Sunday, June 26, 2011 10:34:05 AM
As GOP Continues Its War On Women, Study Shows Female Life Expectancy Is Declining In 313 Counties
By Travis Waldron on Jun 24, 2011 at 3:30 pm
The United States is rapidly falling behind the rest of the industrialized world when it comes to life expectancy, and no demographic is facing a more rapid decline in life expectancy than women. According to a new study [ http://www.healthmetricsandevaluation.org/news-events/news-release/life-expectancy-in-us-counties-2011 (second below)] by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, the life expectancy of the American woman is not just growing too slowly — in 313 American counties, it is actually declining [ http://www.remappingdebate.org/article/life-getting-shorter-women-hundreds-us-counties ].
[ http://www.remappingdebate.org/sites/all/files/images/LifeExpectancy640_0.png ]
In these counties, primarily located in the Southeast, Central Appalachia, and the lower Midwest, life expectancy rates for women are as many as 50 years behind the best-performing countries. In other words, the worst female life expectancy rates in the U.S. are equal to the rate the best countries experienced in the 1950s.
Researchers and analysts caution against attributing the decline to any one factor, but say it is clear that “income plays a very large role in determining adult health outcomes,” suggesting that poverty and socioeconomic status play a key role in raising — or lowering — life expectancy. And while there may not be consensus as to why the decline is occurring, University of Wisconsin professor Dave Kindig told Remapping Debate that, to reverse the trend, the U.S. needs to strengthen its investment into public health programs, particularly those focused on preventive medicine and nutrition:
“If we tripled our investment in public health, and did it in a smart way, we would almost certainly get that money back in savings in the long run because fewer people would be going to the hospital for heart attacks and strokes and cancer and diabetes.”
But the increasing political pressure to cap health care costs, he added, creates a vicious cycle. As more money is spent on treatment, the temptation is to spend less money on public health initiatives that are aimed at prevention. With fewer funds available to increase access in underserved areas, improve environmental conditions, and enhance health awareness, even more money will have to be spent on treatment, ultimately squeezing public health budgets even further.
In Congress and state legislatures across the country, however, Republicans have targeted public health programs for drastic spending cuts or full elimination, focusing especially on programs that benefit women the most [ http://thinkprogress.org/politics/2011/02/10/143458/pelosi-womens-assault/ ]. ThinkProgress compiled a list of the most drastic cuts the GOP has attempted to make to women’s health programs:
WIC: The GOP’s initial budget sought to cut 10 percent [ http://articles.cnn.com/2011-02-25/politics/budget.women.children_1_wic-women-infants-food-costs?_s=PM:POLITICS ] from the 2010 spending level for the Special Supplemental Nutritional Program for Women, Infants, and Children (WIC), which provides aid to low-income pregnant and nursing women and their infant children. The spending resolution passed on April 12, which averted a government shutdown, slashed $500 million [ http://news.firedoglake.com/2011/04/12/a-look-at-the-cuts-in-the-new-leaner-2011-budget/ ] from WIC’s 2010 spending levels. Total cuts to the program for fiscal year 2012 are estimated at $833 million.
Title X: The budget plan the GOP released in February sought to eliminate [ http://www.nashuatelegraph.com/newsworldnation/911752-227/story.html ] funding for Title X, which provides family planning to low-income families, altogether. The program’s $317 million budget was cut by $17 million [ http://www.nationalpartnership.org/site/News2?abbr=daily2_&page=NewsArticle&id=28308&security=1201&news_iv_ctrl=-1 ] in the April 12 spending resolution.
Planned Parenthood: The GOP took the government to the brink of shutdown [ http://thinkprogress.org/economy/2011/04/08/173884/gop-clings-rider/ ] over funding for Planned Parenthood, which provides millions of women with basic health services each year. The deal to avoid a shutdown kept Planned Parenthood’s funding intact, but states across the country have sought to defund its state chapters [ http://thinkprogress.org/?s=planned+parenthood&sort=date+desc ]. In Indiana, defunding Planned Parenthood kept thousands of women [ http://thinkprogress.org/health/2011/06/21/249576/indiana-law-forces-planned-parenthood-clinics-to-close-and-stop-treating-thousands-of-medicaid-patients/ ] from getting care provided by Medicaid. Wisconsin is the latest state to launch an attack [ http://thinkprogress.org/health/2011/06/17/247808/wisconsin-planned-parenthood-next-target-in-gop-attack/ ] on the organization.
Medicare/Medicaid: The House GOP budget authored by Rep. Paul Ryan (R-WI) would end Medicare as we know it and turn Medicaid into a block-grant system, disproportionately hurting women [ http://www.politico.com/news/stories/0511/55632.html ]. Both programs aid more women than men, and women in general retire at lower incomes than men. The average retired woman earns $14,000 in income each year — $12,000 of which comes from Social Security. Under Ryan’s plan, the average female senior would pay all of that $12,000 for Medicare coverage.
Affordable Care Act: During the health care debate, Republicans fought to prevent maternity care [ http://thinkprogress.org/politics/2009/09/25/61634/stabenow-kyl-maternity/ ] from becoming a standard inclusion on medical plans and attempted to keep the bill from passing despite its many benefits [ http://www.americanprogress.org/issues/2011/03/five_ways_women.html ] for women. Those benefits [ http://politicalcorrection.org/factcheck/201103240002 ] include better coverage of preventive procedures like mammograms and cervical cancer scans, the establishment of community health centers to make it easier for low-income women to see doctors, and coverage protection for those with pre-existing conditions, all of which will save lives and allow women to stay healthier longer. The House GOP voted to repeal the law in January and has fought to defund many of its programs, including a Free Choice Voucher program that would have helped give low-income Americans more options when they chose their health coverage had it not been gutted by Republicans [ http://www.dailykos.com/story/2011/04/11/965838/-Free-Choice-program-in-health-reform-sacrificed-in-budget-deal ].
