Women in large swaths of America are dying younger than they were a generation ago, reversing nearly a century of progress in public health and underscoring the rising toll of smoking and record obesity.
Nationwide, life expectancy for American men and women has risen over the past two decades, and some U.S. communities still boast life expectancies as long as any in the world, according to newly released data. But over the past decade, the nation has experienced a widening gap between the most and least healthy places to live. In some parts of the United States, men and women are dying younger on average than their counterparts in nations such as Syria, Panama and Vietnam.
Baltimore remains among the areas with the lowest life expectancies, though improvements accelerated at twice the national average during the most recent decade studied.
Overall, America is falling further behind other industrialized nations, many of which have also made greater strides cutting child mortality and reducing preventable deaths.
In 737 U.S. counties, life expectancies for women actually declined between 1997 and 2007. For life expectancy to decline in a developed nation is rare. Setbacks on this scale have not been seen in the U.S. since the Spanish influenza epidemic of 1918, according to demographers.
"There are just lots of places where things are getting worse," said Dr. Christopher Murray, director of the Institute for Health Metrics and Evaluation at the University of Washington, which conducted the research. "We're not keeping up."
The widening gulf between the healthiest and least healthy populations is partly due to wealth. But part of the gap appears to be attributable to cultural norms and differences in public health efforts, the researchers found.
Communities with large immigrant populations — Southern California, for example — fared considerably better than average despite relatively high poverty rates. The worst-performing counties were clustered primarily in Appalachia, the deep South and the lower Midwest. In those places, women died as much as a year younger in 2007 than women did a decade earlier. Life expectancy for women slipped 21/2 years in Madison County, Miss., which recorded the biggest regression.
A key finding of the data is that "inequality appears to be growing in the U.S.," said Eileen Crimmins, a gerontologist at the University of Southern California who also co-chaired the 2011 National Academies panel on life expectancies. "We are different than other countries." Researchers found substantially fewer geographic disparities in Great Britain, Canada and Japan, for example.
In general, men and women die youngest in poor, mostly rural parts of the South and in struggling urban centers like Philadelphia and St. Louis. In Baltimore, men on average live only 66.7 years.
By contrast, Americans in affluent counties near Washington, the San Francisco Bay Area and elsewhere have among the longest life expectancies in the world, outpacing even international leaders such as Japan and Switzerland.
The state and Baltimore's health officials have long recognized that those in the wealthier suburbs live longer and so do those in wealthier city neighborhoods.
For example, average life expectancy in Hollins Market is 20 years shorter than in wealthier Roland Park.
Dr. Oxiris Barbot, city health commissioner, said it amounts to a lot of "preventable death."
The city has adopted programs over the years to address the disparities, and Barbot recently unveiled a new program called Healthy Baltimore 2015 that seeks to involve most neighborhood, hospitals, businesses and faith organizations in the city. It sets specific goals for reducing the prevalence of Baltimore's most pervasive killers, such as HIV infection, heart disease and smoking.
"The fact that Baltimore City and cities like it continue to have shorter life expectancies than other areas draws attention to the fact that what we do in addressing the public health challenges has to go beyond the traditional health models," Barbot said. "We need to address the social determinants of health and adopt a health-in-all-policies approach."
That approach has already helped the statistics, said Frances B. Phillips, a deputy secretary of the state Department of Health and Mental Hygiene. The University of Washington report showed a jump in life expectancy of 4.1 years for men in Baltimore and 2.2 years for women in the decade ending in 2007 — about twice the national average.
Since then, Phillips said, the state's own data show that life expectancy for men and women in the state increased to 72.9 years in 2008-2009 from 72.4 years in 2006-2008.
She said the city and state have to continue focusing on access to health care, but also social and environmental factors, particularly in less affluent neighborhoods.
For now, she said, "Your ZIP code represents so many influences and opportunities you have to stay healthy or not."
Murray and his team also found counties where, even as wealth increased, life expectancies slipped backward or barely moved.
In Calvert County, a fast-growing area, women's life expectancy was almost 21/2 months shorter in 2007 than in 1997. Yet over the past decade, the median household income in the county increased more than 30 percent, far outpacing the nation, where the median income grew less than 20 percent.
The research is being published in the journal Population Health Metrics.
Life expectancies for black men and women improved faster than for whites since 1987, although blacks continue to have lower life expectancies overall than whites do, the data showed.
Nationwide, women's life expectancy at birth in America hit 81.3 years in 2007, placing the country 35th in the world. That's down from 20th in 1987, according to United Nations data.
Men's life expectancy was 76.7 years, or 24th best, up from 32nd two decades earlier.
The backsliding for women began before 1997, but researchers found that it has accelerated in the past decade. Only 227 counties saw women's life expectancy decline between 1987 and 1997, according to the study.
The grim trend is fueled largely by the persistent influence of smoking, high blood pressure and obesity, according to Murray and other population health experts.
American women historically smoked more heavily than women in other countries, particularly after World War II, said Samuel Preston, a University of Pennsylvania demographer who co-chaired a 2011 National Academies panel that looked at life expectancies in high-income countries.
That had a delayed effect that drove up lung cancer rates among women as this generation aged. The trend may ease as that age group passes and the effects of more recent efforts to reduce smoking are felt, Preston said.
But Preston cautioned that the impact of other unhealthy lifestyles may undermine that progress. "In place of smoking, we have substituted obesity," he said.
The proportion of Americans who are classified as obese hit 34 percent in 2010, more than double the rate in 1980.
Women in southwest Florida's Collier County live to be 86 years old on average, tops in the nation. Collier is among a cluster of counties in South Florida with high life expectancies.
Twelve states, including Pennsylvania, Connecticut and the rest of New England, have no counties where life expectancies slipped backward.
Life expectancies for men and women in Los Angeles County and Cook County, Ill., which includes Chicago, both rose in the last two decades.
Los Angeles County has among the highest life expectancies in the country despite a poverty rate above the national average. Countywide, women live more than a year longer than they do nationally, and men live more than eight months longer on average.
This may be evidence of what demographers and public health officials call the "Hispanic paradox," a long recognized phenomenon in which Latino immigrants are generally healthier than non-Latinos of similar income.
Nearly half of Los Angeles County's 10 million residents are Latino, and more than a third are foreign-born, according to census data. By contrast, less than a sixth of the population nationally is Latino, and less than an eighth is foreign-born.
One explanation of that phenomenon is that the people who become immigrants tend to be healthy. "These are not random people. They are the healthiest people who could get here," said Carmen Nevarez, former president of the American Public Health Association.
But David Hayes-Bautista, who heads the Center for the Study of Latino Health and Culture at UCLA, said other factors, including social support networks, diet and even physical labor, may play a role as well, because not all immigrants have as good health outcomes as Latinos.
Some rural parts of the nation also have done well. Indeed, some of the highest life expectancies in the country are found in rural parts of Minnesota, Wisconsin and Iowa. "These are not wealthy communities," Murray said, noting that many benefit from a "cohesive community" that may improve health outcomes.
Sun reporter Meredith Cohn contributed to this article.