US life expectancy varies by more than 20 years from county to county.

According to the study from the Institute for Health Metrics and Evaluation (IHME) at the University of Washington in Seattle, “The gap between counties with the highest and lowest life expectancies is larger now than it was back in 1980 – a more than a 20-year difference in 2014 – highlighting massive and growing inequality in the health of Americans.”

For example, in Owsley County, Kentucky, one of the poorest counties, life expectancy fell from 72.4 in 1980 to 70.2 in 2014, researchers said.

In some counties, such as Oglala Lakota County, South Dakota, which is home of a Native American reservation, the life expectancy is lower than that of Iraq. The county’s life expectancy was 66.8 in 2014 compared to 67.7 in Iraq.

Some of the counties with the highest life expectancy were in the state of Colorado. Summit County topped the list at 86.8 years, followed by Pitkin County (86.5) and Eagle County (85.9), the study showed. These were better than the country of Andorra, which has the highest life expectancy in the world at 84.8.

“These findings demonstrate an urgent imperative, that policy changes at all levels are gravely needed to reduce inequality in the health of Americans,” said Dr. Ali Mokdad, an author on the study. “Federal, state, and local health departments need to invest in programs that work and engage their communities in disease prevention and health promotion.”

More money doesn’t appear to buy more life expectancy, the study showed.

The U.S. invests more per person on health than many developed countries, spending $9,237 per person in 2014. That compares to $4,032 spent by Australia with a life expectancy of 82.3 and Japan, which spent $3,816 and has one of the highest life expectancy in the world at 83.1.

“The inequality in health in the United States – a country that spends more on health care than any other – is unacceptable,” said Dr. Christopher Murray, the IHME director. “Every American, regardless of where they live or their background, deserves to live a long and healthy life. If we allow trends to continue as they are, the gap will only widen between counties.”

Separately, all counties saw deaths before the age of 5 drop and differences among counties with the highest and lowest levels of under-5 mortality narrowed.

“Looking at life expectancy on a national level masks the massive differences that exist at the local level, especially in a country as diverse as the United States,” said lead author Laura Dwyer-Lindgren, a researcher at IHME. “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.”

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