By Steve Sternberg, USA TODAY
WASHINGTON America is a nation divided by vast differences in life expectancy, a "longevity gap" that can't be readily explained by race, income or access to health care, a study reported Monday.
MAPPING IT OUT : A snapshot of the '8 Americas'
In fact, when viewed through the prism of life expectancy, there are eight Americas, with decades separating groups consisting of millions of people, report Harvard's Christopher Murray and his colleagues.
His team examined state and county life expectancies, the risk of death from specific diseases, health insurance and access to health care for major population groups from 1980 to 2001. They found that life expectancy differences are driven mainly by chronic diseases in young and middle-aged adults. Income, infant mortality, violence and HIV/AIDS, which now responds to drugs, played less of a role.
Among long-lived people 15 to 44, the death toll from chronic disease was as low as among the Japanese. The profile for the group with the shortest life span resembles Russia. "Where we fall down is delivering health care for young and middle-aged adults," Murray says.
The longest living group, "America One," consists of 10.4 million Asians, with an average life expectancy of 85, says the study in the journal PloS Medicine. That's 27 years longer than the average 58-year life expectancy of Native Americans in South Dakota.
The second group, "America Two," indicates that income isn't the key to a longer life span. This group is made up of 3.6 million low-income whites living in Minnesota, the Dakotas, Iowa, Montana and Nebraska, with an average life expectancy of 79. "White populations living below the median incomes in northern states have the best level of health among whites. That runs counter to everything we know," Murray says.
The 214 million people in "America Three," the bulk of the population, have an average life expectancy of 78. Next, in rank order, come poor whites in Appalachia and the Mississippi Valley with an average life expectancy of 75, Western Native Americans, who live to an average of 73, and black middle America, also 73. Low-income Southern rural blacks and high-risk urban blacks, "Americas Seven and Eight," live to 71.
Jonathan Skinner of Dartmouth says much of the variation depends on such individual factors as diet, exercise and smoking, not health care. "Yet we spend much of our attention and 16% of our national income on health care," Skinner says. "There's no way that differences in the quality of health care can explain 20-year gaps in life expectancy."