Baltimore Sun, September 12, 2006

CITY COMES UP SHORT ON LONGEVITY

[Rachel's introduction: A Harvard study has found "longevity gaps" as big as 30 years. Asian women in Bergen County, N.J., a suburb of New York City, have a life expectancy of 91 years, while Native Americans on or near reservations in South Dakota live an average of 58 years.]

By Frank D. Roylance and Chris Emery

Baltimoreans face the lowest life expectancy of almost any jurisdiction in America, according to a new study by the Harvard School of Public Health.

City residents can expect to live 68.6 years on average, the study found. That is worse than in all but a handful of counties in South Dakota that include impoverished Indian reservations, and there has been little improvement since a study published in 1997.

Longevity in Baltimore is much lower than in affluent Montgomery County, where it was 81.3 years, eighth-highest in the nation and trailing seven Colorado counties only fractionally.

Similar disparities persist in many of the nation's high-risk urban settings even when the effects of high rates of homicide and HIV/AIDS are removed, the study found. And the problem does not appear to lie among the very young or the very old.

Instead, the researchers say, the disparities are best explained by chronic health problems among those ages 15 to 59, including cardiovascular and lung disease, diabetes, the effects of smoking and alcohol use, and injuries, all of which are well-understood and preventable.

That would not come as news to John Adams, 57, a longtime security guard at Johns Hopkins Bayview Medical Center who was forced to retire three years ago because of arthritis.

"City life is tough," he said during lunch yesterday at Northeast Market. "Here in the city, truth be told, black men don't live very long."

His eldest brother, 61, recently had a stroke. Drugs, violence and AIDS, he said, threaten black men from their teens into their 30s. "If you can make it past then," he said, "you can live to be real old."

Norma Jackson, who said only that she was in her 70s, observed that older people seemed to be living longer but that young people seem to die more often.

"It's the times," she said. "They don't take care of themselves. They drink too much. They're doing drugs. There are gangs."

Joshua M. Sharfstein, Baltimore's health commissioner, said the city "is not where we want it to be." Despite recent gains against HIV, venereal disease and homicides, he said, the city has "very serious health needs."

"The intermediate ages face special risk in Baltimore, and the safety net systems to care for them need to be strengthened," he said. "It's an age group that traditionally gets less support from both government and the nonprofit world, which is naturally inclined to look at kids and the elderly."

The Harvard study "does sharpen the focus on the need to look at the great number of people in the middle," Sharfstein said. "It's a pretty interesting finding."

When the first Harvard study appeared in 1997, Dr. Peter Beilenson, then the city health commissioner, acknowledged serious public health problems. He also said the city was being compared unfairly with cities such as Detroit, Cleveland, Atlanta and Newark, N.J., that, unlike Baltimore, are part of larger counties with more affluent suburbs.

The new peer-reviewed study was published today in the online journal PLoS Medicine. (PloS stands for Public Library of Science.)

The lead author is Christopher J.L. Murray of the Harvard School of Public Health. Others are from Harvard and the University of California, San Francisco. Their work was sponsored by the federal Centers for Disease Control and Prevention, the Association of Schools of Public Health and the National Institute on Aging.

The researchers gathered and derived population, age, race and gender data from the 1980 and 1990 censuses. More recent data through 2001 were acquired from the National Center for Health Statistics. The reports' longevity averages are from 1999, the most recent available. Other data came from surveys by the CDC and the World Health Organization.

The study is a follow-up to a similar one in 1997, and the Baltimore statistics show few gains. Life expectancy for Baltimore men, which fell from 64.6 years to 63.2 years between 1980 and 1990, recovered only part of that loss by 1999, rising to 63.8 years.

For women in the city, life expectancy was essentially unchanged at 73.4 years.

In Montgomery County, women live an average of 83 years, almost four years longer than men.

"I think it's lifestyle," said Fred Shapiro, 74, a resident of Leisure World retirement community in Rockville. Shapiro ate breakfast at the Panera restaurant in nearby Aspen Hill Shopping Center yesterday with several of his tennis partners after rain washed out their usual Monday matches.

He credits the county's greater longevity to better education, economic status and community resources.

"There is an availability of a lot of different facilities, both intellectual and physical," he said.

Richard Helfrich, the county's deputy health officer, said in a statement that "despite the good news, we remain committed to improving the long-term health of our residents."

"This includes addressing disparities that still exist among different ethnic groups in such areas such as infant mortality, cancer and access to health care services," he said.

Nationally, Baltimore ranked seventh from the bottom, behind the South Dakota counties. In the 1997 report, the city was third from the bottom.

Washington, D.C., finished 49th from the bottom (out of 2,072 counties or county equivalents), with an average life expectancy of 72 years. Montgomery County was eighth from the top, behind seven affluent counties in Colorado ski country.

The methodology that Beilenson complained about nine years ago hasn't changed, Murray said. It's the way the localities report their data to the states.

That puts Baltimore at a disadvantage in the rankings, he said, but also illuminates the disparities in life expectancy.

"It's just remarkable how bad levels of mortality are in these counties at the bottom," he said.

The Harvard study found "longevity gaps" as big as 30 years. Asian women in Bergen County, N.J., a suburb of New York City, have a life expectancy of 91 years, while Native Americans on or near reservations in South Dakota live an average of 58 years.

Among the striking disparities are that the longest-lived Americans can expect to live at least as long as the longevity champions in places such as Iceland and Japan. But other places rank closer to Third World countries.

The 15.4-year gap in life expectancy between Asian men and urban black men in America parallels the gulf between long-lived Icelandic men and those in Belarus and Uzbekistan.

The 12.8-year difference in longevity between Asian women and black women living in the rural South compares with the gap between women in Japan and those in Fiji, Nicaragua and Lebanon.

Among other findings:

** The longevity gap between black men in high-risk urban areas and other groups widened significantly during the late 1980s and early 1990s, mostly because of high HIV and homicide rates.

** Life expectancies for blacks in high-risk urban environments are comparable to those in Russia and sub-Saharan Africa. In 2001, a black 15-year-old was more than three times more likely to die before age 60 than an Asian-American was.

** One of the largest gains in life expectancy has been among the group the researchers called "Black Middle America" -- African- Americans who live outside high-risk urban communities or the Mississippi Valley and the Deep South.

** Men have been closing the longevity gap with women in almost all of the groups.

Murray said one explanation might be tobacco consumption, which is falling faster among men than among women.

"In any given place, higher income groups have better health," Murray said.

But not always. Low-income whites living in the Northern Plains lived four years longer, on average, than low-income whites in the Mississippi Valley.

Sharfstein noted a "huge gap" in Baltimore, both in providing health insurance and in supporting community health centers that offer primary health care.

"In Massachusetts or in D.C., there are funding streams to help care for the uninsured. In Maryland there just aren't. It has the effect of reducing access to health care," he said.

He said the city is preparing to start programs that can improve primary care for people with cardiovascular disease.

"Our goal is to identify the programs that can be implemented in Baltimore and then develop a consensus that they need to be funded" at the city, state and private level, he said.

Narrowing the longevity gap is "a simple, pragmatic issue," Murray said. In addition to shortening lives, chronic illnesses increase health care costs for employers and taxpayers.

"It's both the right thing to do for our fellow citizens and the right thing to do from a straightforward economic perspective," he said.