The U.S. Mortality Crisis as a Preston Curve Reversal
NBER Working Papers · 2026 · Ritikaa Khanna、Rourke O'Brien、Andrew C. Stokes、Atheendar Venkataramani、Elizabeth Wrigley-Field
中文摘要
尽管实际人均收入持续增长，美国预期寿命在2010年代却停滞并下降。我们使用普雷斯顿曲线，将这一现象刻画为收入与寿命关系的变化。利用1980—2019年的州级数据和2000—2019年的县级数据，我们估计了以人口加权、将预期寿命与实际人均收入对数联系起来的普雷斯顿曲线。1980—2010年，美国各州呈现经典的普雷斯顿曲线模式：收入上升伴随预期寿命提高；2000—2010年，各县也呈现相同模式。然而，从2010年到2019年，各州和各县在继续变得更加富裕的同时，预期寿命却停滞或下降。曲线向右移动而未向上移动，且斜率变得更陡，这表明出现了脱钩与分化：随着时间推移，总体资源的增加不再带来广泛的寿命提升；而且在任一给定年份，按收入划分的预期寿命不平等均有所扩大。采用大衰退前后的其他时间锚点，以及以教育替代收入后，这些模式依然稳健；它们也见于不同性别和种族群体。县级分解结果总体上与如下观点一致：寿命下降源于各群体普遍面临的社会状况恶化，这可能解释了普雷斯顿曲线的逆转。总体而言，我们表明，近期美国死亡率危机揭示了将总体资源转化为寿命增益的能力正在减弱，且其中的不平等日益加剧。我们认为，近期美国死亡率危机不仅可以被理解为关于特定死亡原因的故事，也可以被理解为制度与社会转化能力减弱的表现。
Abstract
U.S. life expectancy stagnated and declined in the 2010s despite continued growth in real per capita income. We use Preston curves to characterize this pattern as a change in the relationship between income and longevity. Using state-level data from 1980 to 2019 and county-level data from 2000 to 2019, we estimate population-weighted Preston curves relating life expectancy to logged real per capita income. From 1980 to 2010, U.S. states followed the classic Preston curve pattern: rising income was accompanied by rising life expectancy. Counties followed the same pattern from 2000 to 2010. From 2010 to 2019, however, states and counties continued to become richer while life expectancy stagnated or declined. The curves shifted right without shifting up and became steeper, indicating decoupling and divergence: increases in aggregate resources over time no longer produced broad longevity gains, and, in any given year, inequality in life expectancy by income grew. These patterns are robust to alternative temporal anchors around the Great Recession and to substituting education for income. They also appear across sex and racial groups. County-level decompositions are broadly consistent with arguments that longevity has fallen due to widely shared exposures to social deterioration, which may account for the Preston curve reversal. Collectively, we show that the recent U.S. mortality crisis reveals a weakening—and growing inequality—in the conversion of aggregate resources into longevity gains. We conclude that the recent U.S. mortality crisis could be understood not only as a story about particular causes of death, but also as a weakening of institutional and social translation.