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Tuesday, 22 April 2008 23:34

Falling women lifespans in Deep South, Appalachia, lower Midwest

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A Harvard, UC, and UW study has found female life spans in 180 impoverished and rural U.S. counties fell from the early 1980s to the late 1990s, with causes including increased  smoking, being overweight and obese, and having high blood pressure.


In addition to these 180 counties, women in another 783 counties showed no measurable increase in life spans.

In all, about twelve percent of the women in the United States (in nearly 1,000 counties) have a lower-to-equal life expectancy in 1999 when compared to their life spans sixteen years earlier, in 1983.

The locations of these almost 1,000 counties include the Deep South, along the Mississippi River, in Appalachia, and the southern part of the Midwest and into Texas (but also a number of counties in the Rocky Mountain area and the Four Corners region; and one county in Maine).

The study, performed by researchers from Harvard University, Cambridge, Massachusetts; the University of California at San Francisco; and the University of Washington at Seattle, found that these nearly one thousand counties in the United States were primarily low-income and rural areas.

The scientists looked at mortality statistics from the National Center for Health Statistics and population data from the U.S. Census Bureau between the years 1961 and 1999. To perform the study, they divided the country into 2,068 units, where units might contain a city, a county, or several counties.

They looked into possible deviations from migrations in and out of counties, but found no reason that such movements would adversely affect their conclusions.

In the first half of the time span, from 1961 to 1983, life expectancies went up across the country for both men and women in all counties whether they were considered low, medium, or high income counties and whether they were considered rural or urban, or anywhere in between.

The researchers contribute this increase in longevity to people minimizing risky behaviors such as smoking, hypertension, and high cholesterol—which are all related to risks to cardiovascular health.

They also contributed increased life spans to better medical care, surgical procedures, and medicines. Most of the improvement in life spans during this 21-year span of time was contributable to reduced risk from heart disease and, thus, heart attacks.

However, between 1983 and 1999, women were divided in their life span statistics depending on where they lived in the country. It was not divided due to race or ethnicity, only to location in the country.

How much did life spans go down for women in low income and rural areas? Read on.




The life expectancy for women in 180 counties declined significantly--by 1.3 years--between the years of 1983 and 1999.

In another 783 counties, the life expectancy remained little changed.

The article published on April 22, 2008, in Public Library of Science (PloS) Medicine is entitled “The Reversal of Fortunes: Trends in County Mortality and Cross-County Mortality Disparities in the United States.”

Its authors are: Majid Ezzati (Harvard School of Public Health and Initiative for Global Heath, Harvard University, Cambridge, Massachusetts); Ari B. Friedman (Initiative for Global Health, Harvard University); Sandeep C. Kulkarni (Initiative for Global Health, Harvard University and University of California, San Francisco); and Christopher J. L. Murray (Harvard School of Public Health and Initiative for Global Heath, Harvard University, Cambridge, Massachusetts, and Institute for Health Metrics and Evaluation, University of Washington, Seattle).

Their abstract states, “Counties are the smallest unit for which mortality data are routinely available, allowing consistent and comparable long-term analysis of trends in health disparities. Average life expectancy has steadily increased in the United States but there is limited information on long-term mortality trends in the US counties. This study aimed to investigate trends in county mortality and cross-county mortality disparities, including the contributions of specific diseases to county level mortality trends.”

They also stated within their abstract: “Life expectancy decline in both sexes was caused by increased mortality from lung cancer, chronic obstructive pulmonary disease (COPD), diabetes, and a range of other noncommunicable diseases, which were no longer compensated for by the decline in cardiovascular mortality. Higher HIV/AIDS and homicide deaths also contributed substantially to life expectancy decline for men, but not for women. Alternative specifications of the effects of migration showed that the rise in cross-county life expectancy SD was unlikely to be caused by migration.”

The researchers concluded, “There was a steady increase in mortality inequality across the US counties between 1983 and 1999, resulting from stagnation or increase in mortality among the worst-off segment of the population. Female mortality increased in a large number of counties, primarily because of chronic diseases related to smoking, overweight and obesity, and high blood pressure.”

Majid Ezzati, an author of the study, said, "This is a story about smoking, blood pressure and obesity,” [The Washington Post: “Life Expectancy Drops for Some U.S. Women”]

With respect to being obese (being extremely overweight), according to the Washington Post article, “Obesity has risen markedly in the past two decades, with women more affected than men. About 33 percent of women are now obese, compared with 31 percent of men. Extreme obesity is twice as common in women (7 percent) as in men (3 percent).”

According to high blood pressure, the article also states, “In recent years, the prevalence of high blood pressure has been increasing in women, as well -- partly the result of weight gain. In 1990, 42 percent of women older than 60 had hypertension; by 2000 it was 51 percent. (In men, the trend is still dropping, as it has been for several decades.)”

With respect to smoking, many articles and research studies in the past have written about the increased use of cigarettes among women in the last few decades.

This study gives a good indication that the combination of smoking, obesity, and high blood pressure is unhealthy for women--as has been the case with men for years.


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