Bad health news for women, at least those in many rural counties

Read the Associated Press story, as picked up in the Sacramento Bee, here. The regions most affected are the deep South and Appalachia, where the life expectancy of women declined significantly between 1983 and 1999. The trend for the rest of the country was an increase in life expectancy, + 7 years for men, + 6 years for women, according to the San Francisco Chronicle's coverage.

Nether the Bee nor the Chronicle actually uses the word "rural" to characterize the affected regions, but many of these counties are rural. Here's an excerpt from the Washington Post story, which explicitly observes the rural angle:

The downward trend is evident in places in the Deep South, Appalachia, the lower Midwest and in one county in Maine. It is not limited to one race or ethnicity but it is more common in rural and low-income areas. The most dramatic change occurred in two areas in southwestern Virginia (Radford City and Pulaski County), where women's life expectancy has decreased by more than five years since 1983.

The Chronicle story says:

During the two decades prior to 1980, according to the study, not one of the 3,100 counties in the United States reported a decline in life expectancy of men or women; in the final two decades, the researchers found declines among women in 963 counties and among men in 59 counties.

Using stricter statistical standards that rule out the possibility that the declines were the results of random chance, the researchers still spotted outright declines in female life expectancy in 180 American counties, and for men in 11 counties.

Ezzati and his team linked the reversals to several diseases. Among women, declines were caused by increased rates of lung cancer and chronic obstructive pulmonary disease - two smoking-related killers. Obesity-related illnesses such as adult-onset diabetes and hypertension also contributed to the declines in life expectancy found in men and women, while HIV and homicide caused significant declines in life expectancy for men.

These negative trends ran counter to the increasing life expectancy - seven years among men and six years among women - recorded for the nation as a whole. That underscores that there is a widening gap between the health haves and have-nots in the United States, and the study shows that whether the life expectancy news is good or bad has a lot to do with where a person resides.

In counties where declines occurred, they affected whites as well as blacks, which makes income seem a greater determinant than class. As for the gender divide reflected in the study, it is not immediately obvious to me why smoking-related diseases and hypertension should impact women more than men. Perhaps the impact of such diseases in these counties was already reflected in pre-1980 life expectancies for the male populace. Perhaps as the Washington Post reporter observed, this reflects the beginning of the consequences of the obesity epidemic, and the fact that women took up smoking in large numbers decades after men did so.