WASHINGTON
Where you live, combined with race and income, plays a huge role in whether you die young, says a study issued last week that contends the differences are so stark it’s as if there are eight separate Americas instead of one.
Worse, the gaps in lifespan have persisted over 20 years, despite efforts to tackle them, concluded Dr. Christopher Murray of the Harvard University School of Public Health.
“That’s pretty devastating,” says Murray, who published the exhaustive analysis in the online science journal PLoS Medicine. “Whatever it is that we’re doing isn’t working. That’s a wakeup call.”
Leading the nation in longevity are Asian-American women who live in Bergen County, N.J., and typically reach their 91st birthdays, concluded Murray’s county-by-county analysis.
On the opposite extreme are American Indian men in swaths of South Dakota, who die around 58.
Millions of the worst-off Americans have life expectancies typical of developing countries, says Murray. Asian-American women can expect to live 13 years longer than low-income Black women in the rural South. That’s like comparing women in wealthy Japan to those in poverty-ridden Nicaragua.
Compare those longest-living women to inner-city Black men, and the life-expectancy gap is 21 years. That’s similar to the life-expectancy gap between Iceland and Uzbekistan.
Health disparities are widely considered an issue of minorities and the poor being unable to find or afford good medical care. But Murray’s government-funded study shows the problem is far more complex, and that geography plays a crucial role.
“Although we share in the U.S. a reasonably common culture … there’s still a lot of variation in how people live their lives,” he says.
The longest-living Whites weren’t the relatively wealthy, which Murray calls “Middle America.” They’re edged out, by a year, by low-income residents of the rural Northern Plains states, where the men tend to reach age 76 and the women 82.
Yet low-income Whites in Appalachia and the Mississippi Valley die four years sooner than their Northern counterparts.
“If it’s your family involved, these are not small differences in lifespan,” Murray says. “Yet that sense of alarm isn’t there in the public. If I were living in parts of the country with those sorts of life expectancies, I would want … to be asking my local officials or state officials or my congressman, ‘Why is this?’”
This more precise measure of health disparities will enable federal officials to better target efforts to battle inequalities, sys Dr. Wayne H. Giles of the Centers for Disease Control and Prevention, which helped fund Murray’s work.
The CDC currently has some county-targeted programs, including one in Charleston, S.C., that has cut in half diabetes-caused amputations among Black men since 1999. The new study suggests that more county-specific programs are needed, says Giles.
“It’s not just telling people to be active or not to smoke,” he says. “We need to create the environment which assists people in achieving a healthy lifestyle.”
Murray analyzed mortality data between 1982 and 2001 by county, race, gender and income. He found some distinct groupings, which he named the “eight Americas:”
— Asian-Americans, average per capita income of $21,566, have a life expectancy of 84.9 years.
— Northland low-income rural Whites, $17,758, 79 years.
— Middle America (mostly White), $24,640, 77.9 years.
— Low-income Whites in Appalachia, Mississippi Valley, $16,390, 75 years.
— Western American Indians, $10,029, 72.7 years.
— Black Middle America, $15,412, 72.9 years.
— Southern low-income rural Blacks, $10,463, 71.2 years.
— High-risk urban Blacks, $14,800, 71.1 years.
Longevity disparities were most pronounced in young and middle-aged adults. A 15-year-old urban Black man was 3.8 times as likely to die before the age of 60 as an Asian-American male, for example.
That’s key, Murray says, because this age group is left out of many government health programs, which often focus largely on children and the elderly.
Moreover, the longevity gaps have stayed about the same for 20 years despite increasing national efforts to eliminate obvious racial and ethnic health disparities, he found.
Murray says he was surprised to find that lack of health insurance explained only a small portion of those gaps. Instead, differences in alcohol and tobacco use, blood pressure, cholesterol and obesity seemed to drive death rates.
Most important, he says, will be pinpointing geographically defined factors such as shared ancestry, dietary customs, local industry and which regions are more or less prone to physical activity.
For example, scientists have long thought that the Asian longevity advantage would disappear once immigrant families adopted higher-fat Western diets. Murray’s study, which is the first to closely examine second-generation Asian-Americans, found that their longevity advantage persists.
— Associated Press
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