American Women See Their Life Expectancies Contract

In a surprising finding, women in many counties throughout the United States are dying at younger ages than they did a generation ago, reversing nearly 100 years of progress in public health and emphasizing the rising toll of smoking and obesity and high blood pressure.  Some communities still have life expectancies as long as any in the world.  But over the last 10 years, the nation has experienced a growing gap between the most and least healthy places to live.  In some parts of the United States, men and women are dying younger than their counterparts in Syria, Panama and Vietnam.

In general, the United States is falling further behind other industrialized nations, many of which have also made greater strides in reducing preventable deaths.  In 737 U.S. counties, life expectancies for women fell between 1997 and 2007.  Declining life expectancies in a developed nation are rare.  Setbacks of this kind have not been seen since the Spanish influenza epidemic of 1918, according to demographers.

“There are just lots of places where things are getting worse,” said Dr. Christopher Murray, director of the Institute for Health Metrics and Evaluation at the University of Washington, which led the research.  “We’re not keeping up.  There’s really no reason we can’t keep pace with those other countries.  We spend more on health care.  We have the best health research in the world.  That was a real shock.”

In general, life expectancy in the United States rose 4.3 years for men and 2.4 years for women between 1987 and 2007, but other nations have seen their numbers rise even more.  Four years ago, life expectancy for American women, at 80.8 years, ranked 33rd in the world.  The life expectancy for American men, at 75.6 years, ranked 36th.  The comparison between individual American counties and other nations may not be entirely fair because the formula used for other countries creates “an unusually long-lived frame of reference compared to the U.S.,” said S. Jay Olshansky, a professor of public health and senior research scientist with the Center on Aging at the University of Illinois at Chicago.  “It would have made more sense to compare U.S. county life expectancies with county equivalents in other countries.”

The growing gulf between the healthiest and least healthy populations is partly due to wealth.  Part of the gap can be attributed to cultural norms and differences in public health efforts, according to the researchers.  Communities with large immigrant populations — Southern California is one example — fared far better than average despite relatively high poverty rates.  The worst-performing counties were primarily in Appalachia, the deep South and the lower Midwest.  In those locations, women died as much as 12 months earlier in 2007 as compared to 10 years earlier.  Life expectancy for women slipped 2 ½  years in Madison County, MS, which recorded the highest decline.  A crucial finding is that “inequality appears to be growing in the U.S.,” said Eileen Crimmins, a gerontologist at the University of Southern California who also co-chaired the 2011 National Academies panel on life expectancies.  “We are different than other countries.”  Researchers found substantially fewer geographic disparities in Great Britain, Canada and Japan, for example.

As an example, Holmes County, MS, has the lowest life expectancy in the country.  A woman in this county can expect to live 73.5 years, the average life span that women in the healthiest nations had in 1957. 

To compare American life spans rank internationally, researchers from the U.S. and the U.K. compared life expectancies in the U.S. to a moving average of those in the 10 nations with the lowest death rates, a group that includes other affluent countries such as Switzerland, Australia, Japan, and Canada. From 2000 to 2007, the researchers determined that more than 80 percent of American counties fell below the life-expectancy bar set by that group of leading nations, even though the U.S. spends more on healthcare per capita than any other country in the world.  Given increasing life expectancy in countries like Canada and Australia, the widespread pattern of decline in the U.S. is “a huge surprise,” according to Dr. Murray.  “We all know from previous work that there are great (life expectancy) disparities in the U.S. across counties, but I sort of expected that when we compared progress in counties to what’s possible that we would be keeping up,” Murray said.  “And we’re not.  That’s a staggering statistic. If healthcare reform is to be a success, it should be doing something about our health.  Reversing this trend is essentially what reform should be judged against.”

“The increase in obesity rates are certainly an issue, since being overweight or obese can influence a whole variety of potentially serious and even fatal diseases — coronary artery disease, diabetes, cerebrovascular disease, chronic renal disease, osteoarthritis to name just a few,” said Dr. Henry Black, clinical professor of internal medicine at New York University’s Langone School of Medicine.  “One can’t easily blame the recent recession for these data, since though we suspect that our citizens are postponing seeing a health care professional since the recession began, I doubt that would be a factor large enough to influence life expectancy this quickly.”

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