No County For Old Women

I applaud this advance in women's equality.  Kidding - this is obviously bad news:

Life Expectancy Drops for Some U.S. Women
Historic Reversal, Found in 1,000 Counties, May Be Result of Smoking and Obesity

By David Brown
Washington Post Staff Writer
Tuesday, April 22, 2008; A01

For the first time since the Spanish influenza of 1918, life expectancy is falling for a significant number of American women.

In nearly 1,000 counties that together are home to about 12 percent of the nation's women, life expectancy is now shorter than it was in the early 1980s, according to a study published today.

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.

Before you blame Bush (Hope it's not too late! [Ooops - it is, see UPDATE), this study is based on public health statistics from 1983 to 1999.

In the study, Murray and collaborators at the Harvard School of Public Health examined mortality and cause-of-death data for the United States from 1961 through 1999. They divided the country into 2,068 units, including cities, counties or combinations of counties.

Across that four-decade period, average life expectancy nationwide increased from 66.9 years to 74.1 years for men, and from 73.5 years to 79.6 years for women.

From 1961 to 1983, life expectancy went up everywhere for both sexes. This was largely because the death rate from heart attacks, which had been rising for half a century, began to fall in the late 1960s. There were two reasons.

Huge numbers of people lowered their chances of having a heart attack by modifying "risk factors," such as smoking, hypertension and high cholesterol. Improvements in medicine -- coronary care units, use of aspirin and beta-blocker drugs, and various surgical procedures -- greatly increased survival in patients with heart disease. About two-thirds of the longevity gained over the past four decades has come from the decrease in cardiovascular deaths.

These changes were so dramatic that even the poorest and least healthy groups benefited. In fact, counties with low life expectancy in 1961 had steeper rises over the next dozen years than counties that started out with high life expectancy. Overall, the drop in heart attack deaths more than offset rising mortality from cancer, emphysema and diabetes during this period.

By the early 1980s, however, the rapid gains were coming to an end. The low-hanging fruit on the tree of heart-attack prevention and treatment had been picked. Further strides tended to happen mostly in places where people were already healthy and long-lived.

As a consequence, the rise in longevity began to stagnate in places with the least-healthy people. In those counties, life expectancy increased by only one year (from 74.5 to 75.5) between 1983 and 1999, while in the healthiest places the life expectancy of women had reached 83.

It was during this interval that women's life expectancy fell in nearly 1,000 counties. If one adds counties where it rose only insignificantly, then 19 percent of American women -- nearly 1 in 5 -- are now experiencing stagnating or falling life expectancy.

It is a subtle concept, but I question that last paragraph, which tells us that "19 percent of American women... are now experiencing stagnating or falling life expectancy."

I'll take at face value that 19 percent of American women live in statistical units ("counties") which have seen flat or declining life expectancies.  But is a woman who exercises, doesn't smoke, and minds her weight while living in one of those counties experiencing a declining life expectancy?  Is a fat wreck living in an otherwise healthy county also healthy?

I could see the value of their broad statement if the underlying cause was, for example, high levels of industrial pollution (cited at one time as affecting public health in Romania, for example).

Their conclusion:

"This is a story about smoking, blood pressure and obesity," said Majid Ezzati, of the Harvard Initiative for Global Health, a co-author of the paper.

Volunteers (almost) all.

UPDATE:  Can we count on AmericaBlog to type before they read, or think?  Yes we can!

In the United States in the year 2008, life expectancy for many women is dropping.
by Joe Sudbay (DC); 4/22/2008 09:43:00 AM ET

Another proud legacy of the Bush administration, news you'd probably expect to hear from developing nations, not the United States of America in the year 2008. This is the kind of news that should make people bitter, very bitter:

For the first time since the Spanish influenza of 1918, life expectancy is falling for a significant number of American women.

 

THE WAR TO END ALL READING:  The Mother Jones blog fails to bash Bush but still delivers:

For most of recent human history, one of the few places where women have dominated is on the actuarial charts. But the big news today: Life expectancy for women has plummeted in 1,000 counties across the country, in one area by nearly five years. The drop is unprecedented, and marks the first time since the 1800s that women have seen a major dip in longevity.

Seeing as how the first paragraph of the WaPo story cites the Spanish flu of 1918, I find that "1800's" bit baffling.

Comments

[Jane]

Why do we spend money on things like this? If you are fat, smoke and don't exercise you might die sooner? Stop the presses!

[clarice]

It would also be interesting to know whether these women are immigrants. I took a quick glance at the chart this a.m. and noticed a few counties I'd bet were very predominently peopled by hispanic immigrants.

[Danube of Thought]

I blame Clinton.

