American babies born today may have shorter lifespans than their parents — depending on where they live in the U.S., according to a new study published in JAMA Internal Medicine.

Researchers from the Institute for Health Metrics and Evaluation at the University of Washington analyzed life expectancies for U.S. counties from 1980 to 2014. They found that “the gap between counties with the highest and lowest life expectancies is larger now” than it was in 1980, according to the study’s press release. In 2014, the gap was greater than 20 years.

People living in Oglala Lakota County, South Dakota (which includes the Pine Ridge Native American Reservation) had a life expectancy of 66.8 years in 2014, which is comparable to people living in Sudan (67.2 years), India (66.9 years) and Iraq (67.7 years).

On the other hand, many counties in Colorado — like Summit County and Pitkin County — had life expectancies around 86 years, which is even higher than countries with the highest life expectancies in the world like Andorra (84.8 years) and Iceland (83.3 years).

These findings suggest that location can have a huge impact on health.

The researchers chose to look at lifespan on a county-by-county basis because national estimates obscure “the massive difference that exist at the local level,” lead author Laura Dwyer-Lindgren, a researcher at IHME, said in the press release. She adds that “risk factors like obesity, lack of exercise, high blood pressure, and smoking explain a large portion of the variation in lifespans, but so do socioeconomic factors like race, education, and income.”

For a wealthy country that spends so much on health care, this gap is “unacceptable,” Dr. Christopher Murray, director of IHME, said in the press release. For context, the U.S. spent $9,237 on healthcare per person in 2014. Japan, which has one of the highest life expectancies in the world at 83.1 years, spent $3,816 per person the same year.

The new findings “demonstrate an urgent imperative ” to create policy change, according to Dr. Ali Mokdad, an author on the study and leader of U.S. country health research at IHME. He added that “federal, state and local health departments need to invest in programs that work and engage their communities in disease prevention and health promotion.”

Read the press release here.

Originally published at