WASHINGTON - New government research has found "large and
growing" disparities in life expectancy for richer and poorer
Americans, paralleling the growth of income inequality in the
last two decades.
Life expectancy for the nation as a whole has increased, the
researchers said, but affluent people have experienced greater
gains, and this, in turn, has caused a widening gap.
One of the researchers, Gopal K. Singh, a demographer at the
Department of Health and Human Services, said "the growing
inequalities in life expectancy" mirrored trends in infant
mortality and in death from heart disease and certain cancers.
The gaps have been increasing despite efforts by the federal
government to reduce them. One of the top goals of "Healthy
People 2010," an official statement of national health objectives
issued in 2000, is to "eliminate health disparities among
different segments of the population," including higher- and
lower-income groups and people of different racial and ethnic
Dr. Singh said last week that federal officials had found
"widening socioeconomic inequalities in life expectancy" at birth
and at every age level.
He and another researcher, Mohammad Siahpush, a professor at the
University of Nebraska Medical Center in Omaha, developed an
index to measure social and economic conditions in every county,
using census data on education, income, poverty, housing and
other factors. Counties were then classified into 10 groups of
equal population size.
In 1980-82, Dr. Singh said, people in the most affluent group
could expect to live 2.8 years longer than people in the most
deprived group (75.8 versus 73 years). By 1998-2000, the
difference in life expectancy had increased to 4.5 years (79.2
versus 74.7 years), and it continues to grow, he said.
After 20 years, the lowest socioeconomic group lagged further
behind the most affluent, Dr. Singh said, noting that "life
expectancy was higher for the most affluent in 1980 than for the
most deprived group in 2000."
"If you look at the extremes in 2000," Dr. Singh said, "men in
the most deprived counties had 10 years' shorter life expectancy
than women in the most affluent counties (71.5 years versus 81.3
years)." The difference between poor black men and affluent white
women was more than 14 years (66.9 years vs. 81.1 years).
The Democratic candidates for president, Senators Hillary Rodham
Clinton of New York and Barack Obama of Illinois, have championed
legislation to reduce such disparities, as have some Republicans,
like Senator Thad Cochran of Mississippi.
Peter R. Orszag, director of the Congressional Budget Office,
said: "We have heard a lot about growing income inequality. There
has been much less attention paid to growing inequality in life
expectancy, which is really quite dramatic."
Life expectancy is the average number of years of life remaining
for people who have attained a given age.
While researchers do not agree on an explanation for the widening
gap, they have suggested many reasons, including these:
Doctors can detect and treat many forms of cancer and heart
disease because of advances in medical science and technology.
People who are affluent and better educated are more likely to
take advantage of these discoveries.
Smoking has declined more rapidly among people with greater
education and income.
Lower-income people are more likely to live in unsafe
neighborhoods, to engage in risky or unhealthy behavior and to
eat unhealthy food.
Lower-income people are less likely to have health insurance, so
they are less likely to receive checkups, screenings, diagnostic
tests, prescription drugs and other types of care.
Even among people who have insurance, many studies have
documented racial disparities.
In a recent report, the Department of Veterans Affairs found that
black patients "tend to receive less aggressive medical care than
whites" at its hospitals and clinics, in part because doctors
provide them with less information and see them as "less
appropriate candidates" for some types of surgery.
Some health economists contend that the disparities between rich
and poor inevitably widen as doctors make gains in treating the
major causes of death.
Nancy Krieger, a professor at the Harvard School of Public
Health, rejected that idea. Professor Krieger investigated
changes in the rate of premature mortality (dying before the age
of 65) and infant death from 1960 to 2002. She found that
inequities shrank from 1966 to 1980, but then widened.
"The recent trend of growing disparities in health status is not
inevitable," she said. "From 1966 to 1980, socioeconomic
disparities declined in tandem with a decline in mortality
The creation of Medicaid and Medicare, community health centers,
the "war on poverty" and the Civil Rights Act of 1964 all
probably contributed to the earlier narrowing of health
disparities, Professor Krieger said.
Robert E. Moffit, director of the Center for Health Policy
Studies at the conservative Heritage Foundation, said one reason
for the growing disparities might be "a very significant gap in
health literacy" - what people know about diet, exercise and
healthy lifestyles. Middle-class and upper-income people have
greater access to the huge amounts of health information on the
Internet, Mr. Moffit said.
Thomas P. Miller, a health economist at the American Enterprise
"People with more education tend to have a longer time horizon,"
Mr. Miller said. "They are more likely to look at the long-term
consequences of their health behavior. They are more assertive in
seeking out treatments and more likely to adhere to treatment
advice from physicians."
A recent study by Ellen R. Meara, a health economist at Harvard
Medical School, found that in the 1980s and 1990s, "virtually all
gains in life expectancy occurred among highly educated groups."
Trends in smoking explain a large part of the widening gap, she
said in an article this month in the journal Health Affairs.
Under federal law, officials must publish an annual report
tracking health disparities. In the fifth annual report, issued
this month, the Bush administration said, "Over all, disparities
in quality and access for minority groups and poor populations
have not been reduced" since the first report, in 2003.
The rate of new AIDS cases is still 10 times as high among blacks
as among whites, it said, and the proportion of black children
hospitalized for asthma is almost four times the rate for white
The Centers for Disease Control and Prevention reported last
month that heart attack survivors with higher levels of education
and income were much more likely to receive cardiac
rehabilitation care, which lowers the risk of future heart
problems. Likewise, it said, the odds of receiving tests for
colon cancer increase with a person's education and income.