It’s not too late for the United States to reverse the trend and begin catching up to the best countries in the world when it comes to life expectancy. But cutting programs that are vital to ensuring women’s health is not the way to do it. As Kindig told Remapping Debate, this is a “national problem” that needs to be addressed now.
“Changing these trends is very much in the social and public interest,” he said. “We can’t just assume that everybody is going to get better eventually if we continue down the same path.”
© 2005-2011 Center for American Progress Action Fund (emphasis in original)
http://thinkprogress.org/health/2011/06/24/253392/gop-war-on-women-life-expectancy-declining/ [with comments]
===
Male Life Expectancy, 2007
Female Life Expectancy, 2007
http://www.healthmetricsandevaluation.org/tools/data-visualization/life-expectancy-in-us-counties-2011
===
Life expectancy in most US counties falls behind world’s healthiest nations
The most current county-level analysis finds large disparities nationwide. Women fare worse than men, and people in Appalachia, the Deep South, and Northern Texas live the shortest lives.
June 15, 2011 - While people in Japan, Canada, and other nations are enjoying significant gains in life expectancy every year, most counties within the United States are falling behind, according to a new study by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington.
IHME researchers, in collaboration with researchers at Imperial College London, found that between 2000 and 2007, more than 80% of counties fell in standing against the average of the 10 nations with the best life expectancies in the world, known as the international frontier.
“We are finally able to answer the question of how the US fares in comparison to its peers globally,” said Dr. Christopher Murray [ http://www.healthmetricsandevaluation.org/about-ihme/team/christopher-jl-murray ], IHME Director and one of the paper’s co-authors. “Despite the fact that the US spends more per capita than any other nation on health, eight out of every 10 counties are not keeping pace in terms of health outcomes. That’s a staggering statistic.”
The new study, Falling behind: life expectancy in US counties from 2000 to 2007 in an international context [ http://www.healthmetricsandevaluation.org/research/publication-summary/falling-behind-life-expectancy-us-counties-2000-2007-international-cont ( http://www.pophealthmetrics.com/content/pdf/1478-7954-9-16.pdf )], was published June 15, 2011 in BioMed Central’s open-access journal Population Health Metrics. In conjunction with the study, IHME is releasing a complete time series for life expectancy from 1987 to 2007 for all counties, the most up-to-date analysis available.
When compared to the international frontier for life expectancy, US counties range from being 16 calendar years ahead to more than 50 behind for women. For men, the range is from 15 calendar years ahead to more than 50 calendar years behind. This means that some counties have a life expectancy today that nations with the best health outcomes had in 1957.
The researchers suggest that the relatively low life expectancies in the US cannot be explained by the size of the nation, racial diversity, or economics. Instead, the authors point to high rates of obesity, tobacco use, and other preventable risk factors for an early death as the leading drivers of the gap between the US and other nations.
Five counties in Mississippi have the lowest life expectancies for women, all below 74.5 years, putting them behind nations such as Honduras, El Salvador, and Peru. Four of those counties, along with Humphreys County, MS, have the lowest life expectancies for men, all below 67 years, meaning they are behind Brazil, Latvia, and the Philippines.
Women live the longest in Collier, FL, at 86 years on average, better than France, Switzerland, and Spain. Men live the longest in Fairfax County, VA, at 81.1 years, which is higher than life expectancies in Japan and Australia. Women are also living long lives in Teton, Wyoming; San Mateo and Marin, California; and Montgomery, Maryland. For men, long life spans also can be found in Marin, California; Montgomery, Maryland; Santa Clara, California; and Douglas, Colorado.
Nationwide, women fare more poorly than men. The researchers found that women in 1,373 counties – about 40% of US counties – fell more than five years behind the nations with the best life expectancies. Men in about half as many counties – 661 total – fell that far.
Black men and women have lower life expectancies than white men and women in all counties. Life expectancy for black women ranges from 69.6 to 82.6 years, and for black men, from 59.4 to 77.2 years. In both cases, no counties are ahead of the international frontier, and some are more than 50 years behind. The researchers were not able to analyze other race categories because of low population levels in many counties.
Change in life expectancy is so uneven that within some states there is now a decade difference between the counties with the longest lives and those with the shortest. States such as Arizona, Florida, Virginia, and Georgia have seen counties leap forward more than five years from 1987 to 2007 while nearby counties stagnate or even lose years of life expectancy. In Arizona, Yuma County’s average life expectancy for men increased 8.5 years, nearly twice the national average, while neighboring La Paz County lost a full year of life expectancy, the steepest drop nationwide. Nationally, life expectancy increased 4.3 years for men and 2.4 years for women between 1987 and 2007.
“By creating this time series, which has never been available at the county level, we hope states and counties will be able to take targeted action,” Dr. Sandeep Kulkarni, an IHME research fellow and the paper’s lead author, said. “Counties in one part of the state should not be benefiting from big increases in life expectancy while other counties are actually seeing life spans shrink.”
