A new, county-by-county analysis of life expectancy in the U.S. shows more than 80 percent of U.S. counties are lagging further behind the world's longest-lived countries in 2007 than they did in 2000. Women lag more than men and life expectancy for African Americans is lower than whites.
"The main finding is we are not keeping pace with the progress that other countries are able to achieve," said Christopher Murray, director of the Institute for Health Metrics and Evaluation at the University of Washington, Seattle, and lead author of the new study, released today by the journal Population Health Metrics.
The team found that in 2007, the most recent year available, five Mississippi counties had the lowest life expectancy for both men and women, less than 67 and 74.5 years, respectively. Four of the five counties are the same for both men and women.
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These lowest five are ranked behind at least 102 countries for women and 116 for men. Counties throughout the lower Mississippi Valley, the rural south, eastern Kentucky and West Virginia had "really low" life expectancies, Murray said.
This contrasts with Japan, with the top life expectancy for women of 86.2 years, and Iceland, with the top life expectancy for men of 80.2 years. The life expectancy at birth for the U.S. in 2007 was 75.6 for men (rank: 36) and 80.8 for women (rank: 33).
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When the researchers compared each county's life expectancy to the average of the 10 longest-lived nations, they found that life expectancies in 2007 in 92 counties for men and two counties for women were at levels that the top 10 countries had achieved more than 50 years ago.
Blacks in the U.S. fared worse than whites in every county. The life expectancy for black men ranged from 59.4 to 77.2 years, with 65 percent of counties lagging the international standard by more than 50 years. Black women's life expectancy ranged form 69.6 to 82.6, with 22 percent of counties more than 50 years behind the standard.
The group also looked at how life expectancies changed from 2000 to 2007, and found that 80 percent of counties were losing ground relative to the healthiest nations. "That's where you find there's a big difference between men and women," Murray said. "Women are falling further behind than men."
Life expectancy for women actually declined from 1997 to 2007 in 737 counties, concentrated in Oklahoma, Arkansas, Missouri, Kentucky and Tennessee, Murray said.
Male life expectancy dropped relative to the international top 10 average in 80 percent of counties, while female life expectancy dropped relative to the standard in 91 percent of counties
Despite the bleak picture for so many counties, a few have longer life expectancies than even the top 10 average. "There are some, what I think of as healthy lifestyle destination counties," Murray said, such as Summit County, Colo., and Teton County, Wyo.
These counties have seen huge increases in life expectancy over the last 10-20 years. "You see that there are people moving there for outdoor sports, healthy lifestyle," Murray said. These people are living long lives. "I think that shows you what's possible in the United States."
The longest-lived county for women in the U.S. was Collier, Fla., at 86 years, and for men was Fairfax County, Va., at 81.1.
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Murray points to tobacco, obesity and high blood pressure as the three main drivers of life expectancy lags.
Tobacco is particularly to blame for the growing gap in women's life expectancy, Murray said. Women used to smoke much less than men, and as that has equalized, the health effects of tobacco are catching up to women, taking years off of their lives.
Obesity is a well-documented problem in the U.S., but blood pressure receives relatively little attention, Murray noted. "We are making little-to-no progress in reducing blood pressure. It's probably as big a killer as tobacco," he said.
Murray said that infant mortality is a very small contributor to the lagging U.S. life expectancy: "The place where we do the worst is young and middle-aged adults from 15 to about 64. The gap between us and other countries isn't so great at the higher ages."
"I think this article really shows some pretty staggering amounts of inequality in life expectancy in the U.S. at the county level. It really shows how incredibly low some of these levels are," said Michel Guillot of the Population Studies Center at the University of Pennsylvania in Philadelphia.
"The U.S. is a huge country. It's a very diverse country. You're going to see some more inequality, some more disparity," he added. Nonetheless, "it is very worrisome. There are areas in the U.S. and racial groups that are really disadvantaged."