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June 15, 2011

Life expectancy in most U.S. counties falls behind worlds healthiest nations

Black men and women have lower life expectancies than white men and women in all counties. Life expectancy for black women ranges from 69.6 to 82.6 years, and for black men, from 59.4 to 77.2 years. In both cases, no counties are ahead of the international frontier. Some are more than 50 years behind. The researchers were not able to analyze other race categories because of low populations in many counties.

Change in life expectancy is so uneven that within some states there is now a decade difference between the counties with the longest lives and those with the shortest. States such as Arizona, Florida, Virginia, and Georgia have seen some of their  counties leap forward more than five years from 1987 to 2007 while nearby counties stagnate or even lose years of life expectancy.

In Arizona, Yuma Countys average life expectancy for men increased 8.5 years, nearly twice the national average, while neighboring La Paz County lost a full year of life expectancy, the steepest drop nationwide. Nationally, life expectancy increased 4.3 years for men and 2.4 years for women between 1987 and 2007.

“By creating this time series, which has never been available at the county level, we hope states and counties will be able to take targeted action,” Dr. Sandeep Kulkarni, an IHME research fellow and the papers lead author, said. “Counties in one part of the state should not be benefiting from big increases in life expectancy while other counties are actually seeing life spans shrink.”

The authors propose that state and local policymakers use the life expectancy data and the county comparisons to tailor strategies that will fit the dynamics of their communities. This resonates with local policymakers, such as Dr. David Fleming, director of Public Health – Seattle & King County.

“Its not the health care system thats having the biggest impact on health; its the community,”  Fleming said. “The average person in the United States spends one hour annually in a physicians office unless they are really sick. So until we start moving our interventions out into the communities where people live, we are not going to get ahead of these problems.”

The Seattle & King County health department is collaborating with IHME on an ambitious analysis of health in King County, one of the largest studies of its kind. Called the Monitoring Disparities in Chronic Conditions (MDCC) Study, researchers are integrating data from emergency medical services, hospital discharge databases, pharmacy records, and other sources to identify the biggest health challenges in King County. They are surveying 9,000 people and taking blood samples to analyze for a range of risk factors and diseases.

“We are building the evidence for focused interventions that will make an impact locally,” said Dr. Ali Mokdad, UW professor of global Health and IHME researcher  who is leading the MDCC Study. “If we as a society are going to fund programs to improve health, we must ensure that we are measuring the impact, because these life expectancy numbers show that what we have been doing up until now clearly is not working.”

The Institute for Health Metrics and Evaluation (IHME) is an independent global research center at the UW providing sound measurement of population health and the factors that determine health, as well as rigorous evaluation of health system and health program performance. The Institutes goal is to improve population health by providing the best evidence possible to guide health policy – and by making that evidence easily accessible to decision-makers as they  strategically fund, design, and implement programs to improve health outcomes worldwide. IHME was created in 2007 through funding from the Bill & Melinda Gates Foundation and the state of Washington.