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New York Times
Life Expectancy Is Declining in Some Pockets of the Country
Nicholas Bakalar
April 22, 2008
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 developed country."

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 in women.

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."



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