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'Dangerous disparities' found among U.S. states in life expectancy and other health measures

crying baby
A baby born in West Virginia in 2016 had a healthy life expectancy of 63.8 years — 6.5 fewer years than a child born that same year in Minnesota.

Minnesota’s life expectancy — 80.8 years — is the fourth highest in the nation, behind only Hawaii, California and Connecticut, according to a major study published this week in the Journal of the American Medical Association (JAMA).

As for healthy life expectancy — the years that an individual can expect to live in full health — Minnesota ranks first among all states and the District of Columbia, with 70.3 years.

In fact, Minnesota’s health measures are reported as strong throughout the study, at least relative to other states.

The study is part of an annual assessment known as the “Global Burden of Disease,” which is described as “a comprehensive effort to quantify health internationally.” This JAMA study focuses on health outcomes in the United States between 1990 and 2016. Specifically, the study’s authors looked at 33 diseases and injuries and 84 risk factors on a state-by-state basis. They used the data to estimate various health measures for each state, such as life expectancy, disability rates and the incidence and prevalence of specific diseases, disorders and injuries.

The study shows that the United States is making some notable improvements in its health, but those improvements are not being shared equally across the country.

“We are seeing dangerous disparities among states,” said Dr. Christopher Murray, the coordinator of the study and the director of the Institute for Health Metrics and Evaluation at the University of Washington, in a released statement. “Unless and until leaders of our health care system work together to mitigate risks, such as tobacco, alcohol, and diet, more Americans will die prematurely, and in many cases, unnecessarily.”

Troubling trends

Both life expectancy and healthy life expectancy are clear reflections of those disparities in risk. And, as this study shows, the residents of certain states are much more likely to die an early death and to live fewer healthy years than those living elsewhere in the country.   

A baby born in 2016 in Mississippi had a life expectancy of 74.7 years — 6.6 fewer years than a child born that same year in Hawaii, where life expectancy at birth was 81.3 years. 

And a baby born in West Virginia in 2016 had a healthy life expectancy of 63.8 years — 6.5 fewer years than a child born that same year in Minnesota.

Among the more troubling findings in the study, however, are state disparities in the increases in early death among adults aged 20 to 55. In many states, decades of declining death rates for people in this age group have been reversed. Working-age Americans in 21 states now face a higher probability of premature death than they did in 1990. In fact, among five states — New Mexico, Wyoming, Oklahoma, Kentucky and West Virginia — the likelihood of dying between the ages of 20 to 55 increased by a stunning amount between 1990 and 2016: more than 10 percent.

Here, again, Minnesota ranks well among the states. In 2016, it had the lowest probability of premature death for men and women aged 20 to 55, followed by California, New York, Connecticut, New Jersey and Washington. The states with the highest probability of early death in this age category were West Virginia, Mississippi, Alabama, Oklahoma and Kentucky.

Still, Minnesota’s ranking is nothing to gloat about. Between 1990 and 2016, the rate of premature death among Minnesotans aged 20 to 55 increased by about 6.5 percent. 

Driven by ‘diseases of despair’

“The U.S. has witnessed some improvements among youth under 20 and seniors over 55, but overall the nation and some of our states are falling behind other, less developed countries,” said Ali Mokda, a study co-author and an epidemiologist at the University of Washington, in a statement. “The reversals in premature death among working-age Americans appears driven by increases in substance abuse, suicide and alcohol-related illnesses — conditions often referred to as ‘diseases of despair.’”

The geographical disparities regarding the burden of these “diseases of despair” are quite stark, as comparisons of the rates for the “worst” and “best” states demonstrate:

  • The number of years of life lost to drug abuse was six times higher in West Virginia (982 years lost per 100,000 people) than in North Dakota (161 years lost/100,000) in 2016.
  • The number of years of life lost to alcohol-related conditions was three times higher in New Mexico (328 years lost per 100,000 people) than in Utah (110 years lost/100,000).
  • The number of years of life lost due to suicide was almost twice as high in Utah (979 years lost per 100,000 people) than in the District of Columbia (306 years lost/100,000).

Other factors

But the study also underscores how Americans’ dietary choices and widening girths are also a major part of the problem. Indeed, a poor diet led the causes of premature death in the United States in 2016, followed by tobacco use and high blood pressure, according to the study. And the incidence of types 2 diabetes — a disease associated with poor diet and obesity — increased in almost every state.

In 2016, diabetes jumped to eighth place for years of life lost due to premature death and third place for years lived with disability.

“To an increasing degree, overweight, obesity, and sugary diets are driving up health care costs and are costing Americans years of healthy life,” Murray said. “They are undermining progress toward better health.” 

Americans need greater access to primary care physicians, who can help them identify — and address — the early signs of poor health, Murray added.

“Primary care is our health system’s front line of defense, detection, and treatment,” he said. “Local, state, and federal dollars need to be targeted more effectively for primary care, especially for those millions of Americans not on Medicare.”

FMI: The study can be downloaded and read in full on the JAMA webpage.

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