The authors propose that state and local policymakers use the life expectancy data and the county comparisons to tailor strategies that will fit the dynamics of their communities. This resonates with local policymakers, such as Dr. David Fleming, Director of Public Health - Seattle & King County.
“It’s not the health care system that’s having the biggest impact on health; it’s the community,” Dr. Fleming said. “The average person in the US spends one hour annually in a physician’s office unless they are really sick. So until we start moving our interventions out into the communities where people live, we are not going to get ahead of these problems.”
The Seattle & King County health department is collaborating with IHME on an ambitious analysis of health in King County, one of the largest studies of its kind. Called the Monitoring Disparities in Chronic Conditions (MDCC) Study [ http://www.healthmetricsandevaluation.org/research/project/monitoring-disparities-chronic-conditions-study-mdcc-study ], researchers are integrating data from emergency medical services, hospital discharge databases, pharmacy records, and other sources to identify the biggest health challenges in King County. They are surveying 9,000 people and taking blood samples to analyze for a range of risk factors and diseases.
“We are building the evidence for focused interventions that will make an impact locally,” said Dr. Ali Mokdad, Professor of Global Health at IHME, who is leading the MDCC Study. “If we as a society are going to fund programs to improve health, we must ensure that we are measuring the impact, because these life expectancy numbers show that what we have been doing up until now clearly is not working.”
The Institute for Health Metrics and Evaluation (IHME) is an independent global research center at the University of Washington providing sound measurement of population health and the factors that determine health, as well as rigorous evaluation of health system and health program performance. The Institute’s goal is to improve population health by providing the best evidence possible to guide health policy – and by making that evidence easily accessible to decision-makers as they strategically fund, design, and implement programs to improve health outcomes worldwide. IHME was created in 2007 through funding from the Bill & Melinda Gates Foundation and the state of Washington.
Media contacts
William Heisel
+1-206-897-2886; cell: +1-206-612-0739
wheisel@uw.edu
Jill Oviatt
+1-206-897-2862; cell: +1-206-861-6684
oviattj@uw.edu
Figures
Figure 1. Changes in years of life expectancy in US counties, women, 1987-2007
http://www.healthmetricsandevaluation.org/sites/default/files/figures/Changes%20in%20years%20of%20life%20expectancy%20in%20US%20counties%2C%20women%2C%201987-2007_IHME.pdf
Figure 2. Changes in years of life expectancy in US counties, men, 1987-2007
http://www.healthmetricsandevaluation.org/sites/default/files/figures/Changes%20in%20years%20of%20life%20expectancy%20in%20US%20counties%2C%20men%2C%201987-2007_IHME.pdf
All data for download. Life expectancy by county, sex, and race (US), 1987-2007 (2.6k xls)
http://www.healthmetricsandevaluation.org/sites/default/files/datasets/Life%20Expectancies%20in%20US%20Counties_2011_data_IHME.xls
© 2011 University of Washington
http://www.healthmetricsandevaluation.org/news-events/news-release/life-expectancy-in-us-counties-2011
===
Falling behind: life expectancy in US counties from 2000 to 2007 in an international context
Published in Population Health Metrics, June 2011
Between 2000 and 2007, life expectancies in more than 80% of United States counties fell in standing against the average of the 10 nations with the best life expectancies in the world, according to new research by IHME, in collaboration with researchers from Imperial College London.
The study, Falling behind: life expectancy in US counties from 2000 to 2007 in an international context [ http://www.healthmetricsandevaluation.org/research/publication-summary/falling-behind-life-expectancy-us-counties-2000-2007-international-cont ( http://www.pophealthmetrics.com/content/pdf/1478-7954-9-16.pdf )], shows that compared to countries like Japan and Canada, where life expectancies significantly increase every year, most counties within the US are falling behind.
Research objective
The US has extremely large racial/ethnic and geographic disparities, but data tracking these disparities at the county level are lacking. In order to assess the current state of population health, as well as to provide a baseline for future decisions that need to be made at the county level, this study compares life expectancy of US counties to those of the lowest-mortality nations to assess both absolute and relative progress for each county.
This study is part of ongoing work by IHME to better understand the current state of population health. County-level decision-makers need accurate information about local health trends, health system performance, and whether their local health systems are delivering necessary health interventions to achieve good health outcomes in their counties.
Research findings
Researchers found that across US counties, life expectancy in 2007 ranged from 65.9 to 81.1 years for men and 73.5 to 86 years for women. Geographically, the counties with the lowest life expectancies for both sexes were in counties in Appalachia and the Deep South, extending across northern Texas. Counties with the highest life expectancies tended to be in the northern Plains and along the Pacific coast and the Eastern Seaboard.
One way of analyzing county-level life expectancies is to compare them to a life expectancy time series of the 10 nations with the lowest mortality, known as the “international frontier.” Compared to this international frontier, US counties range from being 16 calendar years ahead to more than 50 calendar years behind for women and from 15 calendar years ahead to more than 50 calendar years behind for men.
Nationwide, women fare more poorly than men. The researchers found that women in 1,373 counties – about 40% of US counties – fell more than five years behind the nations with the best life expectancies. Men in about half as many counties – 661 total – fell that far.
Life expectancy for black women ranges from 69.6 to 82.6 years, and for black men, from 59.4 to 77.2 years. In both cases, no counties are ahead of the international frontier, and some are more than 50 years behind. The researchers note that the poor relative performance of the US compared to the international frontier is not simply due to racial disparities, as the pattern of life expectancy performance for white Americans is similar to that of all races combined.
