COLUMBIA — Women live longer than men in Boone County, but men are closing the gap.
Male life expectancy in the county improved by 18 months between 2000 and 2007, compared to an increase of only about three months in female life expectancy during the same period, according to a new scientific study.
The research, conducted by the Institute for Health Metrics and Evaluation at the University of Washington, estimated life expectancy for all U.S. counties for the years 2000 and 2007. It compared the numbers to international estimates, as well.
According to the report, Boone County ranked third in Missouri for male life expectancy. For female life expectancy, the county improved its position in the state from number 14 in 2000 to 10 in 2007.
Marcia Flesner, clinical educator at the MU Sinclair School of Nursing, said one of the reasons for the gain among men might be that Columbia as a community promotes a healthy lifestyle with lots of opportunities and locations to exercise.
“Being active is promoted," she said. "You have a well-educated population that has the finances to participate in activities, and the weather allows outdoor activities for at least three seasons."
Linda Cooperstock, public health planner at the Columbia/Boone County Department of Public Health and Human Services, said a smoke-free ordinance passed in Columbia in 2007 is expected to decrease the mortality rate further.
The researchers, who say this is the most recent assessment of disparities in mortality at the county level since 1999, found huge variations among the U.S. counties. Some are doing better than the best countries in the world, while others are as much as 50 years behind the international values.
Poverty, race and population sizes cannot fully explain these health disparities. Other health risks, such as obesity and tobacco use, should be taken into account, the researchers suggested in their report.
Cooperstock said this suggestion was in line with the department’s analysis of risks to life expectancy in Boone County.
“The major factors affecting life expectancy for the county in general are obesity, lack of physical activity, lack of nutritious food and smoking,” she said.
Karen Edison, director of the MU Center for Health Policy, said life expectancy is a complex issue that relates to both genetics and social determinants of health.
"It's an outcome measure affected by many, many variables," she said. "From income to health literacy to toxins in the environment to culture and even people's belief systems."
In Missouri, female life expectancy fell for 38 counties from 2000 to 2007. For men, only 15 counties showed a decrease.
Boone County, however, showed improvements in both cases. The average life span of males in Boone County improved from 75 to 76.5 years from 2000 to 2007. Life expectancy for females increased from 80.3 to 80.5 years during the same period, according to the study.
David Oliver, assistant director of the MU Interdisciplinary Center on Aging, said he thinks the presence of the university, other educational institutions and some successful businesses influenced the healthy statistics of Boone County.
“We are not a typical county, and it is difficult to compare us with other counties,” he said. “We have higher income levels, higher education levels and with that, a whole lot of other variables, such as access to health care, fit in.”
Edison said access to health care might be one of the contributing factors to Boone County's better performance, but while the county has better access than most other places in the state, there’s still a need for more.
“While we do have a number of health care facilities, there are still underserved people out there who cannot afford their medical care,” Edison said.
A 2011 county health care assessment report by the public health department showed that Boone County had a greater percentage of uninsured persons than the state of Missouri — 17 percent compared to the state’s 14. This report was compiled from various state and federal data sources.
Edison said it was sometimes difficult for the poor and the uninsured to get medical care in Boone County, and these gaps in the health care system affected life expectancy.
Nationally, Boone County was in the top 15 percent of U.S. counties in terms of male longevity, while it barely missed the top one-third for females by one percent, according to the study.
Despite one-third of Missouri counties showing a decline in female life expectancy, the average age of women in the state was almost 6 years more than the average age of men, according to data from the study.
Flesner cited research done by Harvard Medical School professors T. T. Perls and M. H. Silver and said that a number of factors helped women live longer than men in general, including hormonal differences and risk-taking behavior in men.
She said that testosterone in men makes them inclined toward recklessness in youth. In addition, it increases their bad cholesterol and decreases the good cholesterol. In women, however, production of estrogen has beneficial effects on cardiovascular health and helps lower harmful levels of cholesterol.
Illnesses related to smoking habits and alcohol consumption also impact death rates among males more compared to females, she said.
The researchers used mortality data, income and education statistics to determine the life expectancy for males and females for the years 2000 and 2007. To get the international estimates, they averaged the life expectancy of the top 10 countries with the lowest mortality rates in the world for each year between 1950 and 2010.
These international estimates were then compared with U.S. counties. So, if a county’s life expectancy in 2007 matched the international life expectancy trend value in 1990, the county would be 17 years behind the international trend.
According to the study, Boone County was nine years behind international life expectancy for males and 18 years behind for females.
In Missouri, other counties ranged from 6 to 51 years behind the international estimates for men and 13 to 36 years behind for women. This trend appeared consistently throughout the United States. The study found that 80 percent of U.S. counties had failed to keep up with international life expectancy estimates between 2000 and 2007.
In order to bring Boone County up-to-date with international estimates, the public health department is involved in a number of efforts with local coalitions to spread the message of healthy living in the community and influence health policy development, but recent cuts in federal and state funding are a major challenge to their efforts.
“We had to start charging for some services, and we had to increase fees,” Cooperstock said. “So we have more people to take care of and fewer dollars to do so.”
She said cuts in funding directly relate to the problem of limited access to health care.
“We have plenty of doctors and hospitals, but we also have 17 percent of the population that isn’t insured and doesn’t have access to health care,” Cooperstock said. “People without health insurance are sometimes forced to allow medical conditions to grow worse before they get treatment.”
Cooperstock said poverty and lack of education were some of the major disparities the health department looked to reduce, but in recent years new health disparities regarding race, ethnicity and sexual orientation had emerged, which also needed due attention.
Edison said more research, better data collection methodologies and responsibility on the part of health care providers were needed to remove these disparities.
She said people should be provided with opportunities for healthy living and rewarded for following a healthy lifestyle in ways that are beneficial to them.
“What we need to do is to surround our communities with every evidence-based program we know of, to give people safe places to exercise, to provide access to affordable healthy food choices and most of all, to make them hear the messages about healthy living from their children, from their ministers, from everyone,” Edison said.
Cooperstock said the public health department took on the challenge to educate people to the point that they could make lifestyle changes for themselves, but people have to be willing to adopt a healthy lifestyle.
“The city and county can provide all the opportunities, facts and assistance, but then it is up to the people to make the right decision,” she said.