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<TITLE>Life Expectancy Drops for Some U.S. Women</TITLE>
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Life Expectancy Drops for Some U.S. Women<BR>
<BR>
Washington Post, April 22, 2008<BR>
<BR>
For the first time since the Spanish influenza of 1918, life <BR>
expectancy is falling for a significant number of American women.<BR>
<BR>
In nearly 1,000 counties that together are home to about 12 percent <BR>
of the nation's women, life expectancy is now shorter than it was in <BR>
the early 1980s, according to a study published today.<BR>
<BR>
The downward trend is evident in places in the Deep South, <BR>
Appalachia, the lower Midwest and in one county in Maine. It is not <BR>
limited to one race or ethnicity but it is more common in rural and <BR>
low-income areas. The most dramatic change occurred in two areas in <BR>
southwestern Virginia (Radford City and Pulaski County), where <BR>
women's life expectancy has decreased by more than five years since 1983.<BR>
<BR>
The trend appears to be driven by increases in death from diabetes, <BR>
lung cancer, emphysema and kidney failure. It reflects the long-term <BR>
consequences of smoking, a habit that women took up in large numbers <BR>
decades after men did, and the slowing of the historic decline in <BR>
heart disease deaths.<BR>
<BR>
It may also represent the leading edge of the obesity epidemic. If <BR>
so, women's life expectancy could decline broadly across the United <BR>
States in coming years, ending a nearly unbroken rise that dates to <BR>
the mid-1800s.<BR>
<BR>
"I think this is a harbinger. This is not going to be isolated to <BR>
this set of counties, is my guess," said Christopher J.L. Murray, a <BR>
physician and epidemiologist at the University of Washington who led <BR>
the study. It is being published in PLoS Medicine, an open-access <BR>
journal of the Public Library of Science.<BR>
<BR>
Said Elizabeth G. Nabel, director of the National Heart, Lung and <BR>
Blood Institute of the National Institutes of Health: "The data <BR>
demonstrate a very alarming and deeply concerning increase in health <BR>
disparities in the United States."<BR>
<BR>
The study found a smaller decline, in far fewer places, in the life <BR>
expectancy of men in this country. In all, longevity is declining for <BR>
about 4 percent of males.<BR>
<BR>
The phenomenon appears to be not only new but distinctly American.<BR>
<BR>
"If you look in Western Europe, Australia, Japan, New Zealand, we <BR>
don't see this," Murray said.<BR>
<BR>
About half of all deaths in the United States are attributable to a <BR>
small number of "modifiable" behaviors and exposures, such as <BR>
smoking, poor diet and lack of exercise. Although it is impossible to <BR>
know exactly what is going on in the 1,000 counties, Murray thinks it <BR>
"would be a reasonably obvious strategy" to target them for <BR>
aggressive public health campaigns.<BR>
<BR>
Life expectancy is not a direct measure of how long people live. <BR>
Instead, it is a prediction of how long the average person would live <BR>
if the death rates at the time of his or her birth lasted a lifetime.<BR>
<BR>
For that reason, life expectancy can dip or rise abruptly. The death <BR>
rate from the Spanish flu was so high, especially among the young, <BR>
that life expectancy fell by about seven years in 1918. But it <BR>
rebounded quickly when the epidemic was over.<BR>
<BR>
In general, though, it takes huge forces to drive down life <BR>
expectancy over longer periods. The AIDS epidemic has done so in some <BR>
African countries. In the early 1990s, the social disruption <BR>
following the collapse of the Soviet Union decreased life expectancy <BR>
of Russian men by six years and of women by three years -- an <BR>
unprecedented decline in a modern industrialized nation.<BR>
<BR>
In the study, Murray and collaborators at the Harvard School of <BR>
Public Health examined mortality and cause-of-death data for the <BR>
United States from 1961 through 1999. They divided the country into <BR>
2,068 units, including cities, counties or combinations of counties.<BR>
<BR>
Across that four-decade period, average life expectancy nationwide <BR>
increased from 66.9 years to 74.1 years for men, and from 73.5 years <BR>
to 79.6 years for women.<BR>
<BR>
>From 1961 to 1983, life expectancy went up everywhere for both <BR>
