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

nations.

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."