The Reversal of Fortunes:
Majid Ezzati1,2*, Ari B. Friedman2, Sandeep C. Kulkarni2,3, Christopher J. L. Murray1,2,4
1 Harvard School of Public Health,
States of America, 3 University of California, San Francisco, California, United States of America, 4 Institute for Health Metrics and Evaluation, University of Washington,
PLoS Medicine | www.plosmedicine.org - 22 April 2008 - Volume 5 - Issue 4
Available online as PDF file [12p.] at:
Counties are the smallest unit for which mortality data are routinely available, allowing consistent and comparable long-term analysis of trends in health disparities. Average life expectancy has steadily increased in the
to county level mortality trends.
Methods and Findings
We used mortality statistics (from the
Between 1961 and 1999, the standard deviation (SD) of life expectancy across US counties was at its lowest in 1983, at 1.9 and 1.4 y for men and women, respectively. Cross-county life expectancy SD increased to 2.3 and 1.7 y in 1999. Between 1961 and 1983 no counties had a statistically significant increase in mortality; the major cause of mortality decline for both sexes was reduction in cardiovascular mortality. From 1983 to 1999, life expectancy declined significantly in 11 counties for men (by 1.3 y) and in 180 counties for women (by 1.3 y); another 48 (men) and 783 (women) counties had non significant life expectancy decline. Life expectancy decline in both sexes was caused by increased mortality from lung cancer, chronic obstructive pulmonary disease (COPD), diabetes, and a range of other noncommunicable diseases, which were no longer compensated for by the decline in cardiovascular mortality. Higher HIV/AIDS and homicide deaths also contributed substantially to life expectancy decline for men, but not for women. Alternative specifications of the effects of migration showed that the rise in cross county life expectancy SD was unlikely to be caused by migration.
There was a steady increase in mortality inequality across the
Dataset S1. Change in Probability of Dying in Specific Age Ranges, with Counties Grouped on the Basis of Level of Change in Life Expectancy, Divided by Disease (Numerical Data for Figure 4) (33 KB XLS)
Dataset S2. Life Expectancy at Birth by County, 1961–1999 (2.5 MB ZIP)
Figure S2. Absolute Change in
Movie S1. Life Expectancy at Birth by County, 1961–1999 (Males) (14.4 MB AVI)
Movie S2. Life Expectancy at Birth by County, 1961–1999 (Females) (15.8 MB AVI)
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