NUR 8200 Module 1 Population Health Measures Paper: Income, Life Expectancy and Midlife Mortality in a County Profile Example

A Fourteen-Year Gap: Reading Life Expectancy, Income and Midlife Deaths to Set Population Health Priorities for a New Jersey County

Student Name

Doctor of Nursing Practice, Thomas Edison State University

NUR-8200: Integrating and Evaluating Population Health in Advanced Nursing Practice

Mentor Name

Month Day, Year

A Fourteen-Year Gap: Reading Life Expectancy, Income and Midlife Deaths to Set Population Health Priorities for a New Jersey County

Purpose

This paper is written by an invented DNP-prepared director of population health at a hospital system that serves Warren County, a mixed rural and small-town county in northwest New Jersey with about 110,000 residents. Because it is a nonprofit, every third year the system publishes a community needs study and picks the problems its community benefit dollars will target. The director's task is to profile the county's health using sound epidemiologic measures, place local findings in national context and recommend where to act.

Data come from three places. State vital records supply deaths by cause, age, sex, race and census tract for the past five years. The state's behavioral risk survey and the hospital system's own records supply estimates of diabetes, hypertension and smoking. Census estimates supply population counts and income by tract. Each source has gaps: the survey undercounts people without phones, and the hospital's records see only its own patients. The paper names those gaps rather than hiding them, because a board that trusts the numbers needs to know their limits.

Reading the Measures

Population health starts with measures that can be compared fairly. A crude death rate counts deaths per 100,000 residents, but an older county will have more deaths simply because of age, so age-adjusted rates are used to compare counties and groups. Life expectancy summarizes a population's death rates at every age into a single figure. Years of potential life lost before 75 weight deaths by how early they occur, highlighting overdoses, suicides and injuries that kill younger adults. Incidence counts new cases over time, while prevalence counts all existing cases at one time, and the paper uses each where it fits.

Income and Life Expectancy

Chetty et al. (2016) joined 1.4 billion anonymized tax returns filed between 1999 and 2014 to Social Security death files and estimated remaining life at 40 for every income percentile, separately for men and women and for local labor markets. Higher income was linked with longer life across the entire income distribution. Comparing the top and bottom percentiles of income, men differed by 14.6 years of expected life and women by 10.1. Gains in life expectancy over the period went mostly to higher-income Americans, and for poorer Americans, how long they lived depended a great deal on where they lived, being longer in places with more educated, higher-income residents and more local government spending, and correlated with health behaviors such as smoking.

For Warren County, the director compares census tracts. Using state vital records, the age-adjusted death rate in the three lowest-income tracts is 38 percent higher than in the three highest-income tracts, and estimated life expectancy differs by about seven years. That gap is smaller than the national extremes but large for a single county.

The tract comparison matters because county averages hide it. Warren County as a whole looks close to the state on most measures, which could lead the board to conclude that nothing is unusual. Only when the three poorest tracts, two of them in Phillipsburg and one in a rural township, are separated from the rest does the gap appear. The same is true for overdose deaths, which cluster in two towns. A profile that reports only the county total would send community benefit dollars to the wrong places.

Rising Deaths in Midlife

Case and Deaton (2015) showed that death rates for white non-Hispanic Americans in their late forties and early fifties went up from 1999 through 2013, undoing decades of gains and unique among wealthy countries. Over the same years, Black and Hispanic adults in midlife and all groups over 65 continued to see falling death rates during that period. Overdoses and alcohol poisoning, suicide and cirrhosis accounted for most of the white midlife increase, and people without a college degree bore the brunt. Midlife health and mental health also worsened.

Woolf and Schoomaker (2019) extended the picture: U.S. Americans gained about nine years of expected life between 1959 and 2016, reaching 78.9, before three straight annual declines that began after 2014. Among adults 25 to 64, the death rate climbed between 2010 and 2017, from 328.5 to 348.2 deaths for every 100,000 people, and by 2014 the climb showed up in every racial group, fed by overdoses, drinking, suicide and a long list of organ failures. The largest relative increases were in New England and the Ohio Valley.

The County's Profile

Warren County's data echo these patterns. The county's age-adjusted overdose death rate rose 2.6-fold over a decade, and overdoses, suicides and alcohol-related liver deaths account for the largest share of years of potential life lost. Midlife deaths have risen among residents aged 25 to 64, especially in the county's former manufacturing towns. Adult diabetes prevalence is about 10 percent, and hypertension is common and often uncontrolled. Death rates and these conditions are highest in the lowest-income tracts.

Priorities

The paper recommends three priorities. First, deaths of despair: expand medication for opioid use disorder through the emergency department and primary care, naloxone distribution and suicide prevention, including firearm safety counseling, focused on the former manufacturing towns. Second, cardiometabolic disease: improve hypertension control and diabetes prevention in the lowest-income tracts. Third, measurement: build a tract-level dashboard of age-adjusted rates updated each year so that progress and gaps are visible to the board and community partners.

Each priority is checked against three questions the board must answer: how large is the burden, how unequal is it across the county, and is there an intervention with evidence that the system can deliver? Overdose and suicide score highest on burden measured in early deaths. Cardiometabolic disease scores highest on the number of people affected and on the strength of evidence for programs such as hypertension registries and diabetes prevention. Measurement scores high because without it the board cannot tell whether either of the first two priorities is working.

Limits

Tract-level rates are unstable when deaths are few, so three-year averages are used. National studies describe associations, not causes; income is linked with longer life, but the profile cannot say which local factors would close the gap. The paper uses national findings to guide questions, and the dashboard will test whether local programs change the measures.

Conclusion

Life expectancy in the United States differs by 14.6 years between the richest and poorest men, midlife deaths rose among white Americans, and national life expectancy fell three years running after 2014. Warren County's own measures show a seven-year gap by income tract, rising overdose and suicide deaths and a burden of cardiometabolic disease in its poorest areas. Explaining the measures clearly, the profile recommends three priorities and a dashboard to track them.

References

Case, A., & Deaton, A. (2015). Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century. Proceedings of the National Academy of Sciences, 112(49), 15078-15083. https://doi.org/10.1073/pnas.1518393112

Chetty, R., Stepner, M., Abraham, S., Lin, S., Scuderi, B., Turner, N., Bergeron, A., & Cutler, D. (2016). The association between income and life expectancy in the United States, 2001-2014. JAMA, 315(16), 1750-1766. https://doi.org/10.1001/jama.2016.4226

Woolf, S. H., & Schoomaker, H. (2019). Life expectancy and mortality rates in the United States, 1959-2017. JAMA, 322(20), 1996-2016. https://doi.org/10.1001/jama.2019.16932