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In 1933, the average American could expect to live to the age of 61. Over the following decades, life expectancy increased steadily, reaching 78 years by 2005. At the same time, comprehensive health data revealed widening gaps in health status and mortality rates between different racial and socioeconomic groups.
“Life expectancy is either dropping or stagnating for nearly one in five American women.”
“Life expectancy is either dropping or stagnating for nearly one in five American women.”
Now, a startling new study has revealed that, for the first time, life expectancy is either dropping or stagnating for nearly one in five American women. The study, sponsored by the Centers for Disease Control and Prevention (CDC) and led by Harvard researchers, found the decline greatest in Appalachia, the Deep South and the southern Plains and Texas. Among the hardest-hit areas were 14 Kentucky counties, most in the eastern part of the state.
The researchers looked at data collected by the U.S. Census Bureau and the National Center for Health Statistics from 1961 to 1999. They divided the country into 2,068 units,including cities, counties or combinations of counties. Using data at this level allowed them to more closely examine the disparity in life expectancies between areas with differing social conditions and health programs.
They scrutinized information on all causes of death during these decades. They also studied disease-specific mortality rates and the socioeconomic characteristics of the best- and worst-performing counties. The report appears in the April 2008 issue of PloS Medicine.
From 1961 to 1999, the average life expectancy in the United States increased from 66.9 to 74.1 years for men and from 73.5 to 79.6 years for women. But the evidence shows that by the early 1980s the gains in life expectancy were not distributed evenly.
In the U.S. counties with the lowest mortality rates, life span rose for both men and women. However, in the worst-off counties, it improved very little if at all for either sex. Researchers determined that a reversal in the previous decline of cardiovascular disease, along with an increase in other chronic diseases, accounted in part for this period of stagnation.
In 180 counties, the life expectancy of women dropped significantly. Included were the Kentucky counties of Estill, Grayson, Hart, Laurel, Lee, Leslie, Letcher, McCreary, Madison, Mason, Menifee, Powell, Wayne and Whitley.
The down-turn in mortality rates, particularly for women, appears to be uniquely American and isn’t reflected in other high-income countries, the study’s authors state.
The researchers attributed the drop in female life expectancy in the United States to a corresponding increase in deaths due to lung cancer, diabetes, and chronic obstructive pulmonary disease (COPD) or emphysema. Women also experienced an increase in heart attacks and strokes during this period. The mortality rates associated with all of these diseases are related primarily to smoking, obesity and high blood pressure.
“This stagnation and reversal of mortality decline, although affecting a minority of the nation’s population, is particularly troubling because an oft-stated aim of the U.S. health system is the improvement of the health of ‘all people, and especially those at greater risk of health disparities,’ ” the researchers state. Another report issued by the Congressional Budget Office in April examined the disparities in life spans between persons with high and low income and between those with more and less education. The study found that in 1980, life expectancy at birth was 2.8 years longer for the highest socioeconomic group than for the lowest. By 2000, the difference had grown to 4.5 years.
The report contends that factors possibly contributing to this gap include smoking, obesity, adherence to medical treatments and therapies, healthy lifestyles, and use of health care. Previous research estimates that at least 20 percent of the difference in life expectancy between groups with different levels of education can be attributed to smoking.
According to the CDC, smoking-related diseases caused the deaths of approximately 178,000 women each year from 1995 to 1999. On average, these women died 14.5 years earlier because they smoked. In March 2001, the Office of the U.S. Surgeon General released a detailed report titled “Women and Smoking,” along with the following statement: “When calling attention to public health problems, we must not misuse the word ‘epidemic.’ But there is no better word to describe the 600-percent increase since 1950 in women’s death rates for lung cancer, a disease primarily caused by cigarette smoking. Clearly, smoking-related disease among women is a full-blown epidemic.”
The prevalence of obesity has also increased in the past 20 years. According to the CDC, 62 percent of women age 20 to 74 are overweight and approximately half of those are obese. Being overweight is associated with breast cancer and greatly increases the risk of type 2 diabetes as well as high blood pressure.
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Downturn in mortality rates a wake-up call for women
It’s shocking to learn that mortality rates have either increased or not improved for 19 percent of the female population in this country. But, as the Harvard study points out, many of the causes of the drop in life expectancy are due to essentially preventable chronic diseases brought on by smoking, obesity and high blood pressure. The increase in lung cancer and emphysema in women is an example.
Just by quitting smoking, a woman can decrease her risk for the important diseases linked to early death and disability, such as lung cancer, emphysema, heart disease, strokes and osteoporosis. Healthy eating and increased exercise can also reduce rates of major chronic diseases such as high blood pressure, diabetes, arthritis and many forms of cancer.
The fact that some women in Kentucky have a declining life expectancy is unacceptable and means that we have work to do. No one believes that lifestyle changes are easy to accomplish, and there may be social and psychological factors that make it difficult for women to change behaviors such as smoking, unhealthy eating and lack of exercise. Despite the difficulties, however, it’s really cheaper to eat a healthy diet and give up cigarettes. And help is available at no cost.
One source of free assistance is the toll-free number 1-800-QUIT-NOW (1-800- 784-8669). By calling this number, anyone can get free information about stopping smoking and can obtain access to free tobacco cessation counseling.
“Staying in school has been associated with improved health outcomes.”
The Get Moving Kentucky! program is another way in which women can take responsibility for improving their health by becoming more physically active. This is an ongoing eight-week program for individuals or teams of four people. It encourages participants to earn points by increasing physical activity through a variety of ways – by gardening, cleaning, dancing and walking. The program is operated through county extension agents who work with health departments, school systems and community organizations. County extension agents can also help with healthy eating plans.
The Kentucky Women’s Health Registry provides us with information about women’s health in Kentucky and pinpoints issues that need to be addressed. Through the data we collect, we’re able to look at associations between certain behaviors and health problems. The decline we’re seeing in life expectancy of Appalachian women is likely related to some of these health behaviors we’re studying.
One trait shared by the counties with the worst life expectancy is lower levels of educational attainment. Staying in school has been associated with improved health outcomes. In fact, the link between educational attainment and health is one of the most important predictors of life expectancy. Education helps people adhere to medication, navigate the health care system and communicate with doctors.
Of the more than 4,800 women participating in the Kentucky Women’s Health Registry, 1.5 percent report they did not graduate from high school, 10.9 percent have only a high school diploma or a GED and 87.6 percent have some college or vocational education.
Appalachian women, however, tended to have a lower level of education: 2.4 percent did not graduate from high school, 15.3 percent have not gone beyond a high school diploma or GED, and 82.4 percent have completed some college or vocational education.
The rates of obesity, hypertension, diabetes and cardiovascular disease also were clearly higher among Appalachian women: These women were 8.4 percent more likely to be obese than their non-Appalachian sisters, 3.1 percent more likely to have hypertension, 3.8 percent more likely to have diabetes, and 6.6 percent more likely to have cardiovascular disease.
These facts are a call to action for all of us to eliminate the health disparities across our state by increasing the availability of programs to improve education and healthy lifestyle choices for each and every woman in Kentucky. We believe that the information we receive from the registry will lead to new discoveries about diseases, new treatments and better overall health for Kentucky women today and for all the generations of women to come.
Dr. Crofford is director of the UK Center for the Advancement of Women’s Health, chief of the UK Division of Women’s Health & Rheumatology; and Gloria W. Singletary Professor of Internal Medicine at the UK College of Medicine. She developed the Kentucky Women’s Health Registry, the first statewide registry of its kind in the United States.
Each issue of Advances & Insights summarizes an important piece of medical news, accompanied by commentary from a UK expert.
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