For the first time in generations, life expectancy for large numbers of Americans is stagnating or falling as more people pay for obesity, high blood pressure and other chronic conditions with shortened lives.
The findings, published Monday by researchers at Harvard University and the University of Washington, show that while Americans are living longer than ever on average, life expectancy is changing at increasingly unequal rates among the population.
Shrinking life expectancy is almost unheard of in an advanced nation, said Dr. Majid Ezzati, the studies first author and an associate professor at Harvard School of Public Health. And it is likely to worsen as the fates of the healthiest and least-healthy Americans continue to diverge.
More alarming is the real possibility that a reversal in life expectancy will touch more and more Americans, said Dr. Christopher Murray, director of the Institute for Health Metrics and Evaluation at UW and the paper's co-author.
"This is a harbinger of the future," Murray said.
Policy wake-up call
Researchers analyzed death figures by county between 1961 and 1999 and calculated that the average life expectancy climbed to a record 79.6 years for women and 74.1 years for men. But the gap is widening between the best- and worst-off counties; many of the latter lie in swaths through the Deep South, southern Midwest, Texas and parts of the Rocky Mountains.
About 26 million women, or 19 percent of that population, had stagnant or shortened life spans, compared with 4 percent of the men.
Women's historical gender edge in longevity is slowly shrinking: Women outlived men by an average of 5.5 years in 1999, down from 6.6 years in 1961.
Investigators said this is the first time that average life spans have fallen for significant numbers of American women since the Spanish flu pandemic of 1918, and the first time for men since the cigarettes-and-steaks era of the early 1950s.
"The decline for women is so stunning," Murray said. "This is a real wake-up call for health policy."
The paper appears in today's edition of the online journal PLoS Medicine.
Beginning in the early 1980s, life expectancy for segments of the population began to fall as smoking, obesity and high blood pressure began exacting greater tolls. Specifically, women's deaths from lung cancer, diabetes and lung disease outpaced the drop in deaths from heart diseases, which had propped up overall female life expectancy during the 1960s and 70s.
For men, on the other hand, higher death rates from HIV/AIDS and homicides among young and middle-age males, as well as rising mortality from diabetes, cancers and lung disease, were largely offset by continuing gains against cardiovascular diseases.
Geography, income
Life expectancy for Russians fell during the 1990s, and it continues to fall in countries such as South Africa and Botswana that are grappling with the HIV epidemic and high infant mortality. But the rule of thumb for industrialized countries for a half-century has been ever-lengthening life spans, Ezzati said.
King County had Washington's third-largest gain in overall life expectancy during the past four decades with 8.2 years, to an average of 79.2 years. Jefferson County was No. 1, followed by Island and San Juan counties together. Snohomish County ranked ninth with a gain of 7 years, to an average of 78.4 years.
Douglas County had the smallest gain, with 3.8 years. But Grays Harbor County was last in life expectancy in 1999, with the lowest average of 74.9 years.
Murray and Ezzati said they hope their research will help better guide strategies for tackling health disparities. Geography and income — but not race or migration patterns — appear to bind Americans with stagnant or declining life expectancies.
The researchers couldn't fully explain that, except to say that it suggests the problem goes beyond individual health choices. Murray noted, for instance, that the majority of people with high blood pressure do not get medical care for it.
"This is as much a challenge for better primary health care as it is trying to get people to adopt healthier lifestyles," Murray said.
James Wiley, a public-health expert at San Francisco State University, said the paper should sound an alarm — for individuals and for public officials. Wiley said Americans should heed the message to quit smoking, eat right and exercise, a message he said should be aimed not only at adults but at children as well.
But the government also needs to ensure that all Americans have adequate health care, Wiley said. The only path to longevity, he said, is through "prevention, prevention, prevention."
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