From Our 2008 Archives

Death Gap: Life Expectancy Falls for Some

Analysis Shows Life Expectancy in U.S. Down or Stagnant for 1 in 5 Women, 1 in 20 Men

By Daniel J. DeNoon
WebMD Health News

Reviewed By Louise Chang, MD

April 21, 2008 — Call it the death gap. Some Americans are living longer than ever before. But many aren't just missing out on increased life expectancy, they're dying sooner.

How many? For one in five U.S. women and one in 20 U.S. men, life expectancy is either sinking or stagnant. Most of these women and men live in the Deep South, along the Mississippi river and down into the Delta, or in Appalachia extending into the southern part of the Midwest and into Texas.

The findings come from a county-by-county analysis of life-expectancy data for every year between 1961 and 1999 (the latest year for which data was available) by Harvard researcher Majid Ezzati, PhD, and colleagues.

"In the U.S., people like to say that the rising tide lifts everybody, just some more than others," Ezzati tells WebMD. "But there are many Americans not being lifted by the tide, and some are actually sinking below it."

The study shows that from 1961 to 1983, no county in America had a decline in life expectancy. By 1983, life expectancy for most Americans was tightly clustered around the national average. After that time, a death gap opened — and widened.

"Something happened in the '80s and health disparities started going up," Ezzati says. "The part we weren't expecting was not just that some people stopped getting better, but that some got worse off — whereas the better-off continued to get better."

Before 1983, life expectancy gains occurred for all Americans, regardless of income, and cross-county disparities declined. This broad improvement was due to major reductions in death due to heart and vascular disease.

After 1983, many counties continued to show improvement, while others saw a stagnation or even decline ina life expectancy. In general, greater income meant greater life expectancy, but income wasn't the whole story. Ezzati says his team previously found that low-income white men in the northern plains states lived several years longer than did low-income white men in Appalachian states.Accounting for race did not appear to influence the findings either.

"This tells us the problem is something about how health policy and public health systems are functioning in different parts of the country, apart from the economic or racial disparities," he says.

Death Gap Greater for Women

The death gap was greatest for women. After 1983, life expectancy declined in 180 U.S. counties for women and in 11 counties for men. It remained stagnant in an additional 783 counties for women and in an additional 48 counties for men.

In the counties where life expectancy declined or failed to keep improving, there were increased deaths from causes attributable to obesity, smoking, and high blood pressure.

Rita F. Redberg, MD, director of Women's Cardiovascular Services at the University of California, San Francisco, says the findings are unsettling.

"It is disturbing, in a time when we feel like we know more and we should have better health, that the trends don't show everyone is benefitting," Redberg tells WebMD.

Redberg says much of the problem can be traced to the rise in obesity and to continued smoking.

"We see higher rates of unhealthy behaviors in those who are stressed," she says. "It is really a concern, with the current downturn in the economy, that people are going to be more stressed and the poorer will get poorer and health behaviors are going to get worse."

Ezzati says knowing exactly where health problems are worst should help focus public health efforts.

"If you just look at income disparities, it is hard to know where to start," he says. "But now we are looking at specific geographic areas. We hope it will give those states and regions some place to start and a way to monitor them over time to see how they are doing."

Redberg notes that obesity and tobacco control are national problems and calls for increased funding of the CDC's public health efforts and of education.

"Every time a county's education budget gets cut, it is physical education and nutrition programs that are the first to go," she says. "We really need to emphasize healthy diet and exercise — because we know that these mortality problems are related to obesity."

Ezzati and colleagues report their findings in the April issue of the journal PloS Medicine.

SOURCES: Ezzati, M. PloS Medicine, April 2008; vol 5: p e66. Majid Ezzati, PhD, associate professor of international health, Harvard School of Public Health, Boston. Rita F. Redberg, MD, professor of medicine and director of Women's Cardiovascular Services, University of California, San Francisco.

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