比如美国密歇根州东南部的那些大城市居住的个体。
The Association Between Income and Life Expectancy in the United States, 2001-2014
Raj Chetty, PhD1; Michael Stepner, BA2; Sarah Abraham, BA2; Shelby Lin, MPhil3; Benjamin Scuderi, BA4; Nicholas Turner, PhD5; Augustin Bergeron, MA4; David Cutler, PhD4
Importance The relationship between income and life expectancy is well established but remains poorly understood. Objectives To measure the level, time trend, and geographic variability in the association between income and life expectancy and to identify factors related to small area variation. Design and Setting Income data for the US population were obtained from 1.4 billion deidentified tax records between 1999 and 2014. Mortality data were obtained from Social Security Administration death records. These data were used to estimate race- and ethnicity-adjusted life expectancy at 40 years of age by household income percentile, sex, and geographic area, and to evaluate factors associated with differences in life expectancy. Exposure Pretax household earnings as a measure of income. Main Outcomes and Measures Relationship between income and life expectancy; trends in life expectancy by income group; geographic variation in life expectancy levels and trends by income group; and factors associated with differences in life expectancy across areas. Results The sample consisted of 1 408 287 218 person-year observations for individuals aged 40 to 76 years (mean age, 53.0 years; median household earnings among working individuals, $61 175 per year). There were 4 114 380 deaths among men (mortality rate, 596.3 per 100 000) and 2 694 808 deaths among women (mortality rate, 375.1 per 100 000). The analysis yielded 4 results. First, higher income was associated with greater longevity throughout the income distribution. The gap in life expectancy between the richest 1% and poorest 1% of individuals was 14.6 years (95% CI, 14.4 to 14.8 years) for men and 10.1 years (95% CI, 9.9 to 10.3 years) for women. Second, inequality in life expectancy increased over time. Between 2001 and 2014, life expectancy increased by 2.34 years for men and 2.91 years for women in the top 5% of the income distribution, but by only 0.32 years for men and 0.04 years for women in the bottom 5% (P < .001 for the differences for both sexes). Third, life expectancy for low-income individuals varied substantially across local areas. In the bottom income quartile, life expectancy differed by approximately 4.5 years between areas with the highest and lowest longevity. Changes in life expectancy between 2001 and 2014 ranged from gains of more than 4 years to losses of more than 2 years across areas. Fourth, geographic differences in life expectancy for individuals in the lowest income quartile were significantly correlated with health behaviors such as smoking (r = −0.69, P < .001), but were not significantly correlated with access to medical care, physical environmental factors, income inequality, or labor market conditions. Life expectancy for low-income individuals was positively correlated with the local area fraction of immigrants (r = 0.72, P < .001), fraction of college graduates (r = 0.42, P < .001), and government expenditures (r = 0.57, P < .001). Conclusions and Relevance In the United States between 2001 and 2014, higher income was associated with greater longevity, and differences in life expectancy across income groups increased over time. However, the association between life expectancy and income varied substantially across areas; differences in longevity across income groups decreased in some areas and increased in others. The differences in life expectancy were correlated with health behaviors and local area characteristics.
