Research shows that geographic disparities in life expectancy between leading and lagging states are increasing over time while racial disparities between Black and White Americans have been going down. In the 65+ age strata morbidity is the most common cause of death, making differences in morbidity and associated adverse health-related outcomes between advantaged and disadvantaged groups an important aspect of disparities in life expectancy at age 65 (LE65). In this study, we used Pollard’s decomposition to evaluate the disease-related contributions to disparities in LE65 for two types of data with distinctly differing structures: population/registry and administrative claims. To do so, we analyzed Pollard’s integral, which is exact by construction, and developed exact analytic solutions for both types of data without the need for numerical integration. The solutions are broadly applicable and easily implemented. Applying these solutions, we found that the largest relative contributions to geographic disparities in LE65 were chronic lower respiratory diseases, circulatory diseases, and lung cancer; and, to racial disparities: arterial hypertension, diabetes mellitus, and cerebrovascular diseases. Overall, the increase in LE65 observed over 1998–2005 and 2010–2017 was primarily due to a reduction in the contributions of acute and chronic ischemic diseases; this was partially offset by increased contributions of diseases of the nervous system including dementia and Alzheimer’s disease.

研究表明，随着时间的推移，领先州和落后州之间预期寿命的地理差距正在扩大，而美国黑人和白人之间的种族差距一直在缩小。在 65 岁以上年龄层中，发病率是最常见的死亡原因，这使得优势群体和弱势群体之间发病率和相关不良健康相关结果的差异成为 65 岁预期寿命 (LE65) 差异的一个重要方面。在本研究中，我们使用 Pollard 分解来评估两种结构截然不同的数据类型对 LE65 差异的疾病相关贡献：人口/登记和行政索赔。为此，我们分析了 Pollard 积分（该积分在构造上是精确的），并为两种类型的数据开发了精确的解析解，而无需进行数值积分。该解决方案适用范围广泛且易于实施。应用这些解决方案，我们发现对 LE65 地理差异影响最大的相对贡献是慢性下呼吸道疾病、循环系统疾病和肺癌；以及种族差异：高血压、糖尿病和脑血管疾病。总体而言，1998-2005 年和 2010-2017 年观察到的 LE65 增加主要是由于急性和慢性缺血性疾病的贡献减少；痴呆症和阿尔茨海默病等神经系统疾病的影响增加部分抵消了这一影响。