What the hell is wrong with this country? That is what came to my mind when I read a recent PLoS article “The Reversal of Fortunes: Trends in Country Mortality and Cross-County Mortality Disparities in the United States.” The basic conclusion: life expectancy is going DOWN in parts of the United States. How can that be?!
Here is what the PLoS article tells us: From 1983 to 1999, life expectancy declined significantly in 11 US counties for men and in 180 (!) counties for women. Why? “Life expectancy decline in both sexes was caused by increased mortality from lung cancer, chronic obstructive pulmonary disease, diabetes, and a range of other noncommunicable diseases, which were no longer compensated for by the decline in cardiovascular mortality [driven largely by better drugs and interventions]. Higher HIV/AIDS and homicide deaths also contributed substantially to life expectancy decline for men, but not for women.”
In their conclusions, the authors Majid Ezzati, Ari Friedman, Sandeep Kulkarni, and Christopher Murray single out some specific health problems: “The epidemiological (disease-specific) patterns of female mortality rise are consistent with the geographical patterns of, and trends in, smoking, high blood pressure, and obesity. In particular, the sex and cohort patterns of the increase in lung cancer and chronic respiratory disease mortality point to an important potential role for smoking.” So cigarettes kill.
But before we blame it all on individual behaviors, recall that these data are also geographic, by county. Where did life expectancy go down for 4% of the male population and 19% of the female population? “The majority of these counties were in the Deep South, along the Mississippi River, and in Appalachia, extending into the southern portion of the Midwest and into Texas.” In the worst performing counties, life expectancy dropped SIX years for women and two and a half years for men. In contrast, in the best US counties, life expectancy rose by as much as five years.
Continue reading “Dying Sooner: The New US Pattern”