Life Expectancy Going Down in the United StatesS

In some parts of the United States, medicine has not improved the average life expectancy — and in fact, the average lifespan has been going steadily downward since the 1980s. No, immigration is not to blame for these shifting numbers. These are U.S. citizens in hundreds of different counties whose lives are getting shorter while many other people's lives get longer. A study published on Monday in PLoS Medicine shows where in the U.S. lives (especially women's lives) are getting shorter — and where they're getting longer. In these maps, dark red regions are those of decreasing life expectancy, and dark green regions are areas where it's increasing. Light red means life expectancy is lower than average but not decreasing; and light green means higher than average but not increasing. White is average. So what is killing people at younger ages now that didn't kill them in the 1970s?

According to the authors of the study, diabetes and lung disease were the biggest life-shorteners. In an introductory note to their study, PLoS editors write:

The researchers looked at differences in death rates between all counties in US states plus the District of Columbia over four decades, from 1961 to 1999. They obtained the data on number of deaths from the National Center for Health Statistics, and they obtained data on the number of people living in each county from the US Census. The NCHS did not provide death data after 2001. They broke the death rates down by sex and by disease to assess trends over time for women and men, and for different causes of death.

Over these four decades, the researchers found that the overall US life expectancy increased from 67 to 74 years of age for men and from 74 to 80 years for women. Between 1961 and 1983 the death rate fell in both men and women, largely due to reductions in deaths from cardiovascular disease (heart disease and stroke). During this same period, 1961-1983, the differences in death rates among/across different counties fell. However, beginning in the early 1980s the differences in death rates among/across different counties began to increase. The worst-off counties no longer experienced a fall in death rates, and in a substantial number of counties, mortality actually increased, especially for women, a shift that the researchers call "the reversal of fortunes." This stagnation in the worst-off counties was primarily caused by a slowdown or halt in the reduction of deaths from cardiovascular disease coupled with a moderate rise in a number of other diseases, such as lung cancer, chronic lung disease, and diabetes, in both men and women, and a rise in HIV/AIDS and homicide in men. The researchers' key finding, therefore, was that the differences in life expectancy across different counties initially narrowed and then widened.

So basically there is a growing health gap in the United States. Despite its status as a developed nation, the country is likely to harbor more and more communities where life expectancy is more like a developing nation. We're looking at a future where it's going to be increasingly difficult to say whether a country is "developing" or "developed" since it will exhibit characteristics of both.

The Reversal of Fortunes
[PLoS Medicine]