Examining Variation in Life Expectancy Estimates by ZIP Code Tabulation Area (ZCTA) in Hawaii's Four Main Counties, 2008–2012

Evidence shows that a person’s ZIP Code can affect his or her health. Health disparities are often geographically concentrated. For example, areas that lack sidewalks and safe places to exercise have lower levels of physical activity and higher rates of obesity than areas that have these features. Neighborhoods with poor access to fresh fruits and vegetables and a high density of fast food restaurants have higher rates of obesity than neighborhoods with good access and a low density. Areas with poor access to primary health care, compared with areas with good access, have lower levels of use of preventive health services and a higher burden of chronic disease. Geographic areas with a constellation of risk factors, including those related to the social determinants of health, can lead to disproportionately poor health outcomes (1). Visualizing the distribution of health outcomes at small geographic scales, such as neighborhoods and ZIP codes, is therefore critical; using subcounty geographic units helps identify neighborhoods with the greatest need for intervention. Life expectancy estimates are often used to compare population health across geographic regions because life expectancy is understood by the public, has well-established methodologies, and is influenced by many factors. Historically, Hawai`i has had the highest life expectancy of any state (2). By county, Honolulu County has the highest life expectancy in Hawai`i (3); to date, no subcounty life expectancy estimates for Hawai`i have been published. We aimed to elucidate variation in life expectancy by ZIP Code Tabulation Area (ZCTA) across Hawai`i.