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

As previous studies have shown, Asians have by far the longest life expectancy -- 87.4 years for women and 82.1 for men. Black urban men have the shortest (66.7), followed by Southern rural black men, at 67.7. Indian men in the West are next, at 69.4.

Curiously, Asian women in the United States -- many of whom are second-generation and have spent their whole lives here -- have a life expectancy that is three years longer than Japanese women, who, as a national group, are the longest-living in the world. Previous research suggests that Asians lose their "survival advantage" after they are in the United States for a long time and have adopted an American diet and habits, but the new study suggests that is not happening with Asian women.

Among the more interesting comparisons, however, are those among whites.

Northern Plains whites have a per capita income below that of Middle America whites (about $18,000 vs. $25,000), and essentially the same percentage who are high school graduates (83 vs. 84). But they live longer -- 79 years vs. 77.9 years.

The comparison is even more dramatic with the Appalachian and Mississippi Valley group. The latter has a per capita income only $1,400 less than the Northern Plains group, but a markedly lower high school graduation rate, at 72 percent.

The gap in life expectancy between those groups in 2001 was 4.2 years for men and 3.8 years for women. This is not far off the overall gap of 6.4 years between black men and white men, and the 4.6-year gap between white women and black women.

The paper did not examine the causes of death between the groups. But the researchers note that high mortality in urban black men persists even when homicide and AIDS are removed. Heart attack, stroke, diabetes, cirrhosis and fatal injuries are the major causes of reduced life expectancy in that group.

The huge strides in cutting infant mortality in the past 50 years are clearly evident in the findings. The risk of dying between birth and age 4 is extremely similar among all Eight Americas -- much more similar than at any other age.

While black inner-city men have a mortality risk similar to that of West Africans, that is true only once they reach their forties. West Africans have a risk of dying in childhood more than 10 times that of even the most disadvantaged African Americans.

Interestingly, there was less variation among the Eight Americas in the rate of health insurance coverage and the frequency of routine medical appointments than there was in life expectancy. That finding suggests that access to care does not explain most of the differences in mortality.

Others in the field found the study informative and not surprising -- and also somewhat frustrating.

"The magnitude of the life expectancy disparity is most striking and is perhaps a bit larger than I might have guessed," said Mitchell Wong of the University of California at Los Angeles, who has studied how various diseases contribute to disparities in mortality. "However, it is not surprising that by combining race and geography, disparities are even larger."

Richard Cooper, chairman of preventive medicine at Loyola University School of Medicine, said that "the problem with these sorts of analyses is that they don't tell you anything very illuminating about the underlying social process" that leads to differences in life expectancy.

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