sexes. This was largely because the death rate from heart attacks, <BR>
which had been rising for half a century, began to fall in the late <BR>
1960s. There were two reasons.<BR>
<BR>
Huge numbers of people lowered their chances of having a heart attack <BR>
by modifying "risk factors," such as smoking, hypertension and high <BR>
cholesterol. Improvements in medicine -- coronary care units, use of <BR>
aspirin and beta-blocker drugs, and various surgical procedures -- <BR>
greatly increased survival in patients with heart disease. About <BR>
two-thirds of the longevity gained over the past four decades has <BR>
come from the decrease in cardiovascular deaths.<BR>
<BR>
These changes were so dramatic that even the poorest and least <BR>
healthy groups benefited. In fact, counties with low life expectancy <BR>
in 1961 had steeper rises over the next dozen years than counties <BR>
that started out with high life expectancy. Overall, the drop in <BR>
heart attack deaths more than offset rising mortality from cancer, <BR>
emphysema and diabetes during this period.<BR>
<BR>
By the early 1980s, however, the rapid gains were coming to an end. <BR>
The low-hanging fruit on the tree of heart-attack prevention and <BR>
treatment had been picked. Further strides tended to happen mostly in <BR>
places where people were already healthy and long-lived.<BR>
<BR>
As a consequence, the rise in longevity began to stagnate in places <BR>
with the least-healthy people. In those counties, life expectancy <BR>
increased by only one year (from 74.5 to 75.5) between 1983 and 1999, <BR>
while in the healthiest places the life expectancy of women had reached 83.<BR>
<BR>
It was during this interval that women's life expectancy fell in <BR>
nearly 1,000 counties. If one adds counties where it rose only <BR>
insignificantly, then 19 percent of American women -- nearly 1 in 5 <BR>
-- are now experiencing stagnating or falling life expectancy.<BR>
<BR>
The trend was far less pronounced for men. That is because they <BR>
entered the 1980s with higher death rates from heart attacks than <BR>
women, and thus gained more from better prevention and better <BR>
treatment. In the 1990s, however, AIDS and homicide began to take <BR>
large tolls, depressing male life expectancy in some places.<BR>
<BR>
Murray's team, which also included Ari B. Friedman of Harvard and <BR>
Sandeep C. Kulkarni of the University of California at San Francisco, <BR>
used Internal Revenue Service data to check whether high levels of <BR>
migration, or migration of people with particularly high or low <BR>
incomes, might explain the discrepancy between the 1,000 counties and <BR>
their neighbors. They found no evidence for it.<BR>
<BR>
Unlike some European countries, the United States does not collect <BR>
health information other than birth and death statistics at the local <BR>
level. Instead, there are national, state and regional surveys of <BR>
people's health, behavior and access to medical care. Trends those <BR>
studies have picked up shed light on what is happening in the 1,000 counties.<BR>
<BR>
Obesity has risen markedly in the past two decades, with women more <BR>
affected than men. About 33 percent of women are now obese, compared <BR>
with 31 percent of men. Extreme obesity is twice as common in women <BR>
(7 percent) as in men (3 percent).<BR>
<BR>
Being overweight greatly increases the risk of developing Type 2, or <BR>
"adult-onset," diabetes. A national survey in 2002 found that 85 <BR>
percent of diabetics were overweight or obese.<BR>
<BR>
In recent years, the prevalence of high blood pressure has been <BR>
increasing in women, as well -- partly the result of weight gain. In <BR>
1990, 42 percent of women older than 60 had hypertension; by 2000 it <BR>
was 51 percent. (In men, the trend is still dropping, as it has been <BR>
for several decades.)<BR>
<BR>
"This is a story about smoking, blood pressure and obesity," said <BR>
Majid Ezzati, of the Harvard Initiative for Global Health, a <BR>
co-author of the paper.<BR>
<BR>
===<BR>
<BR>
Majid Ezzati, Ari B. Friedman, Sandeep C. Kulkarni, Christopher J. L. <BR>
Murray. The Reversal of Fortunes: Trends in County Mortality and <BR>
Cross-County Mortality Disparities in the United States. PLOS <BR>
Medicine. 4(4):e66.<BR>
<BR>
Background<BR>
<BR>
Counties are the smallest unit for which mortality data are routinely <BR>
