Wide Gaps Found In Mortality Rates Among U.S. Groups

By David Brown
Washington Post Staff Writer
Tuesday, September 12, 2006

A black man living in a high-crime American city can expect to live 21 fewer years than a woman of Asian descent in the United States. The man's life expectancy, in fact, is closer to that of people living in West Africa than it is to the average white American.

Inhabitants of what a new report calls "Black Middle America" -- African Americans who live outside inner cities and the rural South -- also have a life expectancy five years shorter than those in "Middle America," which encompasses the vast majority of urban and suburban whites.

Even between groups that appear quite similar there are wide differences in the risk of early death. A farmer from a Great Plains state such as North Dakota is likely to live four years longer than a farmer living in Appalachia or the Mississippi Valley.

Those are among the observations of the study, which examines death in the United States through an unusual lens that refracts the population into eight demographic groups, or "Eight Americas."

The differences in life expectancy across that spectrum are as wide as the difference between Iceland and Uzbekistan. The study, based on 2001 data, reveals a United States that is pocked by places where millions of adults face a risk of premature death like that in Angola, Mexico, Nigeria and other parts of the developing world. Furthermore, those differences -- the most obvious sign of the health disparities that have captured the attention of policymakers -- have not changed in two decades.

"I think it's pretty fair to say we're failing," said Christopher J.L. Murray, a researcher at the Harvard School of Public Health. "The score card on the macro level has been failure."

One of the reasons for the persistence of the disparities, Murray says, is that the biggest difference in mortality is seen among people in middle age. That part of the population has not been a major focus of new investment in government health programs in the past two decades.

Instead, children and the elderly -- among whom the disparities are less severe -- have been the principal targets of new and innovative health spending. Those include free vaccines for poor children, the state and federal governments' Children's Health Insurance Program (CHIP), and the drug benefit (Part D) recently added to the Medicare program.

A decade ago, Murray and his colleagues looked at life expectancy county by county. In this study, they began with 2,000 geographical units -- counties or groups of counties. They then divided them into eight groupings based on ethnicity, race and income. Some were broad geographical areas, while others were essentially demographic archipelagos stretching across the nation.

The Eight Americas were: Asians, scattered throughout the country; rural whites in the Northern Plains and the Dakotas; white Middle America, consisting of 214 million people not assigned to other categories; low-income whites in Appalachia and the Mississippi Valley; Western Indians (the smallest group, with 1 million people); black Middle America; low-income rural Southern blacks; and high-risk urban blacks -- those living in places where a person has a 1 percent or greater risk of being killed between 15 and 74 years of age.

The study, by Majid Ezzati, also of Harvard, along with Murray and five other researchers, is published in the Public Library of Science's online journal, PLoS Medicine. It includes a list of the counties with the highest and lowest life expectancies in the nation.

Montgomery County is tied for first (81.3 years), with Fairfax County not far behind at 80.9. Baltimore City is next to last (68.6). The District, at 72 years, is also among the 50 jurisdictions with the shortest life expectancies.

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