[kim]

When the government can no longer tax us for the drugs to treat obesity, hypertension, diabetes, and atherosclerosis, it will tell us to 'Work for Food'.
======================================

[Elroy Jetson]

I heard on the radio this morning that today was equal pay day. This is the day past the new year that women hit the same salary as male counterparts in the 12 months ending 12/31/07.
Equal Rights Amendment, anyone?

[Danube of Thought]

I need to know a bit more about what a "counterpart" is. And the answer concerning the Equal Rights Amendment is a resounding "no."

[MayBee]

I see equal pay day comes before tax freedom day.

[MayBee]

Which means the IRS is still more evil than mens.

[Tom Maguire]

The closest they get to the immigration question seesm to be this:

Murray's team, which also included Ari B. Friedman of Harvard and Sandeep C. Kulkarni of the University of California at San Francisco, used Internal Revenue Service data to check whether high levels of migration, or migration of people with particularly high or low incomes, might explain the discrepancy between the 1,000 counties and their neighbors. They found no evidence for it.

[Gmax]

The ERA was just so stupid in its premise, that not even PC could get it passed in enough states to make it law. No I definitely do not think a return to that is a desirable or necessary thing. Sorry.

[BD57]

Don't bother pointing out the fact that the study concludes before Bush was even elected - it's not about facts ... never was.

[clarice]

Thanks,TM. But I wonder how accurate the IRS records would be at reporting illegal aliens.

[Gmax]

Well with that explanation of "found no evidence of it>" I will note that the IPCC found no evidence of a lot of things which conveniently dont show up in the next report however. Remember how the Mann hockey stick graph was in the 2001 report prominently? Despite defending it for some time, it quietly disappeared in subsequent drafts.

Is it failed to find or does not exist? I will wait on that answer until more is known.

[kim]

'Found no evidence of' sounds like WNL, ostensibly 'Within Normal Limits', but commonly 'We Never Looked'.

Believe it or not Gmax, the hockey stick, or more specifically, the blade, is still alive and well in The Gorebellied Fool's 'An Inconvenient Truth'. It lives on in the purported Thompson hockey stick, but what is shown in the film is Thompson's shaft, and the Piltdown Mann's blade. Thompson's stuff is also suspect because it is irreproducibly archived, and difficult to replicate('Heroic' field trips add to his allure). He claims he knew the image in the film was still Mann's and his wife claims they had no responsibility to correct it. You can't pay a woman enough to say stuff like that.

By the way, Rolands and Horatios still defend Mann's crook't stick, despite the mainstrean effort to distract from the issue by saying that Michael Mann's stuff has been supplanted by better stuff, but which confirms his work. This is not true. The blog 'Open Mind' run by a talented mathematician purports to support Mann's statistical method, but his defense is obscure and wrong. Besides, he has neither an open mind nor an honest forum, despite authentic impulses to both. He used to call himself 'Tamino' but now prefers 'Hansen's Bulldog'. Firm, patient, and silent, he ain't.
=======================

[kim]

He sees as through a glass darkly.
=====================

[Walter]

I've already shown myself to make the occaisional math (and otherwise error), so I'll ask for help here.

If you divide the country into 2,084 units, what are the odds that any 1,000 of them will contain 19% of the population?

Is there any rationale for treating counties as the defining characteristic? For example, Alpine county in CA has some 1,180 people*, Los Angeles county in the same state has some 9,948,081 people.

Is there any good rationale for choosing to use some counties but not others? There seem to be between 3,141 and 3,070 counties in the US as of 1990 (see p 9 in this Census Bureau .pdf).

*Just to show you how clueless I am with regard to this stuff, I get confused by the Census bureau's numbers: 73.4% of the population is white, 8.4% is hispanic, and 70.% is white but not hispanic. People reporting two or more races are 4.7%, but I cannot tell if they are included in the numbers for each individual race or excluded from all.

[M. Simon]

Jane,

If you are fat smoking more could help.

[M. Simon]

Jane,

I take that back. You are not fat.

[M. Simon]

Elroy,

If more women worked in garbage collection their pay would rise. Evidently not many women want to get up at 3 AM on cold winter days to go out and lift heavy stinky garbage cans for 6 or 7 hours.

Not many like to work in mines either.

They don't appear to be rushing to get jobs as as steel workers.

I think the problem is that women refuse to take high paying jobs.

[Walter]

Whoops! I see that the WaPo reports:

In nearly 1,000 counties that together are home to about 12 percent of the nation's women...

Still, what are the odds?

Upon further review, I see that the study itself* states that

Counties are the smallest unit for which mortality data are routinely available, allowing consistent and comparable long-term analysis of trends in health disparities.

And their explanation:

(1) to avoid unstable death rates, smaller counties were merged with adjacent counties to form units with a total population of at least 10,000 males and 10,000 females in 1990 [14]; and (2) to account for changes in county definitions and lines, such as formation of new counties and reversion to non-county status.

These combinations result in the elimination of 1/3 of the counties as individual units, however. Note also that, to avoid confusion, they treat New York City as a single county.

