High cost of high country health care not a factor in life expectancy, study shows
Special to the Daily
By the numbers
U.S. counties with the largest increases in life expectancy from 1980 to 2014:
• Aleutians East Borough, Aleutians West Census Area, Alaska (+18.3 percent)
• North Slope Borough, Alaska (+17.9 percent)
• New York County, New York (+15.2 percent)
• Sumter County, Florida (+13.8 percent)
• San Francisco County, California (+13.5 percent)
• Kings County, New York (+13.2 percent)
• Kodiak Island Borough, Alaska (+13.2 percent)
• Northwest Arctic Borough, Alaska (+12.8 percent)
• Washington, D.C. (+12.8 percent)
• Loudoun County, Virginia (+12.4 percent)
Counties with the largest decreases in life expectancy from 1980 to 2014:
• Owsley County, Kentucky (-3 percent)
• Lee County, Kentucky (-2 percent)
• Leslie County, Kentucky (-1.9 percent)
• Breathitt County, Kentucky (-1.4 percent)
• Clay County, Kentucky (-1.3 percent)
• Powell County, Kentucky (-1.1 percent)
• Estill County, Kentucky (-1 percent)
• Perry County, Kentucky (-0.8 percent)
• Kiowa County, Oklahoma (-0.7 percent)
• Perry County, Alabama (-0.6 percent)
Source: Institute of Health Metrics and Evaluation at the University of Washington
Eagle County has the third highest life expectancy in the country, according to a recently published study conducted by the Institute of Health Metrics and Evaluation at the University of Washington. In the study, which was published in the Journal of the American Medical Association, authors calculated life expectancy by U.S. county from 1980 to 2014.
The results show that inequalities in life expectancy among U.S. counties are large and growing, and can be attributed to differences in socioeconomics and race, behavioral and metabolic risk factors and health care factors. These results surprised Dr. Ali Mokdad, one of the study’s co-authors.
“It was really surprising, and we’ve been doing this for a while, so for us to say we’re surprised, that tells you a lot,” said Mokdad, who is head of U.S. research at the Institute of Health Metrics and Evaluation.
“We’re surprised at the range of the span of this in our country, we’re surprised that it’s getting wider instead of declining, we’re surprised that we are not keeping up with countries that are similar to our wealth … that in this day and age in the United States, we’re not keeping up with everyone else, we’re falling behind.”
According to the Institute of Health Metrics and Evaluation, in 2014 the United States spent $9,237 per person on health care. Australia, a country with a higher life expectancy in 2014 (82.3 years), spent $4,032 per person. Japan, where life expectancy was 83.1 years — one of the highest in the world — spent $3,816 per person.
“We spend about half of the world’s (total) spending on health, and then when you look at what we are getting for this investment, we’re not getting the right return on our investment,” Mokdad said. “The debate should not be about spending more money than others, the debate should be what are we getting for what we’re spending.
“Whatever we are doing right now, quite honestly, is not working for us. What we really need to do is look at it again and say, how can we change it in order to improve the health of our country?”
Summit County topped the life expectancy list at 86.8 years, followed by Pitkin County at 86.5 years and Eagle County at 85.9 years. Oglala Lakota County, South Dakota, is last on the list with the lowest life expectancy in the country in 2014 at 66.8 years, comparable to countries such as Sudan (67.2 years), India (66.9 years) and Iraq (67.7 years).
The study identified five risk factors, including obesity, lack of exercise, smoking, hypertension and diabetes, which accounted for 74 percent of the variation in longevity. Socioeconomic factors, a combination of poverty, income, education, unemployment and race, were independently related to 60 percent of the inequality, and access to and quality of health care explained 27 percent.
The flip side
Summit, Eagle and Pitkin counties landed at the top of the list because the prevalence of these risk factors is low in these high country areas.
“It’s the flip side of these things in Eagle County. You have people who are affluent and are well educated, people who have insurance, people who have access to a good medical center, people who tend to have low risk factors, they tend to smoke less, be less obese and so on,” Mokdad said.
While individuals living in Eagle, Summit and Pitkin counties are typically active and healthy, well-educated and likely to have good health insurance, Colorado’s high country also has some of the highest health care costs in the country. As a result, sick individuals, or those who are aging and/or facing chronic conditions, often move away in search of more affordable care.
But, Mokdad said, the fact that those who are generally healthy stay in these high country counties, while those who are prone to health issues are likely to leave the area, does not impact or skew the results of the study. Mokdad used the state of Florida as an example to illustrate this point.
In Florida’s southern counties, Mokdad said, where many older Americans choose to live in retirement, the life expectancy is higher than that of the state’s northern counties.
For example, Collier County, Florida, which borders the Gulf of Mexico near the southern tip of the state, has the highest life expectancy in the state. According to the U.S. Census Bureau, in 2015, 30 percent of the population was older than 65, yet Collier County saw an increase in life expectancy from 74.48 years in 1980 to 83.43 years in 2014.
By contrast, in Union County, Florida, a northern, landlocked county, which has the lowest life expectancy in the state, the life expectancy in 1980 was 65.84 years, which increased slightly during the life of the study, to 67.57 years in 2014. In 2015, only about 12 percent of the population in Union County was older than 65.
This disparity, Mokdad said, is due to the prevalence of socioeconomic and other risk factors in Florida’s northern counties, versus the lack of those factors in the state’s southern counties.
For example, according to Census Bureau data, the median household income in 2015 in Collier County was $57,452 and the total percent of persons in poverty was 13.6 percent, whereas the median household income in 2015 in Union County was $38,163 and the total percent of persons in poverty was 26.2 percent.
Ultimately, Mokdad said, examples like this show how disparities in life expectancy are impacted more by socioeconomic and other risk factors than by where a person chooses to live. In the case of Eagle County, the area lands in third place for highest life expectancy in the country not because those with health issues move out of the county, but because Eagle County residents tend to be health-conscious, well-educated and affluent.
“I don’t think it’s really a factor of self-selection of people living in a specific neighborhood or county because look at Florida, people who are older go there to retire and they’re doing better,” Mokdad said.
Addressing the system
Addressing those socioeconomic factors, Mokdad said, is a critical first step in addressing the gap in life expectancy in the United States.
“If we decide to live healthier, we’re going to benefit from that behavior; if we decide to go to our regular check-up, if we decide to monitor our conditions, we can live longer,” Mokdad said. “Now, it’s easier said than done for certain people.
“Let me give you an example … pick a neighborhood where poor people live … so if you go to these communities and you’re asking these people to live healthier and they are trying and they believe in that, but, you know, they’re struggling to pay rent, they’re struggling to pay for the food bill and then they’re maybe working two jobs in order to make ends meet, it can be a challenge to make those changes. So, unless we address these socioeconomic factors, and things like economic equity, we’re not going to improve health in this country.”
These changes can start at the county level, Mokdad said, by implementing policies and programs that make it easier for store owners to stock fresh fruits and vegetables and for prospective business owners to open new stores in food deserts (defined by the U.S. Department of Agriculture as parts of the country vapid of fresh fruit, vegetables and other healthful whole foods, usually found in impoverished areas).
“So, if I live in a low-income neighborhood and I decide to live healthier and eat right and exercise, then I need support,” Mokdad said. “If I decide to eat healthy, I need to have an environment around me where I can buy fresh fruits and vegetables at a reasonable price. … So, the system has to support me if I decide to do so, so unless we address the system, we’re not going to be able to improve health.”