Subnational Life Expectancy Disparities in Low and Middle-Income Countries: Measurement and Determinants

This article constructs new indicators of subnational disparities in life expectancy for up to 101 low- and middle-income countries (LMICs) from 2000 to 2021, offering critical insights into health inequalities within countries. The findings reveal that subnational disparities in life expectancy are markedly higher in Sub-Saharan Africa compared to other LMIC world regions throughout the period. Moreover, while subnational disparities in life expectancy have decreased in most regions, Sub-Saharan Africa stands out as an exception, with persistently high disparities alongside rising average life expectancy. A country-level analysis indicates that subnational disparities in life expectancy declined in 61 countries, increased in 30, and remained unchanged in 10. A gender-specific analysis highlights that, while women generally live longer than men across all countries studied, subnational life expectancy disparities are greater for women. Sub-Saharan Africa exhibits the largest disparities in female life expectancy and the widest gap in disparities between men and women. Regression analysis identifies factors influencing life expectancy disparities. Variables such as good governance and public health spending help reduce disparities, while decentralization, larger country size, geographic diversity and ethnic fractionalization tend to increase them. Subnational disparities in income and education emerge as the most significant drivers of life expectancy inequalities, with disparities in female education playing a particularly critical role. These findings emphasize the need for targeted policies aimed at reducing subnational education inequalities, particularly for women, as a key strategy for addressing life expectancy disparities.