Life expectancy is rising overall in the United States, but in some areas, death rates are going conspicuously in the other direction. These geographical disparities are widening, according to a report published Monday in JAMA Internal Medicine.
Life expectancy is greatest in the high country of central Colorado, but in many pockets of the United States, life expectancy is more than 20 years lower, according to the report from the University of Washington’s Institute for Health Metrics and Evaluation.
“Life expectancy in many places in this country is declining. It’s going backward instead of forward,” said Ali Mokdad, a co-author of the report and a professor at the university. “These disparities are widening, so this gap is increasing.”
People are less likely to live longer if they are poor, get little exercise and lack access to health care, the researchers found. Mokdad said the quality and availability of that health care — for example, access to screening for signs of cancer — has a significant effect on health outcomes. The United States, he said, needs to rethink how it delivers medical care, with a much greater investment in prevention, and a more holistic approach to creating healthy communities.
Andrew Cherlin, a professor of sociology and public policy at Johns Hopkins University, said that the increasing inequality in death rates at the county level is troubling. “But it’s unclear from this study what has caused it,” said Cherlin, who was not part of the research team. "It’s hard to separate out the consequences of lower incomes, unhealthy conditions such as obesity, less access to health care providers, and of healthier people moving out of some counties.”
The new research echoes other findings in recent years that show that the United States is failing to keep up with improvements in longevity seen in other affluent nations. In 2013, researchers described what they called a “health disadvantage” in the United States when compared to peer countries. More recent research has focused on “diseases of despair” that have contributed to a dramatic spike in death rates among midlife working-class whites.
Mokdad said countries such as Australia are far ahead of the United States in delivering preventive care and trying to curb such harmful behaviors as smoking. “Smoking, physical inactivity, obesity, high blood pressure — these are preventable risk factors,” Mokdad said.
“We are falling behind our competitors in health. That is going to impact our productivity; that’s going to take away our competitive edge when it comes to the economy,” Mokdad said. “What we’re doing right now is not working. We have to regroup.”
The Institute for Health Metrics and Evaluation researchers looked at death certificates from 1980 through 2014. Among the places with sharply increased life expectancy and lower deaths over that period are the District of Columbia and Loudoun County, Va. — where life expectancy is up 12.8 and 12.4 percent, respectively. Fairfax County has the lowest all-cause death rate in the metropolitan Washington region, significantly lower than the national average.
Of the 10 counties where life expectancy has dropped the most since 1980, eight are in Kentucky. The other two are in Oklahoma and Alabama. The report includes an interactive map of death rates county by county (and sometimes by city, when a city is not part of a county). The areas with the worst mortality metrics include central Appalachia, the Mississippi Delta and areas in the Dakotas with large Native American populations.
The list of counties with the most improved life expectancy includes a number of remote locations in Alaska, including the North Slope and the Aleutian Islands, and the boroughs of Manhattan (a.k.a. “New York County”) and Brooklyn (Kings County), as well as San Francisco.
An earlier study from the same research institute showed a huge disparity in the death rate from lung cancer. Summit County in Colorado, home to ski resorts and the town of Breckenridge, had almost no lung cancer mortality — a death rate of 11 per 100,000 population in 2014. The county with the highest rate, 231 per 100,000, was rural Union County, Fla., a small county that is home to a large prison population.