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, is published June 15 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 3,138 counties and 10 cities, 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."
Hopefully it's not too late to fix it. Thanks in advance.
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."
- Sandeep C Kulkarni, Alison Levin-Rector, Majid Ezzati, Christopher JL Murray. Falling behind: life expectancy in US counties from 2000 to 2007 in an international context. Population Health Metrics, 2011; 9 (1): 16 DOI: 10.1186/1478-7954-9-16
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