Location, Income Key to Longevity, Study Says
Location, Income Key to Longevity, Study Says
Where you live in the United States — as well as your race and income — play a big role in the nation's health disparities. A new report tracks mortality disparities and found that Asian-American women living in Bergen County, N.J., lead the nation in longevity, typically reaching their 91st birthday.
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RENEE MONTAGNE, host:
Where you live could influence how long you live. A new report by the Harvard School of Public Health finds that Asian-American women living in Bergen County, New Jersey typically reach their 91st birthday. But Native American men residing in parts of South Dakota tend to die more than three decades earlier, around age 58.
Dr. Christopher Murray is the lead author of the report, and he joins us now on the line from Cambridge, Massachusetts. Good morning.
Dr. CHRISTOPHER MURRAY (School of Public Health, Harvard University): Good morning.
MONTAGNE: This gap is huge. What accounts for it?
Dr. MURRAY: Well, it's an enormous gap by any standards if you look around the globe in terms of life expectancy, so accounting for it actually takes some doing. And that was really a major thrust of what we were trying to understand in this study.
And usually when we think about disparities, we tend to focus in on differences in child mortality. Sometimes people tend to think these disparities are related to homicide or to HIV, or to differences in the elderly. And those contribute a little bit, but that's actually not the major source. It turns out...
MONTAGNE: And the major source?
Dr. MURRAY: Yeah, the major source of the disparities is actually chronic disease in young, 15 to 44 year olds, and middle-aged 45 to 64 year old adults.
MONTAGNE: And what about the question of race and income? I gather your report doesn't necessarily say that is a determinant of one's lifespan.
Dr. MURRAY: Well, I think it's safe to say from a whole accumulated body of research that in any community, richer people live longer for a host of reasons to do with risk factors, to do with access to care. But when you look across communities in the United States, unusual patterns stand out that tell us that things other than race and income must also be very important.
One group in particular that stands out is below median income white Americans living in rural areas in Minnesota, Iowa, the Dakotas, Nebraska, that have some of the longest life spans in the U.S. And clearly, (unintelligible)...
MONTAGNE: And what could explain that? Very quickly, we just have a few seconds left.
Dr. MURRAY: Oh, well, trying to understand that obviously brings you quickly to the main risk factors for chronic disease in young and middle-aged adults. And in order of importance in the United States those would be tobacco, alcohol, (unintelligible) blood pressure, cholesterol, low fruit and vegetable intake, and physical inactivity. So although our study doesn't have detailed data for each county or each group on those risk factors, it's a reasonable view that those unusually long life spans in poor areas in some subsets and groups have to be related to the culture people have acquired related to those risk factors.
I think an important part of our study, though, is - or the interpretation of our study, is that even though those lifestyle factors have got to account for many of these patterns, what we would do about it may be much more closely related to public health and medicine.
MONTAGNE: Dr. Murray, thanks very much.
Dr. MURRAY: Thank you very much.
MONTAGNE: Christopher Murray is Director of the Harvard Initiative for Global Health, joining us on the line from Cambridge, Massachusetts. And you can see a state-by-state comparison of life expectancy at npr.org.
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Where You Live Can Affect How Long You Live
The 'Eight Americas'
Dr. Christopher 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:"
- Asian-Americans, average per capita income of $21,566, have a life expectancy of 84.9 years.
- Northland low-income rural whites, $17,758, 79 years.
- Middle America (mostly white), $24,640, 77.9 years.
- Low income whites in Appalachia, Mississippi Valley, $16,390, 75 years.
- Western American Indians, $10,029, 72.7 years.
- Black Middle America, $15,412, 72.9 years.
- Southern low-income rural blacks, $10,463, 71.2 years.
- High-risk urban blacks, $14,800, 71.1 years.
--The Associated Press
WASHINGTON (AP) -- Asian-American women living in Bergen County, N.J., lead the nation in longevity, typically reaching their 91st birthdays. Worst off are American Indian men in swaths of South Dakota, who die around age 58 -- three decades sooner.
Where you live, combined with race and income, plays a huge role in the nation's health disparities, differences so stark that a report issued Monday contends it's as if there are eight separate Americas instead of one.
Millions of the worst-off Americans have life expectancies typical of developing countries, concluded Dr. Christopher Murray of the Harvard School of Public Health.
Asian-American women can expect to live 13 years longer than low-income black women in the rural South, for example. That's like comparing women in wealthy Japan with those in poverty-ridden Nicaragua.
Compare those longest-living women with 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. Murray's county-by-county comparison of life expectancy 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," explained Murray, who reported initial results of his government-funded study in the online science journal PLoS Medicine.
Consider: The longest-living whites weren't the relatively wealthy, which Murray calls "Middle America." They're edged out 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.
He cites American Indians as another example. Those who don't live on or near reservations in the West have life expectancies similar to that of whites.
"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 allow 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 reduced by half the diabetes-caused amputations among black men in Charleston, S.C., since 1999, largely by encouraging physical activity -- and the new study argues for more, he said.
"It's not just telling people to be active or not to smoke," Giles said. "We need to create the environment which assists people in achieving a healthy lifestyle."
The study also highlights that the complicated tapestry of local and cultural customs may be more important than income in driving health disparities, said Richard Suzman of the National Institute on Aging, which co-funded the research.
"It's not just low income," Suzman said. "It's what people eat, it's how they behave, or simply what's available in supermarkets."
Longevity disparities were most pronounced in young and middle-aged adults. A 15-year-old urban black man was 3.8 times as likely to die before the age of 60 as an Asian-American, for example.
That's key, Murray said, because this age group is left out of many government health programs that focus largely on children and the elderly.
Moreover, the longevity gaps have stayed about the same for 20 years despite increasing national efforts to eliminate obvious racial and ethnic health disparities, he found.
Murray was surprised to find that lack of health insurance explained only a small portion of those gaps. Instead, differences in alcohol and tobacco use, blood pressure, cholesterol and obesity seemed to drive death rates.
Most important, he said, will be pinpointing geographically defined factors -- such as shared ancestry, dietary customs, local industry, what regions are more or less prone to physical activity -- that, in turn, influence those health risks.
For example, scientists have long thought that the Asian longevity advantage would disappear once immigrant families adopted higher-fat Western diets. Murray's study is the first to closely examine second-generation Asian-Americans, and found their advantage persists.