Analytical approach
The researchers used newly released mortality data from the National Center for Health Statistics by age, sex, and county for the US from 2000 to 2007 to compute life tables separately for each sex, for all races combined, for whites, and for blacks. They used a mixed-effects Poisson regression with time, geospatial, and covariate components to estimate annual life expectancy for US counties.
To show county mortality in an international context, researchers compared county life expectancy to an international frontier time series, defined as the average life expectancy of the 10 countries with the lowest mortality for each year from 1950 to 2010.
Policy implications
Methods to address health risks are likely to narrow the disparities seen in life expectancy. The researchers note that if the leading four risk factors were addressed (smoking, high blood pressure, elevated blood glucose, and adiposity), life expectancy in 2005 would increase by 4.9 years for males and 4.1 years for females. Because risk factor exposures vary by county, and state-level analysis shows that risk factor exposures are larger in places with higher mortality rates, addressing these risk factors would tend to narrow county-level life expectancy disparities.
Given the diversity of demography, epidemiology, physical infrastructure, and health system organization at the local level, a single national solution may not be the most effective for all risk factors. To assess this, the authors call for a more comprehensive attempt to measure mortality attributable to low quality of care in the US and the impact of low quality of care on disparities. Local measurement of the baseline level of key risks and their trends may be essential for priority setting and performance evaluation in the future.
Citation: Kulkarni SC, Levin-Rector A, Ezzati M, Murray CJL. Falling behind: life expectancy in US counties from 2000 to 2007 in an international context. Population Health Metrics. 2011; 9:16.
© 2011 University of Washington
http://www.healthmetricsandevaluation.org/research/publication-summary/falling-behind-life-expectancy-us-counties-2000-2007-international-cont
===
The reversal of fortunes: trends in county mortality and cross-county mortality disparities in the United States
Published in PLoS Medicine, April 2008
Despite gains in overall life expectancy in the United States between 1961 and 1999, the life expectancy of a significant segment of the population is actually declining or, at best, stagnating, according to research from IHME. The study, The reversal of fortunes: trends in county mortality and cross-county mortality disparities in the United States [ http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0050066 ], is the first to look at mortality trends in the US by county over such a long period of time. The work was done in collaboration with scientists at the Harvard School of Public Health.
Research findings
The researchers found that between 1961 and 1999, average overall life expectancy in the US increased from 66.9 to 74.1 years for men and from 73.5 to 79.6 for women. When looking at individual counties, however, the researchers found that beginning in the 1980s, the best-off counties continued to improve, but there was stagnation or worsening of life expectancy in the worst-off counties, where 4% of the male population and 19% of the female population experienced either decline or stagnation in mortality. In the best-off counties, men lived 9.0 years longer than those in the worst-off counties in 1983; by 1999 that gap had increased to 11.0 years. For women, the 1983 life expectancy gap of 6.7 years increased to 7.5 years by 1999.
The majority of the counties that had the worst downward swings in life expectancy were in the Deep South, along the Mississippi River, and in Appalachia, extending into the southern portion of the Midwest and into Texas. The researchers also analyzed data on deaths from different diseases and showed that the stagnation and worsening mortality was primarily a result of an increase in diabetes, cancers, and chronic obstructive pulmonary disease, combined with a slowdown or halt in improvements in cardiovascular mortality. An increase in HIV/AIDS and homicides also played a role for men, but not for women.
Analytical approach
The researchers analyzed mortality data from the National Center for Health Statistics and population data from the US Census Bureau to estimate sex-specific life expectancy for US counties for every year between 1961 and 1999. Metrics of cross-county mortality disparity were calculated, and counties were grouped based on whether their mortality changed favorably or unfavorably relative to the national average. Probability of death was also estimated from specific diseases for counties with above- or below-average mortality performance.
Research objective
One of the major aims of the US health system is improving the health of all people, particularly those segments of the population at greater risk of health disparities. While average life expectancy overall in the US has increased in the last 40 years, evidence indicates that these health gains may not be distributed evenly. This study capitalizes on the benefits of county-level analysis: counties are the smallest measurable unit for which mortality data are available, county-level data allow analyses for small subgroups of the US population, and availability of county-level socioeconomic and cause-specific mortality data allow analysis of trends in all-cause and disease-specific mortality in relation to county environmental and socioeconomic characteristics. With this county-level data, researchers can provide insight into trends in mortality and mortality disparities in US counties for a period of approximately four decades, one of the longest trend analyses of mortality disparities in the US. This research is part of ongoing work by IHME to provide timely, accurate, and comparable health measurements.
Recommendations for future work
Life expectancy decline among some US counties highlights the relative geographic disparities that continue to exist in subpopulations of the United States. The role of risk factors such as smoking, high blood pressure, and obesity in life expectancy should be further investigated, and programs that increase the coverage of interventions for chronic disease and injury risk factors in the worst-off counties, states, and regions should be established and regularly monitored and evaluated with respect to their local, versus aggregate only, impacts.
Citation: Ezzati M, Friedman AB, Kulkarni SC, Murray CJL. The reversal of fortunes: trends in county mortality and cross-county mortality disparities in the United States. PLoS Medicine. 2008 Apr 22; 5(4):e66.
