April 22, 2008

Mortality Inequality: Life Expectancy Declines for Some U.S. Women

The Washington Post has a front-page story today that’s a shocker: Lfe expectancy for some U.S. women is on the decline, and the data points to a growing inequality between the best-off and worst-off counties. Here’s the rundown:

In nearly 1,000 counties that together are home to about 12 percent of the nation’s women, life expectancy is now shorter than it was in the early 1980s, according to a study published today.

The downward trend is evident in places in the Deep South, Appalachia, the lower Midwest and in one county in Maine. It is not limited to one race or ethnicity but it is more common in rural and low-income areas. The most dramatic change occurred in two areas in southwestern Virginia (Radford City and Pulaski County), where women’s life expectancy has decreased by more than five years since 1983.

The trend appears to be driven by increases in death from diabetes, lung cancer, emphysema and kidney failure. It reflects the long-term consequences of smoking, a habit that women took up in large numbers decades after men did, and the slowing of the historic decline in heart disease deaths.

It may also represent the leading edge of the obesity epidemic. If so, women’s life expectancy could decline broadly across the United States in coming years, ending a nearly unbroken rise that dates to the mid-1800s.

There was some decline noted for men, too, but the decline was smaller (affecting 4 percent of males) and limited to fewer areas of the country. According to researchers, higher HIV/AIDS and homicide deaths contributed substantially to the life expectancy decline for men, but this was not the case for women.

The news comes from this study (PDF) published in PLoS Medicine, an open-access journal of the Public Library of Science. The study is based on mortality statistics from the National Center for Health Statistics (NCHS) and population data from the U.S. Census, gathered for the years 1961-1999, the last year data was available from the NCHS.

Overall, the average life expectancy nationwide increased during that period from 66.9 years to 74.1 years for men, and from 73.5 years to 79.6 years for women. (It’s worthwhile noting, as this story does, that life expectancy is “not a direct measure of how long people live,” but is “a prediction of how long the average person would live if the death rates at the time of his or her birth lasted a lifetime.”)

Between 1961 to 1983, life expectancy kept going up everywhere, mostly because the death rate from heart attacks kept going down due to better prevention and improvements in medicine. But then researchers noticed a change:

By the early 1980s, however, the rapid gains were coming to an end. The low-hanging fruit on the tree of heart-attack prevention and treatment had been picked. Further strides tended to happen mostly in places where people were already healthy and long-lived.

As a consequence, the rise in longevity began to stagnate in places with the least-healthy people. In those counties, life expectancy increased by only one year (from 74.5 to 75.5) between 1983 and 1999, while in the healthiest places the life expectancy of women had reached 83.

It was during this interval that women’s life expectancy fell in nearly 1,000 counties. If one adds counties where it rose only insignificantly, then 19 percent of American women — nearly 1 in 5 — are now experiencing stagnating or falling life expectancy.

Precisely why these 1,000 counties are the most affected is something for further study. Christopher J.L. Murray, a physician and epidemiologist at the University of Washington who led the study, tells the Post that it “would be a reasonably obvious strategy” to target them for aggressive public health campaigns.

Campaigns are a positive step, but I wonder whether this news will spark more than well-intentioned programs. Addressing health inequalities in poor communities means addressing everything from access to medical care to access to grocery stores stocked with fresh fruit and vegetables. It means providing real economic opportunity.

Maybe the fact that the life expectancy decline is pretty much to the United States — save for some African countries stricken by the AIDS epidemic, or Russia following collapse of the Soviet Union — will make this country’s shocking health disparities an issue in the presidential campaign, right up there with, say, flag pins.


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