U.S. Life Expectancy Tied to Race and Place

For example, Asian American women live decades longer than urban black males

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By Steven Reinberg
HealthDay Reporter

MONDAY, Sept. 11, 2006 (HealthDay News) -- While Americans are living longer than ever before, the length of your life just might depend on where you reside and what racial group you belong to, researchers say.

Life expectancy in the United States varies widely from place to place and between races, said a team from Harvard University, Boston. In 2001, for example, the average Asian American woman could expect to live 21 years longer that the average black male living in a high-risk area.

"There are very large inequalities in mortality and health in American people," said lead researcher Majid Ezzati, an associate professor of international health at Harvard School of Public Health. "These inequalities can be mapped and described using a small number of sociodemographic and geographical indicators," he said.

Based on this type of data, the researchers came up with "Eight Americas:" life-expectancy categories based on a person's race, local surroundings and other community characteristics.

The report was published in the September issue of the open-access journal PLoS Medicine.

Using data from the U.S. Bureau of the Census and the National Center for Health Statistics, Ezzati's team calculated death rates for 1982 to 2001. They combined this data into a small number of groups -- their Eight Americas -- containing millions or tens of millions of people.

For each group, Ezzati's team estimated life expectancy, the risk of death from specific diseases at different ages, the proportion of people who had health insurance, and the access to health care services. They also created maps of life expectancies for U.S. counties.

Ezzati's Eight Americas are: Asians, northland low-income rural whites, Middle-Americans, low-income whites in Appalachia and the Mississippi Valley, western Native Americans, black Middle-Americans, southern low-income rural blacks, and high-risk urban blacks.

The team found big differences in life expectancy between the eight groups.

For example, for men and women, the life expectancy gap between the best-off and the worst-off groups was 15.4 years for males -- Asians vs. high-risk urban blacks -- and 12.8 years for females -- Asians vs. low-income rural blacks in the South. These differences are as large as those found between Japan, the nation with the highest life expectancy in the world, and many low-income developing countries, the team pointed out.

Heart disease, diabetes and injuries were mainly responsible for the differences, Ezzati noted. Most of these conditions are preventable with specific interventions, he added. The gaps between best-off and worst-off were similar in 2001 to what they were in 1987.

"Something needs to happen about the inequalities in health care," Ezzati said. "Given the types of diseases that are the cause of these inequalities, disease prevention should have a major role. Instead of thinking about how many lives are going to be saved by lowering blood pressure and cholesterol, etc., we should think about whose lives we are saving," he said.

One expert found the findings disturbing.

"How sobering it is to learn that we live in as many as eight different worlds -- and all within the United States," said Dr. David L. Katz, an associate professor of public health and director of the Prevention Research Center at Yale University School of Medicine.

The United States is the world leader in biomedical advances, high-tech care, and health care expenditure, Katz said, but "we are also the world leader in health disparities. Within the borders of just this one country, the health experiences of diverse populations are truly worlds apart."

According to Katz, a concerted effort is required to focus attention on these disparities, and to mobilize targeted efforts to eliminate them.

"Culturally tailored interventions that take messages of disease prevention and health promotion to the places they are most urgently needed should be a national public health priority," he said. "A system that allocates both health care and health as inequitably as ours cannot be considered anything but a failure."

More information

For more on disparities in health care, head to the U.S. Centers for Disease Control and Prevention.

SOURCES: Majid Ezzati, Ph.D., associate professor, international health, Harvard School of Public Health, Boston; David L. Katz, M.D., M.P.H., associate professor, public health, director, Prevention Research Center, Yale University School of Medicine, New Haven, Conn.; September 2006, PLoS Medicine

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