© 2008 University of Washington
http://www.healthmetricsandevaluation.org/research/publication-summary/reversal-fortunes-trends-county-mortality-and-cross-county-mortality-di
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By Travis Waldron on Jun 24, 2011 at 3:30 pm
The United States is rapidly falling behind the rest of the industrialized world when it comes to life expectancy, and no demographic is facing a more rapid decline in life expectancy than women. According to a new study [ http://www.healthmetricsandevaluation.org/news-events/news-release/life-expectancy-in-us-counties-2011 (second below)] by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, the life expectancy of the American woman is not just growing too slowly — in 313 American counties, it is actually declining [ http://www.remappingdebate.org/article/life-getting-shorter-women-hundreds-us-counties ].
[ http://www.remappingdebate.org/sites/all/files/images/LifeExpectancy640_0.png ]
In these counties, primarily located in the Southeast, Central Appalachia, and the lower Midwest, life expectancy rates for women are as many as 50 years behind the best-performing countries. In other words, the worst female life expectancy rates in the U.S. are equal to the rate the best countries experienced in the 1950s.
Researchers and analysts caution against attributing the decline to any one factor, but say it is clear that “income plays a very large role in determining adult health outcomes,” suggesting that poverty and socioeconomic status play a key role in raising — or lowering — life expectancy. And while there may not be consensus as to why the decline is occurring, University of Wisconsin professor Dave Kindig told Remapping Debate that, to reverse the trend, the U.S. needs to strengthen its investment into public health programs, particularly those focused on preventive medicine and nutrition:
“If we tripled our investment in public health, and did it in a smart way, we would almost certainly get that money back in savings in the long run because fewer people would be going to the hospital for heart attacks and strokes and cancer and diabetes.”
But the increasing political pressure to cap health care costs, he added, creates a vicious cycle. As more money is spent on treatment, the temptation is to spend less money on public health initiatives that are aimed at prevention. With fewer funds available to increase access in underserved areas, improve environmental conditions, and enhance health awareness, even more money will have to be spent on treatment, ultimately squeezing public health budgets even further.
In Congress and state legislatures across the country, however, Republicans have targeted public health programs for drastic spending cuts or full elimination, focusing especially on programs that benefit women the most [ http://thinkprogress.org/politics/2011/02/10/143458/pelosi-womens-assault/ ]. ThinkProgress compiled a list of the most drastic cuts the GOP has attempted to make to women’s health programs:
WIC: The GOP’s initial budget sought to cut 10 percent [ http://articles.cnn.com/2011-02-25/politics/budget.women.children_1_wic-women-infants-food-costs?_s=PM:POLITICS ] from the 2010 spending level for the Special Supplemental Nutritional Program for Women, Infants, and Children (WIC), which provides aid to low-income pregnant and nursing women and their infant children. The spending resolution passed on April 12, which averted a government shutdown, slashed $500 million [ http://news.firedoglake.com/2011/04/12/a-look-at-the-cuts-in-the-new-leaner-2011-budget/ ] from WIC’s 2010 spending levels. Total cuts to the program for fiscal year 2012 are estimated at $833 million.
Title X: The budget plan the GOP released in February sought to eliminate [ http://www.nashuatelegraph.com/newsworldnation/911752-227/story.html ] funding for Title X, which provides family planning to low-income families, altogether. The program’s $317 million budget was cut by $17 million [ http://www.nationalpartnership.org/site/News2?abbr=daily2_&page=NewsArticle&id=28308&security=1201&news_iv_ctrl=-1 ] in the April 12 spending resolution.
Planned Parenthood: The GOP took the government to the brink of shutdown [ http://thinkprogress.org/economy/2011/04/08/173884/gop-clings-rider/ ] over funding for Planned Parenthood, which provides millions of women with basic health services each year. The deal to avoid a shutdown kept Planned Parenthood’s funding intact, but states across the country have sought to defund its state chapters [ http://thinkprogress.org/?s=planned+parenthood&sort=date+desc ]. In Indiana, defunding Planned Parenthood kept thousands of women [ http://thinkprogress.org/health/2011/06/21/249576/indiana-law-forces-planned-parenthood-clinics-to-close-and-stop-treating-thousands-of-medicaid-patients/ ] from getting care provided by Medicaid. Wisconsin is the latest state to launch an attack [ http://thinkprogress.org/health/2011/06/17/247808/wisconsin-planned-parenthood-next-target-in-gop-attack/ ] on the organization.
Medicare/Medicaid: The House GOP budget authored by Rep. Paul Ryan (R-WI) would end Medicare as we know it and turn Medicaid into a block-grant system, disproportionately hurting women [ http://www.politico.com/news/stories/0511/55632.html ]. Both programs aid more women than men, and women in general retire at lower incomes than men. The average retired woman earns $14,000 in income each year — $12,000 of which comes from Social Security. Under Ryan’s plan, the average female senior would pay all of that $12,000 for Medicare coverage.
Affordable Care Act: During the health care debate, Republicans fought to prevent maternity care [ http://thinkprogress.org/politics/2009/09/25/61634/stabenow-kyl-maternity/ ] from becoming a standard inclusion on medical plans and attempted to keep the bill from passing despite its many benefits [ http://www.americanprogress.org/issues/2011/03/five_ways_women.html ] for women. Those benefits [ http://politicalcorrection.org/factcheck/201103240002 ] include better coverage of preventive procedures like mammograms and cervical cancer scans, the establishment of community health centers to make it easier for low-income women to see doctors, and coverage protection for those with pre-existing conditions, all of which will save lives and allow women to stay healthier longer. The House GOP voted to repeal the law in January and has fought to defund many of its programs, including a Free Choice Voucher program that would have helped give low-income Americans more options when they chose their health coverage had it not been gutted by Republicans [ http://www.dailykos.com/story/2011/04/11/965838/-Free-Choice-program-in-health-reform-sacrificed-in-budget-deal ].
