‘71.3 years’ was the average life expectancy globally, according to the World Health Organization in 2021. When a certain number of people die in a year, that number adds to the mortality rate of a county. There are big differences in death rates depending on where people live, especially between different counties. Mortality rates of counties can reflect a lot about them, how well their healthcare system is, what diseases are more prevalent, and what resources they are lacking. These things show the quality of life led by people in that particular county. So, what is stopping a county whose mortality rates are high from decreasing these deaths? The difference in how many people die is often tied to things like education and income. Studies have already shown that areas with higher average incomes tend to see the biggest jumps in life expectancy and have lower death rates from all causes. But until now, few studies have specifically looked at death rates from particular diseases across counties based on how rich or poor they are. Linking Poverty to Leading Causes of Death Researchers at the American Cancer Society (ACS) recently studied how death rates in U.S. counties (not including Alaska and Hawaii) are connected to how much poverty exists in those counties. They examined death rates for all causes of death and for the 10 diseases that cause the most deaths in the county. These top 10 causes were responsible for almost all deaths in 2020. Heart diseases (like heart attacks, heart failure, artery blockages)CancerStroke and other brain blood flow issuesPneumonia/influenzaUnintentional injuries (like falls, car accidents, poisoning, drug overdose)Chronic Obstructive Pulmonary Disease (COPD), a serious lung diseaseAlzheimer's diseaseType 2 diabetesSuicideKidney diseaseThe researchers looked at changes in death rates over two time periods: from 1990 to 1994, and from 2016 to 2020 (they avoided the main COVID-19 years). They defined the poorest counties as those where 20% or more residents lived below the federal poverty line (for example, a family of four earning less than $26,200 a year in 2020). The richest counties had less than 10% of residents below this line. Have The Death Rates Improved? Overall, death rates got better in all types of counties for general deaths and for four of the main causes: heart diseases, cancer, stroke-related diseases, and pneumonia/influenza. However, the improvements were much bigger in counties with less poverty. Because the poorest counties saw less improvement, the gap in death rates actually grew wider between the richest and poorest areas. These improvements also varied a lot by location. The biggest drops in death rates happened on the East and West coasts and in some northern parts of the U.S. The smallest improvements were in the Midwest, Appalachia, and parts of the South—areas that often have higher poverty levels. Heart disease and cancer death rates improved the least in the South and Midwest. Where Have Death Rates Worsened? Unfortunately, death rates actually increased across the nation from other leading causes of death: accidents/injuries, COPD, Alzheimer's disease, Type 2 diabetes, suicide, and kidney disease. The effect of poverty on these conditions was mixed. For COPD and Type 2 diabetes, death rates improved in the richest counties but got worse in the poorest ones. Overall, death rates worsened the most for accidents/injuries (likely due to the ongoing drug crisis) and Alzheimer's disease (partly because people are living longer and doctors are better at diagnosing it). Interestingly, for women, Type 2 diabetes death rates improved in all income levels studied. For men, COPD death rates improved across all income levels. Why These Gaps Exist? Some health differences are getting bigger than others. The largest increases in the gap in death rates between rich and poor counties were for Type 2 diabetes, pneumonia/influenza, COPD, kidney diseases, and heart diseases.Factors like smoking and obesity are more common in certain areas, particularly the South. These are big risk factors for many of the diseases studied. Also, some Southern states haven't expanded their Medicaid programs, which help low-income people get healthcare. Access to Medicaid has been linked to better health outcomes and lower death rates.