The US Counties With The Shortest Life Expectancy

Although the United States spends more per capita on healthcare than any other nation ($15,474 per person, according to data from the Centers for Medicare & Medicaid Services), the average life expectancy lags behind its peer countries. In 2014, the national average life expectancy in the U.S. was 79.1 years. National averages do not show extreme local variations, however. Longevity in America is not just due to genetics or personal choices, but is deeply rooted in geography, economy, and historical systemic inequalities. Four of the top 10 counties with the shortest lifespans are in Kentucky, and three are in South Dakota. That national figure and the county lifespans examined below come from a study by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, which measured life expectancy across the U.S. through 2014, the most recent year in that dataset.

1. Oglala Lakota County, South Dakota - 66.8 years

Widely known as the county with the lowest life expectancy in the U.S., at 66.8 years in 2014, Oglala Lakota County in South Dakota's southwestern corner is completely filled with the Pine Ridge Native American Reservation. (The reservation is 2.1 million acres, taking up all of this county as well as parts of Bennett and Jackson Counties). Almost all (91%) of Oglala Lakota County's residents are Native American. A study by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington found that Native Americans in Midwestern and Western states have lifespans almost 20 years shorter than that of Asian Americans. Shorter life expectancy in this county can be attributed to the fact that Oglala Lakota County, population 13,491, also has the lowest per capita income in the nation, at $11,771, and more than half of its residents live below the poverty line. The county, which includes towns like Pine Ridge and Wounded Knee, ranks the worst in South Dakota in health outcomes relating to quality of life and health factors such as medical care, social, and physical environment. The local healthcare system in the county is underfunded and faces shortages, plus many medical centers are far from where people live.

2. Union County, Florida - 67.6 years

Located in north-central Florida and the smallest county in the state, measuring 243.6 sq. mi., Union County records the lowest life expectancy in Florida, at 67.6 years, and the second-lowest in the nation. A contributing factor is that the county has a high concentration of correctional facilities such as the Union Correctional Institution, and as high as 30% of the county's population of 15,701 are prison inmates. Many inmates enter the facility with severe chronic illnesses and substance abuse problems, leading to earlier deaths, which skews the statistics. Additionally, Union County, home to towns like Lake Butler and Raiford, has some of the highest mortality rates in the U.S. for cancers, HIV/AIDS, and tuberculosis, per the IHME. Union County is a medical desert, with a lack of major medical institutions, and 19.5% of the county's population lives below the poverty line. Union County also has the second-highest smoking rate in Florida and high rates of obesity, all of which contribute to early death.

3. Todd County, South Dakota - 68.5 years

Contained entirely within the Rosebud Indian Reservation on South Dakota's southern border, Todd County's reasons for its placement as the county with the third-lowest life expectancy in the nation, at 68.5 years, are similar to those of Oglala Lakota County. Almost half of the county's 9,244 residents live below the federal poverty line, and 82% of them are Native American. About 40% of the county's population smokes, and rates of diabetes, obesity, heart disease, and kidney disease are higher in Todd County than in the rest of the state or the nation. Once again, health care is underfunded within Indian reservations, and it is often difficult for residents to access routine or preventative health care that could help to prolong their lives.

3. Sioux County, North Dakota - 68.5 years

Located within the Standing Rock Indian Reservation in south-central North Dakota along the border with South Dakota, Sioux County is another county with a high Native American population (82% of its 3,740 residents) and low life expectancy of 68.5 years. Life expectancy in Sioux County is the lowest in the state, and tied for third-lowest in the nation. The poverty rate is 43.3% in Sioux County. As part of the Standing Rock reservation, the county suffers from underfunding of infrastructure, limited economic opportunities, and isolation. Towns in the county such as Fort Yates and Cannon Ball face high rates of chronic illnesses, behavioral health challenges, and premature mortality, all of which drive down the county's average lifespan. Residents face barriers to quality medical care, as federal programs like the Indian Health Service are underfunded.

5. Buffalo County, South Dakota - 69.1 years

Buffalo County, South Dakota, along the eastern bank of the Missouri River, overlaps with the Crow Creek Indian Reservation and is another small county of just 1,808 people where the life expectancy has lowered to 69.1 years in part, due to the health inequalities facing its Native American residents (who account for 78% of the population). One of the poorest counties in South Dakota, residents of Buffalo County face limited local access to medical care and underfunded regional health services. County residents in towns like Fort Thompson and Gann Valley experience higher rates of diabetes, heart disease, obesity, and cancer, all of which contribute to lowered life expectancies. Added stressors include trauma, racism, and struggles with substance abuse that the Native American population has faced for generations.