available, allowing consistent and comparable long-term analysis of <BR>
trends in health disparities. Average life expectancy has steadily <BR>
increased in the United States but there is limited information on <BR>
long-term mortality trends in the US counties This study aimed to <BR>
investigate trends in county mortality and cross-county mortality <BR>
disparities, including the contributions of specific diseases to <BR>
county level mortality trends.<BR>
<BR>
Methods and Findings<BR>
<BR>
We used mortality statistics (from the National Center for Health <BR>
Statistics [NCHS]) and population (from the US Census) to estimate <BR>
sex-specific life expectancy for US counties for every year between <BR>
1961 and 1999. Data for analyses in subsequent years were not <BR>
provided to us by the NCHS. We calculated different metrics of <BR>
cross-county mortality disparity, and also grouped counties on the <BR>
basis of whether their mortality changed favorably or unfavorably <BR>
relative to the national average. We estimated the probability of <BR>
death from specific diseases for counties with above- or <BR>
below-average mortality performance. We simulated the effect of <BR>
cross-county migration on each county's life expectancy using a <BR>
time-based simulation model. Between 1961 and 1999, the standard <BR>
deviation (SD) of life expectancy across US counties was at its <BR>
lowest in 1983, at 1.9 and 1.4 y for men and women, respectively. <BR>
Cross-county life expectancy SD increased to 2.3 and 1.7 y in 1999. <BR>
Between 1961 and 1983 no counties had a statistically significant <BR>
increase in mortality; the major cause of mortality decline for both <BR>
sexes was reduction in cardiovascular mortality. From 1983 to 1999, <BR>
life expectancy declined significantly in 11 counties for men (by 1.3 <BR>
y) and in 180 counties for women (by 1.3 y); another 48 (men) and 783 <BR>
(women) counties had nonsignificant life expectancy decline. Life <BR>
expectancy decline in both sexes was caused by increased mortality <BR>
from lung cancer, chronic obstructive pulmonary disease (COPD), <BR>
diabetes, and a range of other noncommunicable diseases, which were <BR>
no longer compensated for by the decline in cardiovascular mortality. <BR>
Higher HIV/AIDS and homicide deaths also contributed substantially to <BR>
life expectancy decline for men, but not for women. Alternative <BR>
specifications of the effects of migration showed that the rise in <BR>
cross-county life expectancy SD was unlikely to be caused by migration.<BR>
<BR>
Conclusions<BR>
<BR>
There was a steady increase in mortality inequality across the US <BR>
counties between 1983 and 1999, resulting from stagnation or increase <BR>
in mortality among the worst-off segment of the population. Female <BR>
mortality increased in a large number of counties, primarily because <BR>
of chronic diseases related to smoking, overweight and obesity, and <BR>
high blood pressure.<BR>
<BR>
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Heartburn or Worse <a href="http://us.ard.yahoo.com/SIG=13rkbbcr1/M=493064.12016303.12582636.9706571/D=grphealth/S=1705061146:NC/Y=YAHOO/EXP=1208888548/L=/B=4QzHANFJq2k-/J=1208881348210291/A=5191947/R=0/SIG=13k5hfu0i/*http://health.yahoo.com/gerd-overview/gastroesophageal-reflux-dis"><http://us.ard.yahoo.com/SIG=13rkbbcr1/M=493064.12016303.12582636.9706571/D=grphealth/S=1705061146:NC/Y=YAHOO/EXP=1208888548/L=/B=4QzHANFJq2k-/J=1208881348210291/A=5191947/R=0/SIG=13k5hfu0i/*http://health.yahoo.com/gerd-overview/gastroesophageal-reflux-dis></a> <BR>
<BR>
<BR>
What symptoms<BR>
<BR>
<BR>
are most serious?<BR>
<BR>
<BR>
<BR>
Yahoo! Groups<BR>
<BR>
<BR>
w/ John McEnroe <a href="http://us.ard.yahoo.com/SIG=13raan3hr/M=493064.12016283.12445687.8674578/D=grphealth/S=1705061146:NC/Y=YAHOO/EXP=1208888548/L=/B=4gzHANFJq2k-/J=1208881348210291/A=5202322/R=0/SIG=11aijbghb/*http://new.groups.yahoo.com/allbrangroup"><http://us.ard.yahoo.com/SIG=13raan3hr/M=493064.12016283.12445687.8674578/D=grphealth/S=1705061146:NC/Y=YAHOO/EXP=1208888548/L=/B=4gzHANFJq2k-/J=1208881348210291/A=5202322/R=0/SIG=11aijbghb/*http://new.groups.yahoo.com/allbrangroup></a> <BR>
<BR>
<BR>
Join the All-Bran<BR>
<BR>
<BR>
Day 10 Club.<BR>
<BR>
<BR>
<BR>
<BR>
.<BR>
<BR>
<FONT COLOR="#FFFFFF">__,_._,___<BR>
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