It would be interesting to see if running the numbers without adjustments would show more or fewer women living amongst those with less lengthy life expectancies.

*It's good to see that I'm not the only one easily confused. From the paper: "even analysis by race may be affected by changes in self-reported race in census figures over time." But variation in race-reporting between individuals in a single census is still negligible, I guess.

[sylvia]

Well I just saw this article on the effects of pollution on MSNBC

http://www.msnbc.msn.com/id/24254926

and wonder if they are related. I remember once seeing a map of where the pollution is greatest and I remember the deep South being one of the worst areas because of large energy plants there, maybe even wind patterns. Pollution is a known risk factor in heart disease.

[Walter]

I can quit anytime, really. But until that time:

The mean population for the counties in the study was 134,930. The standard deviation was 381,880. It is unusual for the standard deviation to exceed the mean, no?

And I noted above that they combined counties to ensure that they had a population of at least 10,000 males and 10,000 females. Somehow the smallest county-like unit used in their study had 18,780 people in '99.

'Tis true, we city folk really don't know all that much about the inner life of country folk.

.

.

.

(Yeah, I know, it's far more likely that the population was at least 6.5% higher before Clinton 'improved' the farm economy, but the other explanation is more interesting.)

[Walter]

TM and Clarice,

The study looked at movement between counties within the United States as a causative factor.* There is no reference to consideration of external migration as a cause.

It may be possible to come up with a proxy for (legal) immigration by looking at SSN's or TIN's or ITIN's newly issued to adults. Legal immigration can also be tracked by SSN range.

Also, place of birth should be included in the source documents (if not in the readily accessible database) they used for mortality statistics.**

-----------

*...cross-county migration, IRS External Data Product ‘‘County-to-County Migration Flows’’ (see http://www.irs.gov/pub/irs-soi/prodserv.pdf), which contains tabulations of the number of individuals moving from each county to every other county, and their mean and median income, by matching the Taxpayer Identification Number and comparing zip codes of filing addresses from one year to the next. Detailed data to quantify cross-county migration for all counties were available for 1993–1999.

**Mortality statistics, including county of residence and cause of death certified and coded according to the International Classification of Diseases (ICD) system, were obtained from the National Center for Health Statistics (NCHS). Standard public-use mortality files do not include geographic identifiers for deaths in counties with fewer than 100,000 people.

[lonetown]

Its not due to global warming?

[sbw]

So this decline puts women more in line with the life expectancy of men? I would have thought this would please Democrats, given their penchant for equality.

[Walter]

Oh, and "All statistical significance was assessed at 90%."

Better (or at least more) results that way.

[Danube of Thought]

OT (from the artist formerly so known):

ABC News has revealed that a shot of an antarctic glacier calving is actually a 100% computer-generated scene from a Hollywood flick, "The Day After Tomorrow." The dismayingly fat Mr. Gore could not be reached for comment.

[clarice]

Walter, if my eyes don't fail me one of those counties in New Mexico is the site of a piece of God forsaken property my F-I-L bought many decades ago in another of his failed business ventures. (Rumor was the railroad was coming through there.)We pay tax on it year after year out of sentiment but it is unmarketable--largely because it is now part of the freedom trail from Mexico.

Aside from illegals and poisonous critters and perhaps some starving Indians with no casino, I can't imagine who lives there.

[Danube of Thought]

Did I omit to mention that the scene was in "An Inconvenient Truth?" I believe I did...

[cathyf]

Further edit, DOT: that was a scene from the Oscar-winning "documentary" An Inconvenient Truth

[michaelt]

A lot of counties with small populations and a few counties with large populations would give you a mean that is smaller than the standard deviation.

[Seixon]

LOL @ AmericaBlog. Bush is almost out of the White House, the haters don't even make an effort anymore, they're just phoning it in. With a cellphone.

[Walter]

Well put, michaelt.

I was going for something along the lines of "the selection of a variable to study (life expectancy by county) when the population by county varies so widely is unusual", but I couldn't figure out how to say it well. Still haven't, yet.

After all, LA county has approximately 3% of the the total US population, the pseudo-county of New York has 2.7%, and Cook county IL another 1.7%.

Regardless of statistical significance (any guess as to the variation that was significant at 99%?), lumping those monsters in the same category as a 'county' of 20,000 forces smaller counties to be outliers. (To be fair, it appears that LA as a whole has more improved longevity than the rest of the country. All the more reason to compare apples to other fruit.)

[JorgXMcKie]

Walter, with the results they got at 90% (which, by the way seems to imply that they went for directionality but may, in fact, mean the reduced the more normal 95% confidence level because otherwise they couldn't get significant results) I wouldn't be a bit surprised if, given that most of the reduction takes place in pretty small counties, if most of the variation was a result of reporting errors. I have to admit that it's an intellectually stimulating work, but it should *NEVER* be taken for anything more than an exercise. There's no there, there.

