States with higher taxes and more government expenditures tend to have lower mortality rates among middle-aged Americans, according to new research published in PLOS One.

“I am interested because longevity in the USA is stalling and falling behind dozens of other countries. This is not American exceptionalism. It is American mediocrity,” said study author Todd MacKenzie, a professor of biostatistics at Dartmouth College.

The researchers analyzed data from the Tax Foundation, the Tax Policy Center, and the Center for Disease Control to investigate the relationship between state tax burden, state expenditures per capita, and mortality rates between the years of 2006 and 2015.

The study was limited to middle-aged Americans (ages 40 to 64) because those over 65 have access to Medicare, a form of federally-funded universal health care, which could impact the results.

An increase of one percentage point in state tax burden was associated with about a six percent reduction in mortality, after adjusting for sex, age, and race, but was associated with about a 1 percent reduction with further adjustment for state income and education levels.

The findings indicate that “communities, e.g. states, that pool their resources and work as a team have better results,” MacKenzie said.

“But it is not clear how long it takes for increases in social welfare, education and other expenditures to take effect. Is it immediate, as it may be in the case of hospital care, or does it have a small but long-lasting effect as may be the case with education?” he added.

The study, “Middle-aged death and taxes in the USA: Association of state tax burden and expenditures in 2005 with survival from 2006 to 2015“, was authored by Todd A. MacKenzie, Jason Houle, Steven Jiang, and Tracy Onega.