Life expectancy declines in some U.S. populations

Although life expectancy has been increasing in the U.S. for most people, there is a growing disparity in mortality depending on race, income and geography, according to a study published on Monday in the online journal PLoS Medicine, the New York Times reports.

For the study, lead author Majid Ezzati, an associate professor of international health at Harvard University, and colleagues analyzed life expectancy in all 3,141 U.S. counties from 1961 to 1999, the latest year for which data were available (Bakalar, New York Times, 4/22). The data were taken from the National Center for Health Statistics and the U.S. Census Bureau (AP/Long Island Newsday, 4/21).

Findings

The study found that for the nation as a whole, life expectancy increased by seven years among men and by six years among women (Russell, San Francisco Chronicle, 4/22). Life expectancy from 1961 to 1999 increased from 66.9 years to 74.1 years for men, and from 73.5 years to 79.6 years for women (Brown, Washington Post, 4/22).

However, the study found that in the last two decades of the millennium, 19% of women and 4% of men in the U.S. saw either no change or a decline in life expectancy (Kornblum, USA Today, 4/22). Researchers found that life expectancy for women declined by an average of 1.3 years from 1983 to 1999 in 180 counties, while men's life expectancy decline by 1.3 years in 11 counties (AP/Long Island Newsday, 4/21). According to the study, "The majority of these counties were in the Deep South, along the Mississippi River and in Appalachia, extending into the southern portion of the Midwest and into Texas" (Fox, Reuters/Boston Globe, 4/22).

When comparing the 2.5% of counties with the lowest life expectancies and the 2.5% of counties with the highest life expectancies, the difference in life expectancy was 11 years for men and 7.5 years for women in 1999, compared with nine years for men and 6.7 years for women in 1983 (New York Times, 4/22).

Causes

Ezzati said that race and poverty account for some of the disparity, but not all of it (USA Today, 4/22). According to the study, "Female mortality increased in a large number of counties, primarily because of chronic diseases related to smoking, overweight and obesity, and high blood pressure" (Reuters/Boston Globe, 4/22). Obesity-related illnesses, such as adult-onset diabetes and hypertension, also contributed to increases in male and female mortality. HIV/AIDS and homicide were significant factors in male life expectancy declines (San Francisco Chronicle, 4/22).

Researchers said that they do not believe access to health care led to all of the declines in life expectancy. Study co-author Christopher Murray, director of the University of Washington Institute for Health Metrics and Evaluation, said, "Even if everyone were insured, we'd still be seeing most of the pattern that we're seeing here" (Francis, Wall Street Journal, 4/22). The researchers said that race appears to be less of a factor than income in the disparity (Russell, San Francisco Chronicle, 4/22).

Comments

"What's driving the disparity is the worsening of the worst off," Ezzati said, adding, "In the U.S., there has always been a view, stated or unstated, that we can live with some inequality if everyone is getting better. This is the first sign that not everyone is getting better" (New York Times, 4/22). Ezzati said he hopes the study will be a catalyst to some "pretty serious discussion at the national, state and arguably county level" about how to combat disparities.

James Marks of the Robert Wood Johnson Foundation said, "These counties may be the canary in the coal mine [indicating] the deterioration in the U.S. health standings relative to the rest of the world" (USA Today, 4/22).

Murray said, "I think this is a harbinger. This is not going to be isolated to this set of counties, is my guess" (Washington Post, 4/22).

The study is available online.