Where you live can affect how long you live

POSTED: 9:14 a.m. EDT, September 12, 2006

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WASHINGTON (AP) -- The longest-living Americans can expect to survive decades longer than the worst off -- and the explanation is far more complex than poverty, says a startling report on the nation's health disparities.

It turns out that where you live, combined with race and income, plays a huge role in whether you die young, says a study issued Monday that contends the differences are so stark it's as if there are eight separate Americas instead of one.

Worse, the gaps in lifespan have persisted over 20 years, despite efforts to tackle them, concluded Dr. Christopher Murray of the Harvard School of Public Health.

"That's pretty devastating," said Murray, who published the exhaustive analysis in the online science journal PLoS Medicine. "Whatever it is that we're doing isn't working. That's a wakeup call."

Leading the nation in longevity are Asian-American women who live in Bergen County, New Jersey, and typically reach their 91st birthdays, concluded Murray's county-by-county analysis.

On the opposite extreme are American Indian men in swaths of South Dakota, who die around 58.

Millions of the worst-off Americans have life expectancies typical of developing countries, lamented Murray. The Asian-American women can expect to live 13 years longer than low-income black women in the rural South. That's like comparing women in wealthy Japan to those in poverty-ridden Nicaragua.

Compare those longest-living women to inner-city black men, and the life-expectancy gap is 21 years. That's similar to the life-expectancy gap between Iceland and Uzbekistan.

Health disparities are widely considered an issue of minorities and the poor being unable to find or afford good medical care. But Murray's government-funded study shows the problem is far more complex, and that geography plays a crucial role.

"Although we share in the U.S. a reasonably common culture ... there's still a lot of variation in how people live their lives," he explained.

The longest-living whites weren't the relatively wealthy, which Murray calls "Middle America." They're edged out, by a year, by low-income residents of the rural Northern Plains states, where the men tend to reach age 76 and the women 82.

Yet low-income whites in Appalachia and the Mississippi Valley die four years sooner than their Northern neighbors.

"If it's your family involved, these are not small differences in lifespan," Murray said. "Yet that sense of alarm isn't there in the public.

"If I were living in parts of the country with those sorts of life expectancies, I would want ... to be asking my local officials or state officials or my congressman, 'Why is this?"'

This more precise measure of health disparities will enable federal officials to better target efforts to battle inequalities, said Dr. Wayne Giles of the Centers for Disease Control and Prevention, which helped fund Murray's work.

The CDC has some county-targeted programs -- like one that has cut in half diabetes-caused amputations among black men in Charleston, South Carolina, since 1999, largely by encouraging physical activity -- and the new study argues for more, Giles said.

"It's not just telling people to be active or not to smoke," he said. "We need to create the environment which assists people in achieving a healthy lifestyle."

Murray analyzed mortality data between 1982 and 2001 by county, race, gender and income. He found some distinct groupings that he named the "eight Americas:"