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Life Expectancy Drops for Some U.S. Women

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By David Brown
Washington Post Staff Writer
Tuesday, April 22, 2008

For the first time since the Spanish influenza of 1918, life expectancy is falling for a significant number of American women.

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In nearly 1,000 counties that together are home to about 12 percent of the nation's women, life expectancy is now shorter than it was in the early 1980s, according to a study published today.

The downward trend is evident in places in the Deep South, Appalachia, the lower Midwest and in one county in Maine. It is not limited to one race or ethnicity but it is more common in rural and low-income areas. The most dramatic change occurred in two areas in southwestern Virginia (Radford City and Pulaski County), where women's life expectancy has decreased by more than five years since 1983.

The trend appears to be driven by increases in death from diabetes, lung cancer, emphysema and kidney failure. It reflects the long-term consequences of smoking, a habit that women took up in large numbers decades after men did, and the slowing of the historic decline in heart disease deaths.

It may also represent the leading edge of the obesity epidemic. If so, women's life expectancy could decline broadly across the United States in coming years, ending a nearly unbroken rise that dates to the mid-1800s.

"I think this is a harbinger. This is not going to be isolated to this set of counties, is my guess," said Christopher J.L. Murray, a physician and epidemiologist at the University of Washington who led the study. It is being published in PLoS Medicine, an open-access journal of the Public Library of Science.

Said Elizabeth G. Nabel, director of the National Heart, Lung and Blood Institute of the National Institutes of Health: "The data demonstrate a very alarming and deeply concerning increase in health disparities in the United States."

The study found a smaller decline, in far fewer places, in the life expectancy of men in this country. In all, longevity is declining for about 4 percent of males.

The phenomenon appears to be not only new but distinctly American.

"If you look in Western Europe, Australia, Japan, New Zealand, we don't see this," Murray said.

About half of all deaths in the United States are attributable to a small number of "modifiable" behaviors and exposures, such as smoking, poor diet and lack of exercise. Although it is impossible to know exactly what is going on in the 1,000 counties, Murray thinks it "would be a reasonably obvious strategy" to target them for aggressive public health campaigns.

Life expectancy is not a direct measure of how long people live. Instead, it is a prediction of how long the average person would live if the death rates at the time of his or her birth lasted a lifetime.


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