I found this interpretation of the results in our local paper "The Age", which was a reprint of the same story from the "LA Times"
"The difference is not directly related to income, insurance, infant mortality, AIDS or violence, factors commonly associated with such disparities.
The most important contributors to increased mortality, in order of importance, were tobacco, alcohol, obesity, high-blood pressure, high cholesterol, diet and physical inactivity, said Christopher Murray of the Harvard School of Public Health, who led the study. "Those seven are likely to explain a lot of the patterns that we see," he said. "They also give us some hints about the types of public health and medical care interventions that could make a difference in these disparities."
Dave
David Young
Sally Birch Fellow in Cancer Control
Cancer Control Research Institute
100 Drummond St
Carlton Vic 3053
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"Relativity is not the relativity of truth, but the truth of relation"; Gille Deleuze, "The Fold: Leibnitz and the Baroque"
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-----Original Message-----
From: Social Determinants of Health [mailto:[log in to unmask]]On Behalf Of
Dennis Raphael
Sent: Tuesday, 12 September 2006 5:00 PM
To: [log in to unmask]
Subject: [SDOH] Wide Gaps Found In Mortality Rates Among U.S. Groups
http://www.washingtonpost.com/wp-dyn/content/article/2006/09/11/AR2006091101297_pf.html
Wide Gaps Found In Mortality Rates Among U.S. Groups
By David Brown
Washington Post Staff Writer
Tuesday, September 12, 2006; A01
A black man living in a high-crime American city can expect to live 21
fewer years than a woman of Asian descent in the United States. The man's
life expectancy, in fact, is closer to that of people living in West Africa
than it is to the average white American.
Inhabitants of what a new report calls "Black Middle America" -- African
Americans who live outside inner cities and the rural South -- also have a
life expectancy five years shorter than those in "Middle America," which
encompasses the vast majority of urban and suburban whites.
Even between groups that appear quite similar there are wide differences in
the risk of early death. A farmer from a Great Plains state such as North
Dakota is likely to live four years longer than a farmer living in
Appalachia or the Mississippi Valley.
Those are among the observations of the study, which examines death in the
United States through an unusual lens that refracts the population into
eight demographic groups, or "Eight Americas."
The differences in life expectancy across that spectrum are as wide as the
difference between Iceland and Uzbekistan. The study, based on 2001 data,
reveals a United States that is pocked by places where millions of adults
face a risk of premature death like that in Angola, Mexico, Nigeria and
other parts of the developing world. Furthermore, those differences -- the
most obvious sign of the health disparities that have captured the
attention of policymakers -- have not changed in two decades.
"I think it's pretty fair to say we're failing," said Christopher J.L.
Murray, a researcher at the Harvard School of Public Health. "The score
card on the macro level has been failure."
One of the reasons for the persistence of the disparities, Murray says, is
that the biggest difference in mortality is seen among people in middle
age. That part of the population has not been a major focus of new
investment in government health programs in the past two decades.
Instead, children and the elderly -- among whom the disparities are less
severe -- have been the principal targets of new and innovative health
spending. Those include free vaccines for poor children, the state and
federal governments' Children's Health Insurance Program (CHIP), and the
drug benefit (Part D) recently added to the Medicare program.
A decade ago, Murray and his colleagues looked at life expectancy county by
county. In this study, they began with 2,000 geographical units -- counties
or groups of counties. They then divided them into eight groupings based on
ethnicity, race and income. Some were broad geographical areas, while
others were essentially demographic archipelagos stretching across the
nation.
The Eight Americas were: Asians, scattered throughout the country; rural
whites in the Northern Plains and the Dakotas; white Middle America,
consisting of 214 million people not assigned to other categories;
low-income whites in Appalachia and the Mississippi Valley; Western Indians
(the smallest group, with 1 million people); black Middle America;
low-income rural Southern blacks; and high-risk urban blacks -- those
living in places where a person has a 1 percent or greater risk of being
killed between 15 and 74 years of age.
The study, by Majid Ezzati, also of Harvard, along with Murray and five
other researchers, is published in the Public Library of Science's online
journal, PLoS Medicine. It includes a list of the counties with the highest
and lowest life expectancies in the nation.
Montgomery County is tied for first (81.3 years), with Fairfax County not
far behind at 80.9. Baltimore City is next to last (68.6). The District, at
72 years, is also among the 50 jurisdictions with the shortest life
expectancies.
As previous studies have shown, Asians have by far the longest life
expectancy -- 87.4 years for women and 82.1 for men. Black urban men have
the shortest (66.7), followed by Southern rural black men, at 67.7. Indian
men in the West are next, at 69.4.
Curiously, Asian women in the United States -- many of whom are
second-generation and have spent their whole lives here -- have a life
expectancy that is three years longer than Japanese women, who, as a
national group, are the longest-living in the world. Previous research
suggests that Asians lose their "survival advantage" after they are in the
United States for a long time and have adopted an American diet and habits,
but the new study suggests that is not happening with Asian women.
Among the more interesting comparisons, however, are those among whites.
Northern Plains whites have a per capita income below that of Middle
America whites (about $18,000 vs. $25,000), and essentially the same
percentage who are high school graduates (83 vs. 84). But they live longer
-- 79 years vs. 77.9 years.
The comparison is even more dramatic with the Appalachian and Mississippi
Valley group. The latter has a per capita income only $1,400 less than the
Northern Plains group, but a markedly lower high school graduation rate, at
72 percent.
The gap in life expectancy between those groups in 2001 was 4.2 years for
men and 3.8 years for women. This is not far off the overall gap of 6.4
years between black men and white men, and the 4.6-year gap between white
women and black women.
The paper did not examine the causes of death between the groups. But the
researchers note that high mortality in urban black men persists even when
homicide and AIDS are removed. Heart attack, stroke, diabetes, cirrhosis
and fatal injuries are the major causes of reduced life expectancy in that
group.
The huge strides in cutting infant mortality in the past 50 years are
clearly evident in the findings. The risk of dying between birth and age 4
is extremely similar among all Eight Americas -- much more similar than at
any other age.
While black inner-city men have a mortality risk similar to that of West
Africans, that is true only once they reach their forties. West Africans
have a risk of dying in childhood more than 10 times that of even the most
disadvantaged African Americans.
Interestingly, there was less variation among the Eight Americas in the
rate of health insurance coverage and the frequency of routine medical
appointments than there was in life expectancy. That finding suggests that
access to care does not explain most of the differences in mortality.
Others in the field found the study informative and not surprising -- and
also somewhat frustrating.
"The magnitude of the life expectancy disparity is most striking and is
perhaps a bit larger than I might have guessed," said Mitchell Wong of the
University of California at Los Angeles, who has studied how various
diseases contribute to disparities in mortality. "However, it is not
surprising that by combining race and geography, disparities are even
larger."
Richard Cooper, chairman of preventive medicine at Loyola University School
of Medicine, said that "the problem with these sorts of analyses is that
they don't tell you anything very illuminating about the underlying social
process" that leads to differences in life expectancy.
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