"Why does Costa Rica outperform the United States in life expectancy?  A tale of two inequality gradients"

Abstract: Costa Rica is among the few low or middle income countries with high quality adult vital statistics mortality data. We link these mortality records with census data to create a Costa Rican National Longitudinal Mortality Study, and compare adult mortality patterns to those in the United States. We find that mortality in the U.S. is 18% higher than in Costa Rica among adult men and 10% higher among middle-aged women, despite the several times higher income and health expenditures of the U.S. The U.S.’s underperformance is strongly linked to its much steeper socioeconomic (SES) gradients in health. Although the highest SES quartile in the U.S. has better mortality than the highest quartile in Costa Rica, U.S. mortality in its lowest quartile is markedly worse than in Costa Rica’s lowest quartile. Further examination of cause-specific mortality and risk factors suggest that these patterns are strongly related to behaviors leading to lung cancer and heart disease.

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