6. Owsley County, Kentucky - 70.2 years

In the rural Eastern Coalfield region of Kentucky, Owsley County, one of the smallest (3,971 residents) and poorest counties in the state, has a low life expectancy of 70.2 years. This is due to the county's extreme poverty rate, higher rate of health risks such as obesity and smoking, lack of physical activity, and lack of access to health care. The county is a hospital desert, and, although outpatient care is available in Booneville, the county's only incorporated city, the nearest small hospital is 35 minutes away. Additionally, in the county, deaths related to prescription drugs, drug overdoses, and alcohol-related liver disease occur at high rates, ending lives prematurely.

6. Breathitt County, Kentucky - 70.2 years

Also in the rural Eastern Kentucky Coalfield region, Breathitt County's low life expectancy of 70.2 years is tied with that of its neighbor, Owsley County. Its reasons for low lifespan are similar to those of its neighboring county. More than a third of the population of 13,276 lives below the poverty line. The decline of the local coal industry has led to long-term unemployment. Residents in the county have higher rates of smoking, obesity, physical inactivity, and diabetes, all of which drive up mortality rates. They are also isolated from health care, with shortages in primary care and mental health services. Although a hospital exists in Jackson, the county's only incorporated town, some residents living in the county's outer rural areas find travel there difficult.

8. McDowell County, West Virginia - 70.3 years

A historic Appalachian region formerly dominated by coal mining, McDowell County is at the southern tip of West Virginia, along the border with Virginia. Its mountainous terrain helps to isolate many of its rural communities, making healthcare difficult for its 17,943 residents to access. Consequently, the life expectancy in McDowell County is just 70.3 years. The decline of coal mining in the area has contributed to high unemployment and a poverty rate of 34.2%. The region also suffers from high rates of opioid abuse, addiction, and fatal drug overdoses. Towns in the county like Kimball and Gary lack fresh grocery stores, and residents rely on processed foods or convenience stores, contributing to higher rates of diabetes and heart disease. Failing water systems also means the county residents are faced with unclean drinking water, adding to chronic health risks. Per the West Virginia Bureau for Behavioral Health, 42.7% of McDowell County's residents live with a disability. The region reports higher rates of mental health challenges and suicide compared to state and national averages.

9. Perry County, Kentucky - 70.6 years

Another county in the rural Eastern Kentucky Coalfield Appalachian Mountains area with a low life expectancy of 70.6 years, Perry County's 27,499 residents face a poverty rate of 26.8% and high unemployment rates. Some of this can be attributed to the decline in the coal mining industry, and this generational poverty and unemployment has continued. Rates of smoking, obesity, diabetes, and physical inactivity are all higher in towns like Hazard, Vicco, and Buckhorn, contributing to a lower life expectancy. Higher rates of prescription drug abuse and opioid overdoses all add to the problem. Many county residents face isolation and doctor shortages, limiting their access to preventative care and treatment for chronic diseases.

10. Wolfe County, Kentucky - 70.7 years

The rural Eastern Kentucky Coalfield Appalachian county of Wolfe County with 6,443 residents, where life expectancy is 70.7 years, follows the trend of its neighboring counties. Poverty rates in the county have approached 40%. Educational levels are also lower, limiting job opportunities and economic stability. Rural isolation and lack of local industry contribute to residents' economic challenges. Plus, rates of smoking are higher in Wolfe County, as are rates of obesity, inactivity, and poor nutrition. Residents in towns like Hazel Green have reported having little to no access to fresh grocery stores and healthy foods, and food insecurity in the county is 24%. These factors all contribute to the county's lower life expectancy.

Can Life Expectancies Improve in these Counties?

Looking at this list of the top 10 counties with the lowest life expectancies in the U.S., it is clear that lower life expectancy is based upon many contributors. These include socioeconomic factors, behavioral and metabolic risks, healthcare deserts, sub-populations such as Native American reservations, and rural communities who have become trapped in generational poverty. Fixing this gap in longevity requires looking past clinical medicine and addressing some of the social causes that can lead to better health, like economic opportunity, nutrition, and regional infrastructure.