Advances in medicine and public health have pushed average life expectancy steadily up --but not for everyone in the United States.
In a detailed, county-by-county analysis of death rates, researchers found, much to their surprise, that women and men are dying younger than they did 20 years ago in many places. From 1983 to 1999, life expectancy among women fell by more than a year in 180 counties, and among men in 11 counties.
"You have to go back to 1918, the time of the Spanish flu epidemic, to find a period in U.S. history when female life expectancy fell for an appreciable segment of the population," said study co-author Christopher Murray of the University of Washington.
"It's pretty disturbing," Murray said, "considering we spend more money per capita on health care than anywhere else on the planet."
The 1980s marked the beginning of increasing inequality in life expectancy between the longest- and shortest-lived regions, reversing a 20-year trend. Worsening life expectancy appeared mostly in the Deep South, along the Mississippi River, in Appalachia, and in the southern parts of the Midwest into Texas.
Neither income nor racial differences explain the pattern, researchers said. They speculate it reflects localized increases in smoking, high blood pressure and obesity.
Steep reductions in death from heart disease account for much of the national gain in life expectancy. But rising deaths from cancer, diabetes and chronic obstructive lung disease drove the deterioration in lagging counties.
"In these counties, the heart disease decline is not big enough to mask the rise of these other causes of death," Murray said. "As the decline in deaths from heart disease slows down nationally, we could see this decline in life expectancy emerge more broadly."
Source: The Reversal of Fortunes: Trends in County Mortality and Cross-County Mortality Disparities in the United States. PLoS Medicine, April 22, 2008.