While the poor are at a disadvantage, the odds of living a longer life are better for less affluent people in certain parts of the country than others. In an accompanying editorial in JAMA, the Journal of the American Medical Association, Dr. J. Michael McGinnis of the National Academy of Medicine wrote that "community is powerfully associated with life expectancy." "I would have thought these very expensive big cities, like New York City and San Francisco, for most poor would be stressful and would be places with poor health among the poor, but that's not at all what these data suggest," Chetty said. The research, based on the tax and Social Security records of everyone in America between 1999 and 2014 with a valid Social Security number and earnings, gives the most precise look yet at a pattern that has long troubled health experts: In America, the richer you are, the longer you live. "A lot of variations seem to be driven by health behaviors," he said, even when there is access to health care. The gap in life expectancy between the richest 1% and poorest 1% of individuals was 14.6 years (95% CI, 14.4 to 14.8 years) for men and 10.1 years (95% CI, 9.9 to 10.3 years) for women. Between 2001 and 2014, life expectancy increased by 2.34 years for men and 2.91 years for women in the top 5% of the income distribution, but by only 0.32 years for men and 0.04 years for women in the bottom 5% (P < .001 for the differences for both sexes). Changes in life expectancy between 2001 and 2014 ranged from gains of more than 4 years to losses of more than 2 years across areas. What's driving early death 
 
 Across the country, shorter life expectancies for the poor, measured at age 40, were most closely correlated with places that had lower exercise rates and higher rates of smoking and obesity. Some of the results also align with the findings of a recent Washington Post analysis of mortality rates that found deteriorating health, particularly for whites, outside big cities in rural America where unhealthy behaviors are on the rise. For example, life expectancy is on the rise for the poor in Birmingham, Alabama, but in Tampa, Florida, the poor are on the downslide when it comes to life expectancy. Main Outcomes and Measures Relationship between income and life expectancy; trends in life expectancy by income group; geographic variation in life expectancy levels and trends by income group; and factors associated with differences in life expectancy across areas. Those two cities were among the first to restrict tobacco and ban trans fats, for example. The poor have a much higher life expectancy in prosperous urban areas like San Francisco and New York City, said Chetty. But in the new research, New York City ranks as the place where the poor have the longest life expectancies, ahead of all the California cities.
– A new study says America's wealthy live longer than its poor, which is hardly surprising. But it also says low-income people live longer in certain places—like affluent cities including New York and San Francisco, NPR reports. Why isn't clear, but lead study author Raj Chetty of Stanford University was surprised. "I would have thought these very expensive big cities ... for most poor would be stressful and would be places with poor health among the poor, but that's not at all what these data suggest," he tells CBS News. Media reports note that local health policies may have an effect (New York City and San Francisco banned trans fats and restricted tobacco use early on), and Chetty agrees that "thinking about policies that change health behaviors at a local level is likely to be important." The study's other findings highlight the crushing effects of inequality. By analyzing over a billion tax and Social Security records, the Stanford researchers found that the richest 1% of men live roughly 15 years longer than the poorest 1% of men. And in the 21st century, life expectancy has risen 2.3 years for the richest 5% of men and 3 years for the richest 5% of women, while the poorest 5% of Americans saw hardly any improvement. An overall three-year boost in lifespan, the Washington Post notes, is about the difference we'd expect to see from curing cancer. As Chetty puts it, "The poorest men in America have a life expectancy comparable to those living in Sudan and Pakistan." (One study says that eating like the Japanese will make you live longer.)