Researchers increasingly track variations in health outcomes across counties in the United States, but current ranking methods do not reflect changes in health outcomes over time. We examined trends in male and female mortality rates from 1992-96 to 2002-06 in 3,140 US counties. We found that female mortality rates increased in 42.8 percent of counties, while male mortality rates increased in only 3.4 percent. Several factors, including higher education levels, not being in the South or West, and low smoking rates, were associated with lower mortality rates. Medical care variables, such as proportions of primary care providers, were not associated with lower rates. These findings suggest that improving health outcomes across the United States will require increased public and private investment in the social and environmental determinants of health-beyond an exclusive focus on access to care or individual health behavior.
"Kulkarni et al.
 reported that from 2000 to 2007, many US counties fell increasingly behind the levels achieved in high-income countries with the best outcomes. Kindig and Cheng
 found evidence that mortality increases occurred from 1992–1996 to 2002–2006 for females in 42% of US counties. These reversals for females in life expectancy are cause for broad concern especially coming on top of large pre-existing disparities in the US. "
[Show abstract][Hide abstract] ABSTRACT: The United States spends more than any other country on health care. The poor relative performance of the US compared to other high-income countries has attracted attention and raised questions about the performance of the US health system. An important dimension to poor national performance is the large disparities in life expectancy.
We applied a mixed effects Poisson statistical model and Gaussian Process Regression to estimate age-specific mortality rates for US counties from 1985 to 2010. We generated uncertainty distributions for life expectancy at each age using standard simulation methods.
Female life expectancy in the United States increased from 78.0 years in 1985 to 80.9 years in 2010, while male life expectancy increased from 71.0 years in 1985 to 76.3 years in 2010. The gap between female and male life expectancy in the United States was 7.0 years in 1985, narrowing to 4.6 years in 2010. For males at the county level, the highest life expectancy steadily increased from 75.5 in 1985 to 81.7 in 2010, while the lowest life expectancy remained under 65. For females at the county level, the highest life expectancy increased from 81.1 to 85.0, and the lowest life expectancy remained around 73. For male life expectancy at the county level, there have been three phases in the evolution of inequality: a period of rising inequality from 1985 to 1993, a period of stable inequality from 1993 to 2002, and rising inequality from 2002 to 2010. For females, in contrast, inequality has steadily increased during the 25-year period. Compared to only 154 counties where male life expectancy remained stagnant or declined, 1,405 out of 3,143 counties (45%) have seen no significant change or a significant decline in female life expectancy from 1985 to 2010. In all time periods, the lowest county-level life expectancies are seen in the South, the Mississippi basin, West Virginia, Kentucky, and selected counties with large Native American populations.
The reduction in the number of counties where female life expectancy at birth is declining in the most recent period is welcome news. However, the widening disparities between counties and the slow rate of increase compared to other countries should be viewed as a call for action. An increased focus on factors affecting health outcomes, morbidity, and mortality such as socioeconomic factors, difficulty of access to and poor quality of health care, and behavioral, environmental, and metabolic risk factors is urgently required.
Population Health Metrics 07/2013; 11(1):8. DOI:10.1186/1478-7954-11-8 · 2.11 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Research conducted to date has deepened our understanding of sex and gender differences in the etiology, diagnosis, treatment, and outcomes for many conditions that affect both women and men. The Sex and Gender Women's Health Collaborative (SGWHC) is supported by the coordinated efforts of our founding partners: the American Medical Women's Association, the American College of Women's Health Physicians and Society for Women's Health Research to address the gaps in medical education with regard to sex and gender competency in the care of women. The SGWHC initiated and continues to build a novel digital resource library of sex and gender specific materials to be adopted and adapted into medical education and clinical practice, residing @ www.sgwhc.org. This article presents a case for the inclusion of sex and gender focused content into medical curricula and describes a means for students, faculty, and practitioners to access a centralized, interactive repository for these resources.
Biology of Sex Differences 06/2013; 4(1):11. DOI:10.1186/2042-6410-4-11 · 4.84 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Health is a complex construct. An individual’s physical and mental health is directly influenced by the social conditions in which they live, work, worship and play, -- most popularly referred to as the “social determinants of health”. More importantly health disparities are linked to the factors that consist of the social determinants of health. This adds complexity to addressing inequalities in health because there are too many moving parts to consider such as behavior, the built environment, and social aspects. The social aspect of health specifically relates to the concept of equity and should be addressed within a broader social-ecological context.
International Making Cities Livable Conference, Portland, OR; 06/2013
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