It’s not too late for the United States to reverse the trend and begin catching up to the best countries in the world when it comes to life expectancy. But cutting programs that are vital to ensuring women’s health is not the way to do it. As Kindig told Remapping Debate, this is a “national problem” that needs to be addressed now.
“Changing these trends is very much in the social and public interest,” he said. “We can’t just assume that everybody is going to get better eventually if we continue down the same path.”
© 2005-2011 Center for American Progress Action Fund (emphasis in original)
http://thinkprogress.org/health/2011/06/24/253392/gop-war-on-women-life-expectancy-declining/ [with comments]
===
Male Life Expectancy, 2007
Female Life Expectancy, 2007
http://www.healthmetricsandevaluation.org/tools/data-visualization/life-expectancy-in-us-counties-2011
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Life expectancy in most US counties falls behind world’s healthiest nations
The most current county-level analysis finds large disparities nationwide. Women fare worse than men, and people in Appalachia, the Deep South, and Northern Texas live the shortest lives.
June 15, 2011 - While people in Japan, Canada, and other nations are enjoying significant gains in life expectancy every year, most counties within the United States are falling behind, according to a new study by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington.
IHME researchers, in collaboration with researchers at Imperial College London, found that between 2000 and 2007, more than 80% of counties fell in standing against the average of the 10 nations with the best life expectancies in the world, known as the international frontier.
“We are finally able to answer the question of how the US fares in comparison to its peers globally,” said Dr. Christopher Murray [ http://www.healthmetricsandevaluation.org/about-ihme/team/christopher-jl-murray ], IHME Director and one of the paper’s co-authors. “Despite the fact that the US spends more per capita than any other nation on health, eight out of every 10 counties are not keeping pace in terms of health outcomes. That’s a staggering statistic.”
The new study, Falling behind: life expectancy in US counties from 2000 to 2007 in an international context [ http://www.healthmetricsandevaluation.org/research/publication-summary/falling-behind-life-expectancy-us-counties-2000-2007-international-cont ( http://www.pophealthmetrics.com/content/pdf/1478-7954-9-16.pdf )], was published June 15, 2011 in BioMed Central’s open-access journal Population Health Metrics. In conjunction with the study, IHME is releasing a complete time series for life expectancy from 1987 to 2007 for all counties, the most up-to-date analysis available.
When compared to the international frontier for life expectancy, US counties range from being 16 calendar years ahead to more than 50 behind for women. For men, the range is from 15 calendar years ahead to more than 50 calendar years behind. This means that some counties have a life expectancy today that nations with the best health outcomes had in 1957.
The researchers suggest that the relatively low life expectancies in the US cannot be explained by the size of the nation, racial diversity, or economics. Instead, the authors point to high rates of obesity, tobacco use, and other preventable risk factors for an early death as the leading drivers of the gap between the US and other nations.
Five counties in Mississippi have the lowest life expectancies for women, all below 74.5 years, putting them behind nations such as Honduras, El Salvador, and Peru. Four of those counties, along with Humphreys County, MS, have the lowest life expectancies for men, all below 67 years, meaning they are behind Brazil, Latvia, and the Philippines.
Women live the longest in Collier, FL, at 86 years on average, better than France, Switzerland, and Spain. Men live the longest in Fairfax County, VA, at 81.1 years, which is higher than life expectancies in Japan and Australia. Women are also living long lives in Teton, Wyoming; San Mateo and Marin, California; and Montgomery, Maryland. For men, long life spans also can be found in Marin, California; Montgomery, Maryland; Santa Clara, California; and Douglas, Colorado.
Nationwide, women fare more poorly than men. The researchers found that women in 1,373 counties – about 40% of US counties – fell more than five years behind the nations with the best life expectancies. Men in about half as many counties – 661 total – fell that far.
Black men and women have lower life expectancies than white men and women in all counties. Life expectancy for black women ranges from 69.6 to 82.6 years, and for black men, from 59.4 to 77.2 years. In both cases, no counties are ahead of the international frontier, and some are more than 50 years behind. The researchers were not able to analyze other race categories because of low population levels in many counties.
Change in life expectancy is so uneven that within some states there is now a decade difference between the counties with the longest lives and those with the shortest. States such as Arizona, Florida, Virginia, and Georgia have seen counties leap forward more than five years from 1987 to 2007 while nearby counties stagnate or even lose years of life expectancy. In Arizona, Yuma County’s average life expectancy for men increased 8.5 years, nearly twice the national average, while neighboring La Paz County lost a full year of life expectancy, the steepest drop nationwide. Nationally, life expectancy increased 4.3 years for men and 2.4 years for women between 1987 and 2007.
“By creating this time series, which has never been available at the county level, we hope states and counties will be able to take targeted action,” Dr. Sandeep Kulkarni, an IHME research fellow and the paper’s lead author, said. “Counties in one part of the state should not be benefiting from big increases in life expectancy while other counties are actually seeing life spans shrink.”
