San Francisco Chronicle - April 21, 2008
Sabin Russell, srussell@sfchronicle.com.

While the overall life expectancy of Americans increased by about seven years between 1960 and 2000, the report by researchers at the Harvard School of Public Health and the University of Washington found a "reversal of fortunes" beginning in the early 1980s for large segments of the population.

The study, published online Monday in the journal PLoS Medicine, reinforces concerns about long-term trends in the health of the American population.

In a broad swath of the nation's midsection - stretching from the Appalachian Mountains westward toward Texas and brushing to northern reaches of the Deep South - lies a concentration of counties where the lengthening of life span either sputtered out or actually declined during the last two decades of the 20th century.

Within these pockets of poorer health, the decline in life span was most pronounced among women. For 20 percent - 1 in 5 - of all American women, the trend in rising life expectancy from 1980 to 1999 stalled or reversed, according to the study. Tobacco use, obesity and diabetes were cited as probable causes.

"This paper is going to be a classic. It's going to have a big impact," said Richard Suzman, director of Behavioral and Social Research at the National Institute on Aging in Bethesda, Md. Suzman is an expert in population health who was not involved in the research.

Numerous studies have suggested that the rise in life expectancy enjoyed by the majority of Americans was not being shared by all. This report, led by population health researcher Majid Ezzati at the Harvard School of Public Health, examined those disparities in greater detail - a county-by-county analysis that combines modern computerized mapping technologies with health data collected over the course of four decades.

"One out of five American women was quite a surprise to us," Ezzati said. "When I hear of declines in life expectancy, I think of Sub-Saharan Africa or in the former Soviet Union."

During the two decades prior to 1980, according to the study, not one of the 3,100 counties in the United States reported a decline in life expectancy of men or women; in the final two decades, the researchers found declines among women in 963 counties and among men in 59 counties.

Using stricter statistical standards that rule out the possibility that the declines were the results of random chance, the researchers still spotted outright declines in female life expectancy in 180 American counties, and for men in 11 counties.

Ezzati and his team linked the reversals to several diseases. Among women, declines were caused by increased rates of lung cancer and chronic obstructive pulmonary disease - two smoking-related killers. Obesity-related illnesses such as adult-onset diabetes and hypertension also contributed to the declines in life expectancy found in men and women, while HIV and homicide caused significant declines in life expectancy for men.

These negative trends ran counter to the increasing life expectancy - seven years among men and six years among women - recorded for the nation as a whole. That underscores that there is a widening gap between the health haves and have-nots in the United States, and the study shows that whether the life expectancy news is good or bad has a lot to do with where a person resides.

California, by and large, fared well in the national analysis. In nearly all counties in the state, the life expectancy for men and women increased during the 40-year period. The concentration of counties in the southern and eastern portions of the country with less-favorable trends tend to be lower-income areas that also have a higher concentration of obesity and tobacco-related illnesses. "It is a worsening for the worst off," said Ezzati.

Earlier studies have shown a gap in life expectancies between black and white Americans, but this latest research found that in the counties where declines occurred, they occurred in whites as well as blacks. Race appears less a factor in health disparities than income.

The findings linking county of residence to health outcomes also mirror the results of other studies of health disparities within neighborhoods of individual counties. "We found the same thing in Alameda County. Blacks in the flatlands live less long than blacks in the hills; whites in the flatlands live less long than whites in the hills," said Alameda County Health Officer Dr. Anthony Iton.

According to Iton, studies such as these are building evidence linking social policy to measurable health outcomes, such as mortality rates. "There are health consequences to poor social policy," Iton said. "If the stress engine is constantly revved up, you basically have organ damage. That, over time, kills you earlier. It makes your life shorter."

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Online resource

The study can be found at: links.sfgate.com/ZDDA

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