Falling behind: life expectancy in US counties from 2000 to 2007 in an international context

BackgroundThe United States health care debate has focused on the nation's uniquely high rates of lack of insurance and poor health outcomes relative to other high-income countries. Large disparities in health outcomes are well-documented in the US, but the most recent assessment of county disparities in mortality is from 1999. It is critical to tracking progress of health reform legislation to have an up-to-date assessment of disparities in life expectancy across counties. US disparities can be seen more clearly in the context of how progress in each county compares to international trends.MethodsWe use newly released mortality data by age, sex, and county for the US from 2000 to 2007 to compute life tables separately for each sex, for all races combined, for whites, and for blacks. We propose, validate, and apply novel methods to estimate recent life tables for small areas to generate up-to-date estimates. Life expectancy rates and changes in life expectancy for counties are compared to the life expectancies across nations in 2000 and 2007. We calculate the number of calendar years behind each county is in 2000 and 2007 compared to an international life expectancy time series.ResultsAcross US counties, life expectancy in 2007 ranged from 65.9 to 81.1 years for men and 73.5 to 86.0 years for women. When compared against a time series of life expectancy in the 10 nations with the lowest mortality, US counties range from being 15 calendar years ahead to over 50 calendar years behind for men and 16 calendar years ahead to over 50 calendar years behind for women. County life expectancy for black men ranges from 59.4 to 77.2 years, with counties ranging from seven to over 50 calendar years behind the international frontier; for black women, the range is 69.6 to 82.6 years, with counties ranging from eight to over 50 calendar years behind. Between 2000 and 2007, 80% (men) and 91% (women) of American counties fell in standing against this international life expectancy standard.ConclusionsThe US has extremely large geographic and racial disparities, with some communities having life expectancies already well behind those of the best-performing nations. At the same time, relative performance for most communities continues to drop. Efforts to address these issues will need to tackle the leading preventable causes of death.

[1]  M. Siahpush,et al.  Widening socioeconomic inequalities in US life expectancy, 1980-2000. , 2006, International journal of epidemiology.

[2]  Julio Frenk,et al.  Ranking 37th--measuring the performance of the U.S. health care system. , 2010, The New England journal of medicine.

[3]  Joyce M. Manchester,et al.  Growing Disparities in Life Expectancy , 2008 .

[4]  W. Hadden,et al.  The increasing disparity in mortality between socioeconomic groups in the United States, 1960 and 1986. , 1993, The New England journal of medicine.

[5]  Lester R Curtin,et al.  U.S. decennial life tables for 1999-2001, United States life tables. , 2008, National vital statistics reports : from the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System.

[6]  H. Howe,et al.  County-level poverty and distant stage cancer in the United States , 2009, Cancer Causes & Control.

[7]  E. Feuer,et al.  Projecting SEER cancer survival rates to the US: an ecological regression approach , 2002, Cancer Causes & Control.

[8]  S. Eberhardt,et al.  Life Expectancy in Four U.S. Racial/Ethnic Populations: 1990 , 1995, Epidemiology.

[9]  P. Sicherl.  Integrating Comparisons Across Time and Space: Methodology and Applications to Disparities within Yugoslavia , 1992, Journal of Public Policy.

[10]  Pavle Sicherl.  TIME-DISTANCE AS A DYNAMIC MEASURE OF DISPARITIES IN SOCIAL AND ECONOMIC DEVELOPMENT* , 1973 .

[11]  S. Harper,et al.  Trends in the black-white life expectancy gap in the United States, 1983-2003. , 2007, JAMA.

[12]  Victor R. Preedy,et al.  Population Health Metrics , 2010 .

[13]  S. Preston,et al.  Demography: Measuring and Modeling Population Processes , 2000 .

[14]  D. Mozaffarian,et al.  The Preventable Causes of Death in the United States: Comparative Risk Assessment of Dietary, Lifestyle, and Metabolic Risk Factors , 2009, PLoS medicine.

[15]  Stephen S Lim,et al.  Tracking progress towards universal childhood immunisation and the impact of global initiatives: a systematic analysis of three-dose diphtheria, tetanus, and pertussis immunisation coverage , 2008, The Lancet.

[16]  H. Freeman,et al.  Excess mortality in Harlem. , 1990, The New England journal of medicine.

[17]  M. Coleman,et al.  Toward a comparison of survival in American and European cancer patients , 2000, Cancer.

[18]  J. Lynch,et al.  Inequality in income and mortality in the United States: analysis of mortality and potential pathways , 1996, BMJ.

[19]  M. Kogan,et al.  Persistent Socioeconomic Disparities in Infant, Neonatal, and Postneonatal Mortality Rates in the United States, 1969–2001 , 2007, Pediatrics.

