Life expectancy has long been growing steadily for most
Americans. But it has not for a significant minority, according
to a new study, which finds a growing disparity in mortality
depending on race, income and geography.
The study, published Monday in the online journal PLoS, analyzed
life expectancy in all 3,141 counties in the United States from
1961 to 1999, the latest year for which complete data have been
released by the National Center for Health Statistics. Although
life span has generally increased since 1961, the authors
reported, it began to level off or even decline in the 1980s for
4 percent of men and 19 percent of women.
"It's very troubling that there are parts of the wealthiest
country in the world, with the highest health spending in the
world, where health is getting worse," said Majid Ezzati, the
lead author and an associate professor of international health at
Harvard. It is a phenomenon, he added, "unheard of in any other
Counties with significant declines were concentrated in
Appalachia, the Southeast, Texas, the southern Midwest and along
the Mississippi River. Life expectancy increases were mainly in
the Northeast and on the Pacific Coast.
The researchers also compared the 2.5 percent of counties with
the lowest life expectancies and the 2.5 percent with the
highest. The disparity between those two groups rose to 11 years
for men in 1999, from 9 years in 1983, and to 7.5 years from 6.7
The study found that from 1961 to 1983, there was little
difference in average income for the counties where life
expectancy rose at rates above and below the mean. But after
1983, life span rose with wealth. Race may also be a factor. In
counties where life expectancy declined, the proportion of
African-Americans was higher.
From 1961 to 1983, no county had a statistically significant
decline in life expectancy, and reductions in cardiovascular
disease led to a generally increasing length of life for both
sexes. But after 1983, life expectancy declined an average of 1.3
years in 11 counties for men, and in 180 counties for women.
This lack of progress among the worst off was caused by a slowing
or halt of reductions in cardiovascular disease, combined with
increases in lung cancer and diabetes for women and in H.I.V.
infection and homicide for men.
This rise in mortality for chronic diseases runs counter to
trends in other developed countries, and the geographical
differences are consistent with regional trends in smoking, high
blood pressure and obesity. Dr. Ezzati speculates that data after
1999 will show more decreases in life span for the worst-off
women. He expects to see a slight increase for men, with improved
treatment for H.I.V. and AIDS.
"What's driving the disparity is the worsening of the worst off,"
Dr. Ezzati said. "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."