And as for Astroboy Jetson, repeating one of the more bogus uses of descriptive stats is hardly the way to make friends and influence people. The fact of the matter is, that when including all the more interesting variables, women make approximately 98.5% of what men make, which would mean that 'equal pay day' would be around December 24th -- Christmas Eve.

As examples of 'the more interesting variables' one might include: amount of voluntary overtime worked; educational achievement; tenure on the job; shift differential; number of voluntarily taken days off, and so on. When all of the relevant variables are run in a regression equation, the result is as I mentioned.

Almost *ALL* the variation in pay between men and women is due to women voluntarily limiting the amount of time they work and voluntary interruptions of tenure. By voluntary, I mean the women make an unforced choice *not* to work more overtime and to interrupt their careers/work history (frequently to care for others, but businesses don't force them to do that).

In fact, in NYC, women make on average more than men do.

Those who don't understand statistics nor chain saws should play with neither.

[M. Simon]

Clarice,

Sounds like a perfect place to sell bottled water at $5 a pop. Throw in oranges at $3 ea and I see some serious money possible.

You have an unrealized profit center.

Hire some of the passers by and I see at least a chance to get your taxes covered.

A camp grounds could be another money maker.

Profit from the trend, don't fight it.

[kim]

J, wouldn't the equal pay day be more like the Twelfth Day of Christmas?
===================

[RJM]

After reading all these comments pros and cons, I long for the sanity of combat in desert storm....People..any change in our circumstances--economics, social, etc takes time.

For example: Reagan is blamed for the changes in the federal government that caused departments to close, people to lose their jobs, etc...butin reality, the changes in the federal government personnel policy began in 1962 with an EO from JFK. Discussions began under Johnson to revamp the federal system, and proposed changes occured under Nixon and Ford. They were signed into law in 1977 in the Carter Administration with an implementation start date of Oct 1, 1979--as we all know, things NEVER go on time in government, and the actual inception time was in late 1980/early 1981. Literally a 20 year process in the making.

Ironically this urge to fix things takes an unexpected twist...remember Clinton in September 1993 on the lawn of the white house with the pallet that held the old FPM (Federal Personnel Manual) he supposedly whittled it down? It would make gov't more effective? Including the deletion of some old natural disaster provisions?

Fast forward to Katrina---federal employees who wanted to help were barred from being activated to help and recieve pay---other employees who had the legal right to refuse to help and legally take unemployment were forced to work.

The case load in the federal personnel appeals system is legion on this issue.

All change--social or economic takes time. We're just beginning to feel the impact of 2000 right now--and by the way..the mortgage crisis was caused not by Bush, but by the repeal of the Glass-Stegal act....which occured under the Clinton Adminstration (and ironically was lobbied and defeated every time it came up prior to his administration)

[clarice]

FT on the migration aspect which most of us thought was poorly treated in the underlying study:

The authors too hastily discount the possibility that migration accounts for widening mortality disparities at the county level. New York city shows why. Life expectancy there has risen 6.2 years since 1990. It would be absurd to believe that this dramatic shift is the result of public health measures or private resolves to quit smoking and eat right. New Yorkers live longer not because they are doing different things than in 1990 but because they are a different set of people. Certain people have moved in – disproportionately young, employed elites with health insurance, good diet habits and health club memberships. Others have moved out. If those people have been priced out – and there is every reason to believe they have been – then they are disproportionately more likely to be smokers, more likely to be under- or uninsured, and less likely to know what trans-fats are. Now they are in some other part of the country, driving the life expectancy down.

What kind of inequality is “mortality inequality”? This is a question for the political system, not the medical profession. Politicians will imply that it is like income inequality, liable to obvious if controversial remedies. But more probably it just the occasion to have a counterproductive, liberty-threatening ruckus over something that the political system can do nothing about. Life is a funny commodity. It is not a private resource that, like income, can be pooled and then more fairly distributed by an equitable government. Laisser-faire is not a recipe for creating more of it. It is a commodity for which the demand always approaches infinity and the supply always equals one.

http://www.ft.com/cms/s/0/4b1f4b38-12f8-11dd-8d91-0000779fd2ac.html>Gentrification

This would suggest that as our urban areas become richer and more and more gentrified--a pattern I believe will continue with a few exceptions like Detroit where the governance is so awful no one with brains will live there--poorer, sicker, less educated people with worse access to health care will be migrating out of them to rural areas.

[clarice]

http://www.ft.com/cms/s/0/4b1f4b38-12f8-11dd-8d91-0000779fd2ac.html>Gentrification

[battery]

Interestingly Churchill and Hitler almost met before the war, but Churchill who was in Berlin at the time refused a dinner (or lunch) invitation with him.