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There are striking disparities in how long an American is likely to live based on where they call home, and according to a new study, those gaps are only getting worse.

The analysis, published Monday in JAMA Internal Medicine, found that the county where you live can cut–or add–decades to your life expectancy. “It’s dramatic,” Christopher Murray, one of the study’s researchers, told NPR on Monday.

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The study found that people in counties with the highest life expectancies can live to be about 87. On the other end of the spectrum, people living in the counties with the lowest life expectancies only live to around 67, a gap of 20 years. Unsurprisingly, wealthy, well-educated areas like Marin County, CA, have significantly longer life expectancies, whereas people in the poorest areas lead shorter lives.

As an animation of the data shows in stark detail, certain counties, especially in North and South Dakota, had life expectancies that barely improved over the course of the study, which ran from 1980 to 2014. Those areas also mapped onto areas with high Native American populations, particularly those living on reservations, where the stunning disparities between Native Americans and other groups of Americans are well-documented.