The authors propose that state and local policymakers use the life expectancy data and the county comparisons to tailor strategies that will fit the dynamics of their communities. This resonates with local policymakers, such as Dr. David Fleming, Director of Public Health - Seattle & King County.
“It’s not the health care system that’s having the biggest impact on health; it’s the community,” Dr. Fleming said. “The average person in the US spends one hour annually in a physician’s office unless they are really sick. So until we start moving our interventions out into the communities where people live, we are not going to get ahead of these problems.”
The Seattle & King County health department is collaborating with IHME on an ambitious analysis of health in King County, one of the largest studies of its kind. Called the Monitoring Disparities in Chronic Conditions (MDCC) Study [ http://www.healthmetricsandevaluation.org/research/project/monitoring-disparities-chronic-conditions-study-mdcc-study ], researchers are integrating data from emergency medical services, hospital discharge databases, pharmacy records, and other sources to identify the biggest health challenges in King County. They are surveying 9,000 people and taking blood samples to analyze for a range of risk factors and diseases.
“We are building the evidence for focused interventions that will make an impact locally,” said Dr. Ali Mokdad, Professor of Global Health at IHME, who is leading the MDCC Study. “If we as a society are going to fund programs to improve health, we must ensure that we are measuring the impact, because these life expectancy numbers show that what we have been doing up until now clearly is not working.”
The Institute for Health Metrics and Evaluation (IHME) is an independent global research center at the University of Washington providing sound measurement of population health and the factors that determine health, as well as rigorous evaluation of health system and health program performance. The Institute’s goal is to improve population health by providing the best evidence possible to guide health policy – and by making that evidence easily accessible to decision-makers as they strategically fund, design, and implement programs to improve health outcomes worldwide. IHME was created in 2007 through funding from the Bill & Melinda Gates Foundation and the state of Washington.
Media contacts
William Heisel
+1-206-897-2886; cell: +1-206-612-0739
wheisel@uw.edu
Jill Oviatt
+1-206-897-2862; cell: +1-206-861-6684
oviattj@uw.edu
Figures
Figure 1. Changes in years of life expectancy in US counties, women, 1987-2007
http://www.healthmetricsandevaluation.org/sites/default/files/figures/Changes%20in%20years%20of%20life%20expectancy%20in%20US%20counties%2C%20women%2C%201987-2007_IHME.pdf
Figure 2. Changes in years of life expectancy in US counties, men, 1987-2007
http://www.healthmetricsandevaluation.org/sites/default/files/figures/Changes%20in%20years%20of%20life%20expectancy%20in%20US%20counties%2C%20men%2C%201987-2007_IHME.pdf
All data for download. Life expectancy by county, sex, and race (US), 1987-2007 (2.6k xls)
http://www.healthmetricsandevaluation.org/sites/default/files/datasets/Life%20Expectancies%20in%20US%20Counties_2011_data_IHME.xls
© 2011 University of Washington
http://www.healthmetricsandevaluation.org/news-events/news-release/life-expectancy-in-us-counties-2011
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Falling behind: life expectancy in US counties from 2000 to 2007 in an international context
Published in Population Health Metrics, June 2011
Between 2000 and 2007, life expectancies in more than 80% of United States counties fell in standing against the average of the 10 nations with the best life expectancies in the world, according to new research by IHME, in collaboration with researchers from Imperial College London.
The study, Falling behind: life expectancy in US counties from 2000 to 2007 in an international context [ http://www.healthmetricsandevaluation.org/research/publication-summary/falling-behind-life-expectancy-us-counties-2000-2007-international-cont ( http://www.pophealthmetrics.com/content/pdf/1478-7954-9-16.pdf )], shows that compared to countries like Japan and Canada, where life expectancies significantly increase every year, most counties within the US are falling behind.
Research objective
The US has extremely large racial/ethnic and geographic disparities, but data tracking these disparities at the county level are lacking. In order to assess the current state of population health, as well as to provide a baseline for future decisions that need to be made at the county level, this study compares life expectancy of US counties to those of the lowest-mortality nations to assess both absolute and relative progress for each county.
This study is part of ongoing work by IHME to better understand the current state of population health. County-level decision-makers need accurate information about local health trends, health system performance, and whether their local health systems are delivering necessary health interventions to achieve good health outcomes in their counties.
Research findings
Researchers found that across US counties, life expectancy in 2007 ranged from 65.9 to 81.1 years for men and 73.5 to 86 years for women. Geographically, the counties with the lowest life expectancies for both sexes were in counties in Appalachia and the Deep South, extending across northern Texas. Counties with the highest life expectancies tended to be in the northern Plains and along the Pacific coast and the Eastern Seaboard.
One way of analyzing county-level life expectancies is to compare them to a life expectancy time series of the 10 nations with the lowest mortality, known as the “international frontier.” Compared to this international frontier, US counties range from being 16 calendar years ahead to more than 50 calendar years behind for women and from 15 calendar years ahead to more than 50 calendar years behind for men.
Nationwide, women fare more poorly than men. The researchers found that women in 1,373 counties – about 40% of US counties – fell more than five years behind the nations with the best life expectancies. Men in about half as many counties – 661 total – fell that far.
Life expectancy for black women ranges from 69.6 to 82.6 years, and for black men, from 59.4 to 77.2 years. In both cases, no counties are ahead of the international frontier, and some are more than 50 years behind. The researchers note that the poor relative performance of the US compared to the international frontier is not simply due to racial disparities, as the pattern of life expectancy performance for white Americans is similar to that of all races combined.
