Life expectancy in the U.S. - differences

U.S residents in eight groups based on geography, income and race have significant differences in life expectancy, according to a study published on Monday in the journal PloS Medicine, USA Today reports (Sternberg, USA Today, 9/12).

For the study, Harvard University researchers analyzed population, mortality and health insurance statistics for 2,072 individual and merged counties nationwide from 1982 to 2001 (McKay, Wall Street Journal, 9/12). The eight groups, called the eight Americas, include:

• Asian Americans, who have a per capita income of $21,566 and an average life expectancy of 84.9 years (Neergaard, AP/Detroit Free Press, 9/12);
• Low-income rural whites in Minnesota, North Dakota, South Dakota, Montana and Nebraska, who have a per capita income of $17,758 and an average life expectancy of 79 years (USA Today, 9/12);
• Middle Americans, who have a per capita income of $24,640 and an average life expectancy of 77.9 years;
• Low-income whites in Appalachia and the Mississippi Valley, who have a per capita income of $16,390 and an average life expectancy of 75 years;
• Black Middle Americans, who have a per capita income of $15,412 and an average life expectancy of 72.9 years;
• Western American Indians, who have a per capita income of $10,029 and an average life expectancy of 72.7 years;
• Southern, low-income, rural blacks, who have a per capita income of $10,463 and an average life expectancy of 71.1 years (AP/Detroit Free Press, 9/12); and
• Urban blacks in counties with homicide rates that exceed the 95th percentile, who have a per capita income of $14,800 and an average life expectancy of 71 years (USA Today, 9/12).

The study finds that some of the eight groups "have some of the longest life spans in the world, while others can be expected to live no longer than they would in a developing country," according to the Journal (Wall Street Journal, 9/12).

Reasons for Differences

According to the study, race, income and access to health care alone cannot explain the differences in life expectancy among the eight groups (USA Today, 9/12). Premature deaths of young and middle-aged adults, in large part from chronic diseases and injuries, account for most of the differences in life expectancy among the eight groups, the study finds (Wall Street Journal, 9/12). Christopher Murray, director of the Harvard Initiative for Global Health and lead author of the study, said that income did not account for the differences in life expectancy among the eight groups because whites "living below the median incomes in northern states have the best level of health among whites," adding, "That runs counter to everything we know" (USA Today, 9/12). In addition, the study finds "less variation among the eight Americas in the rate of health insurance coverage and the frequency of routine medical appointments than there was in life expectancy," an indication that access to health care "does not explain most of the differences in mortality," the Washington Post reports (Brown, Washington Post, 9/12). Murray said that many government health care programs focus on children and seniors and that few focus on at-risk young and middle-aged adults (AP/Detroit Free Press, 9/12). "Where we fall down is delivering health care for young and middle-aged adults," Murray said (USA Today, 9/12). He added, "This really requires a rethink about what is the focus of health care policy discussions in the U.S."

Additional Results

The study also finds that the difference in "life expectancy between the healthiest and most ill-prone in the U.S. is about 33 years," the Journal reports. According to the study, Asian-American women in Bergen County, N.J., had the highest average life expectancy in the nation at 91 years, and American Indian men in several South Dakota counties had the lowest life expectancy at 58 years. By county, seven Colorado counties, two Iowa counties and Montgomery County, Md., had the highest average life expectancy at 81.3 years, and six South Dakota counties had the lowest average life expectancy at 66.6 years, the study finds. By state, Hawaii had the highest average life expectancy at 80 years, followed by Minnesota at 78.8 years, and the District of Columbia had the lowest average life expectancy at 72 years, followed by Mississippi at 73.6 years, according to the study (Wall Street Journal, 9/12).

Reaction

Jonathan Skinner of Dartmouth College said, "There's no way that differences in the quality of health care can explain 20-year gaps in life expectancy." Skinner said much of the variation was caused by factors such as diet, exercise and smoking, adding, "Yet we spend much of our attention and 16% of our national income on health care" (USA Today, 9/12). Mitchell Wong of the University of California-Los Angeles said, "The magnitude of the life expectancy disparity is most striking and is perhaps a bit larger than I might have guessed. However, it is not surprising that by combining race and geography, disparities are even larger." Richard Cooper, chair of preventive medicine at Loyola University School of Medicine, said the "problem with these sorts of analyses is that they don't tell you anything very illuminating about the underlying social process" that account for differences in life expectancy (Washington Post, 9/12).

The study is available online.

NPR's "Morning Edition" on Tuesday included an interview with Murray (Montagne, "Morning Edition," NPR, 9/12). The complete segment is available online in RealPlayer. Expanded NPR coverage is available online.

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This article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.