When the gods dance...

Sunday, June 26, 2011

Life Expectancy in Most US Counties Falls Behind World's Healthiest Nations

Life Expectancy in Most US Counties Falls 
Behind World's Healthiest Nations


Study authors: Sandeep C Kulkarni, Alison Levin-Rector,
Majid Ezzati and Christopher JL Murray
Institute for Health Metrics and Evaluation
June 15, 2011

The most current county-level analysis finds large
disparities nationwide. Women fare worse than men, and
people in Appalachia, the Deep South, and Northern Texas
live the shortest lives.

While people in Japan, Canada, and other nations are
enjoying significant gains in life expectancy every
year, most counties within the United States are falling
behind, according to a new study by the Institute for
Health Metrics and Evaluation (IHME) at the University
of Washington. IHME researchers, in collaboration with
researchers at Imperial College London, found that
between 2000 and 2007, more than 80% of counties fell in
standing against the average of the 10 nations with the
best life expectancies in the world, known as the
international frontier.

"We are finally able to answer the question of how the
US fares in comparison to its peers globally," said Dr.
Christopher Murray, IHME Director and one of the paper's
co-authors. "Despite the fact that the US spends more
per capita than any other nation on health, eight out of
every 10 counties are not keeping pace in terms of
health outcomes. That's a staggering statistic."

The new study, Falling behind: life expectancy in US
counties from 2000 to 2007 in an international context,
was published June 15, 2011 in BioMed Central's open-
access journal Population Health Metrics. In conjunction
with the study, IHME is releasing a complete time series
for life expectancy from 1987 to 2007 for all counties,
the most up-to-date analysis available.

When compared to the international frontier for life
expectancy, US counties range from being 16 calendar
years ahead to more than 50 behind for women. For men,
the range is from 15 calendar years ahead to more than
50 calendar years behind. This means that some counties
have a life expectancy today that nations with the best
health outcomes had in 1957.

The researchers suggest that the relatively low life
expectancies in the US cannot be explained by the size
of the nation, racial diversity, or economics. Instead,
the authors point to high rates of obesity, tobacco use,
and other preventable risk factors for an early death as
the leading drivers of the gap between the US and other

Five counties in Mississippi have the lowest life
expectancies for women, all below 74.5 years, putting
them behind nations such as Honduras, El Salvador, and
Peru. Four of those counties, along with Humphreys
County, MS, have the lowest life expectancies for men,
all below 67 years, meaning they are behind Brazil,
Latvia, and the Philippines.

Women live the longest in Collier, FL, at 86 years on
average, better than France, Switzerland, and Spain. Men
live the longest in Fairfax County, VA, at 81.1 years,
which is higher than life expectancies in Japan and
Australia. Women are also living long lives in Teton,
Wyoming; San Mateo and Marin, California; and
Montgomery, Maryland. For men, long life spans also can
be found in Marin, California; Montgomery, Maryland;
Santa Clara, California; and Douglas, Colorado.

Nationwide, women fare more poorly than men. The
researchers found that women in 1,373 counties - about
40% of US counties - fell more than five years behind
the nations with the best life expectancies. Men in
about half as many counties - 661 total - fell that far.

Black men and women have lower life expectancies than
white men and women in all counties. Life expectancy for
black women ranges from 69.6 to 82.6 years, and for
black men, from 59.4 to 77.2 years. In both cases, no
counties are ahead of the international frontier, and
some are more than 50 years behind. The researchers were
not able to analyze other race categories because of low
population levels in many counties.

Change in life expectancy is so uneven that within some
states there is now a decade difference between the
counties with the longest lives and those with the
shortest. States such as Arizona, Florida, Virginia, and
Georgia have seen counties leap forward more than five
years from 1987 to 2007 while nearby counties stagnate
or even lose years of life expectancy. In Arizona, Yuma
County's average life expectancy for men increased 8.5
years, nearly twice the national average, while
neighboring La Paz County lost a full year of life
expectancy, the steepest drop nationwide. Nationally,
life expectancy increased 4.3 years for men and 2.4
years for women between 1987 and 2007.

"By creating this time series, which has never been
available at the county level, we hope states and
counties will be able to take targeted action," Dr.
Sandeep Kulkarni, an IHME research fellow and the
paper's lead author, said. "Counties in one part of the
state should not be benefiting from big increases in
life expectancy while other counties are actually seeing
life spans shrink."

The authors propose that state and local policymakers
use the life expectancy data and the county comparisons
to tailor strategies that will fit the dynamics of their
communities. This resonates with local policymakers,
such as Dr. David Fleming, Director of Public Health -
Seattle & King County.

"It's not the health care system that's having the
biggest impact on health; it's the community," Dr.
Fleming said. "The average person in the US spends one
hour annually in a physician's office unless they are
really sick. So until we start moving our interventions
out into the communities where people live, we are not
going to get ahead of these problems."

The Seattle & King County health department is
collaborating with IHME on an ambitious analysis of
health in King County, one of the largest studies of its
kind. Called the Monitoring Disparities in Chronic
Conditions (MDCC) Study, researchers are integrating
data from emergency medical services, hospital discharge
databases, pharmacy records, and other sources to
identify the biggest health challenges in King County.
They are surveying 9,000 people and taking blood samples
to analyze for a range of risk factors and diseases.

"We are building the evidence for focused interventions
that will make an impact locally," said Dr. Ali Mokdad,
Professor of Global Health at IHME, who is leading the
MDCC Study. "If we as a society are going to fund
programs to improve health, we must ensure that we are
measuring the impact, because these life expectancy
numbers show that what we have been doing up until now
clearly is not working."

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