Analytical approach
The researchers used newly released mortality data from the National Center for Health Statistics by age, sex, and county for the US from 2000 to 2007 to compute life tables separately for each sex, for all races combined, for whites, and for blacks. They used a mixed-effects Poisson regression with time, geospatial, and covariate components to estimate annual life expectancy for US counties.
To show county mortality in an international context, researchers compared county life expectancy to an international frontier time series, defined as the average life expectancy of the 10 countries with the lowest mortality for each year from 1950 to 2010.
Policy implications
Methods to address health risks are likely to narrow the disparities seen in life expectancy. The researchers note that if the leading four risk factors were addressed (smoking, high blood pressure, elevated blood glucose, and adiposity), life expectancy in 2005 would increase by 4.9 years for males and 4.1 years for females. Because risk factor exposures vary by county, and state-level analysis shows that risk factor exposures are larger in places with higher mortality rates, addressing these risk factors would tend to narrow county-level life expectancy disparities.
Given the diversity of demography, epidemiology, physical infrastructure, and health system organization at the local level, a single national solution may not be the most effective for all risk factors. To assess this, the authors call for a more comprehensive attempt to measure mortality attributable to low quality of care in the US and the impact of low quality of care on disparities. Local measurement of the baseline level of key risks and their trends may be essential for priority setting and performance evaluation in the future.
Citation: Kulkarni SC, Levin-Rector A, Ezzati M, Murray CJL. Falling behind: life expectancy in US counties from 2000 to 2007 in an international context. Population Health Metrics. 2011; 9:16.
© 2011 University of Washington
http://www.healthmetricsandevaluation.org/research/publication-summary/falling-behind-life-expectancy-us-counties-2000-2007-international-cont
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The reversal of fortunes: trends in county mortality and cross-county mortality disparities in the United States
Published in PLoS Medicine, April 2008
Despite gains in overall life expectancy in the United States between 1961 and 1999, the life expectancy of a significant segment of the population is actually declining or, at best, stagnating, according to research from IHME. The study, The reversal of fortunes: trends in county mortality and cross-county mortality disparities in the United States [ http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0050066 ], is the first to look at mortality trends in the US by county over such a long period of time. The work was done in collaboration with scientists at the Harvard School of Public Health.
Research findings
The researchers found that between 1961 and 1999, average overall life expectancy in the US increased from 66.9 to 74.1 years for men and from 73.5 to 79.6 for women. When looking at individual counties, however, the researchers found that beginning in the 1980s, the best-off counties continued to improve, but there was stagnation or worsening of life expectancy in the worst-off counties, where 4% of the male population and 19% of the female population experienced either decline or stagnation in mortality. In the best-off counties, men lived 9.0 years longer than those in the worst-off counties in 1983; by 1999 that gap had increased to 11.0 years. For women, the 1983 life expectancy gap of 6.7 years increased to 7.5 years by 1999.
The majority of the counties that had the worst downward swings in life expectancy were in the Deep South, along the Mississippi River, and in Appalachia, extending into the southern portion of the Midwest and into Texas. The researchers also analyzed data on deaths from different diseases and showed that the stagnation and worsening mortality was primarily a result of an increase in diabetes, cancers, and chronic obstructive pulmonary disease, combined with a slowdown or halt in improvements in cardiovascular mortality. An increase in HIV/AIDS and homicides also played a role for men, but not for women.
Analytical approach
The researchers analyzed mortality data from the National Center for Health Statistics and population data from the US Census Bureau to estimate sex-specific life expectancy for US counties for every year between 1961 and 1999. Metrics of cross-county mortality disparity were calculated, and counties were grouped based on whether their mortality changed favorably or unfavorably relative to the national average. Probability of death was also estimated from specific diseases for counties with above- or below-average mortality performance.
Research objective
One of the major aims of the US health system is improving the health of all people, particularly those segments of the population at greater risk of health disparities. While average life expectancy overall in the US has increased in the last 40 years, evidence indicates that these health gains may not be distributed evenly. This study capitalizes on the benefits of county-level analysis: counties are the smallest measurable unit for which mortality data are available, county-level data allow analyses for small subgroups of the US population, and availability of county-level socioeconomic and cause-specific mortality data allow analysis of trends in all-cause and disease-specific mortality in relation to county environmental and socioeconomic characteristics. With this county-level data, researchers can provide insight into trends in mortality and mortality disparities in US counties for a period of approximately four decades, one of the longest trend analyses of mortality disparities in the US. This research is part of ongoing work by IHME to provide timely, accurate, and comparable health measurements.
Recommendations for future work
Life expectancy decline among some US counties highlights the relative geographic disparities that continue to exist in subpopulations of the United States. The role of risk factors such as smoking, high blood pressure, and obesity in life expectancy should be further investigated, and programs that increase the coverage of interventions for chronic disease and injury risk factors in the worst-off counties, states, and regions should be established and regularly monitored and evaluated with respect to their local, versus aggregate only, impacts.
Citation: Ezzati M, Friedman AB, Kulkarni SC, Murray CJL. The reversal of fortunes: trends in county mortality and cross-county mortality disparities in the United States. PLoS Medicine. 2008 Apr 22; 5(4):e66.
© 2008 University of Washington
http://www.healthmetricsandevaluation.org/research/publication-summary/reversal-fortunes-trends-county-mortality-and-cross-county-mortality-di
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