[20]  Vasja Vehovar,et al.  Methodological Challenges of Digital Divide Measurements , 2006, Inf. Soc..

[21]  K. Fiscella,et al.  Inequality in quality: addressing socioeconomic, racial, and ethnic disparities in health care. , 2000, JAMA.

[22]  Steffie Woolhandler,et al.  Health insurance and mortality in US adults. , 2009, American journal of public health.

[23]  A. Coale,et al.  Revised regional model life tables at very low levels of mortality. , 1989, Population index.

[24]  N. Krieger,et al.  The Fall and Rise of US Inequities in Premature Mortality: 1960–2002 , 2008, PLoS medicine.

[25]  E. Arias,et al.  United States Census 2000 population with bridged race categories. , 2003, Vital and health statistics. Series 2, Data evaluation and methods research.

[26]  Majid Ezzati,et al.  Eight Americas: Investigating Mortality Disparities across Races, Counties, and Race-Counties in the United States , 2006, PLoS medicine.

[27]  V. Navarro,et al.  Race or class versus race and class: mortality differentials in the United States , 1990, The Lancet.

[28]  C. Simpson.  Remarks on behalf of the Office of Minority Health, U.S. Department of Health and Human Services. , 1996, Asian American and Pacific Islander journal of health.

[29]  Susan L Ettner,et al.  Contribution of major diseases to disparities in mortality. , 2002, The New England journal of medicine.

[30]  M. Thun,et al.  Individual- and area-level socioeconomic status variables as predictors of mortality in a cohort of 179,383 persons. , 2004, American journal of epidemiology.

[31]  J. Martin,et al.  National Vital Statistics Reports , 2002 .

[32]  T. Getzen,et al.  Economic and demographic trends signal an impending physician shortage. , 2002, Health affairs.

[33]  J. Feldman,et al.  National trends in educational differentials in mortality. , 1989, American journal of epidemiology.

[34]  Ellen Nolte,et al.  Measuring the health of nations: updating an earlier analysis. , 2008, Health affairs.

[35]  Gopal K. Singh,et al.  Area deprivation and widening inequalities in US mortality, 1969-1998. , 2003, American journal of public health.

[36]  T. Waidmann,et al.  Poverty, time, and place: variation in excess mortality across selected US populations, 1980-1990. , 1999, Journal of epidemiology and community health.

[37]  E. Eaker,et al.  Poverty and Death in the United States , 1996, International journal of health services : planning, administration, evaluation.

[38]  Ari B. Friedman,et al.  The Reversal of Fortunes: Trends in County Mortality and Cross-County Mortality Disparities in the United States , 2008, PLoS medicine.

[39]  N. Kressin,et al.  Agreement between administrative data and patients' self-reports of race/ethnicity. , 2003, American journal of public health.

[40]  S. Preston,et al.  Low Life Expectancy in the United States: Is the Health Care System at Fault? , 2009 .

[41]  S. Schroeder,et al.  Class - the ignored determinant of the nation's health. , 2004, The New England journal of medicine.

[42]  R. Cardarelli.  The primary care workforce: a critical element in mending the fractured US health care system , 2009, Osteopathic medicine and primary care.

[43]  G. Singh,et al.  Trends and differentials in adolescent and young adult mortality in the United States, 1950 through 1993. , 1996, American journal of public health.

[44]  C. Murray,et al.  Trends in national and state-level obesity in the USA after correction for self-report bias: analysis of health surveys. , 2006, Journal of the Royal Society of Medicine.

[45]  S. Preston,et al.  Effects of Age Misreporting on Mortality Estimates at Older Ages , 1999 .

[46]  B. Miller,et al.  Health, life expectancy, and mortality patterns among immigrant populations in the United States. , 2004, Canadian journal of public health = Revue canadienne de sante publique.

[47]  P. Sicherl.  Comparing in two dimensions: a broader concept and a novel statistical measure of the time dimension of disparities , 2004 .

[48]  Jiaquan Xu,et al.  Deaths: final data for 2007. , 2010, National vital statistics reports : from the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System.

[49]  Jonathan Cylus,et al.  Health spending projections through 2019: the recession's impact continues. , 2010, Health affairs.

[50]  M. Kogan,et al.  Widening socioeconomic disparities in US childhood mortality, 1969 2000. , 2007, American journal of public health.

[51]  Ari B. Friedman,et al.  Diabetes prevalence and diagnosis in US states: analysis of health surveys , 2009, Population health metrics.

[52]  Mark E. Hill,et al.  African-american mortality at older ages: Results of a matching study , 1996, Demography.

[53]  C. Murray,et al.  Trends and Cardiovascular Mortality Effects of State-Level Blood Pressure and Uncontrolled Hypertension in the United States , 2008, Circulation.

[54]  S. Preston,et al.  US mortality in an international context: age variations. , 2010, Population and development review.