Life expectancy is one of the most important and commonly cited indicators of population health — and in the United States, life expectancy is falling at a historic rate. According to the Centers for Disease Control and Prevention, life expectancy at birth declined by 1.5 years in 2020, the largest one-year drop since World War II. 

The CDC attributes the decline to the COVID-19 pandemic and 93,000 drug overdose deaths — an all-time one-year high. Homicide, diabetes, and liver disease were also contributing factors. Here is a look at the states with the most drug overdose deaths in 2020. 

Even before the pandemic, there were parts of the country where life expectancy at birth was far lower than the national average — in some cases by five years or more. 

Using data from County Health Rankings & Roadmaps, a Robert Wood Johnson Foundation and University of Wisconsin Population Health Institute joint program, 24/7 Tempo identified the 50 U.S. metro areas with the shortest average life expectancy at birth. Life expectancy figures are averages for the years 2017 through 2019, the most recent period for which metro-level data is available.

Among the metro areas on this list, average life expectancy at birth ranges from 75.9 years down to less than 73 years — compared to the national average of 79.2 years. The vast majority of the metro areas on this list are located in the South, including seven in Alabama alone. 

Variations in life expectancy are tied to a number of both economic and behavioral factors. For example, tobacco use is the leading cause of preventable death in the U.S., and in every metro area on this list, the share of adults who smoke is above the 16.6% national average. Here is a look at the American cities where the most people smoke. 

Income levels are also linked to life expectancy. Poverty, for example, presents challenges and stressors that can take a cumulative toll on both physical and mental health. Additionally, lower-income Americans are less able to afford adequate health care or a range of healthy options related to diet and lifestyle. Recent studies have shown that life expectancy among the wealthiest 1% of Americans exceeds that of the poorest 1% by well over a decade. In all but a few metro areas on this list, the poverty rate exceeds the 12.3% national average.

Click here to see the metros with the shortest life expectancy
Click here to read our detailed methodology