A startling decline in life expectancy is concentrated among women living in rural America.

In nearly 1,000 counties, most of them rural, life expectancy among women is now lower than it was in the early 1980s. It is the first time life expectancy has declined in the United States since the Spanish flu outbreak in 1918.

There have been two reports issued in the last two weeks that have found a growing difference in how long Americans are likely to live. A Congressional Budget Office report found that while, on average, life expectancy in the U.S. continues to climb, there is a "growing disparity in life expectancy between individuals with high and low income and between those with more and less education. The difference in life expectancy across socioeconomic groups is significantly larger now than in 1980 or 1990."

Harvard researchers, meanwhile, found that this disparity in life expectancy had a geography. In 1,000 mostly rural counties concentrated in the Deep South, along the Mississippi River, in Appalachia and extending into the southern plains and Texas there was no increase in life expectancy for women from 1983 until 1999. Those counties are home to 12 percent of the nation's population. A much smaller number of counties showed declines in life expectancy for men.

The cause of this increased inequality in mortality was chronic disease related to smoking, obesity and high blood pressure, according to the Harvard researchers.

Not all of those declines were statistically significant. Links to lists of those rural counties with significant declines in life expectancy can be found on the next page.

From 1961 to 1983, there were very few U.S. counties that showed no increase in life expectancy. Not one county out of more than 3,100 showed a real decrease in life expectancy.

That trend toward longer lives reversed in 1983 — especially in rural communities.

The largest declines were in Pulaski County, Virginia, and the city of Radford, exurban communities near Blacksburg. In 1983, life expectancy for women there was about 84 years. By 1999, it had dropped 5.8 years, to 78.

The rural community with the most significant declines was McNairy County, Tennessee. Between 1983 and '99, life expectancy declined significantly for men (from 70.9 in 1983 to 67.6 in 1999); for women (from 79.4 to 76.1) and for the combination of men and women (from 75.1 to 71.9). No other rural county showed declines in all three categories.

(McNairy County and the county seat of Selmer were the home of Buford Pusser, the legendary "Walking Tall" sheriff. The county is in southwest Tennessee, on the Mississippi state line.)

The findings that a large portion of America showed declining years of life expectancy left authors of the two reports stunned — and searching for both explanations and solutions. Peter R. Orszag, the budget office’s director, told the New York Times that a decline in life expectancy among some Americans was “remarkable in an advanced industrial nation.” Orszag said the growing gap appeared to be related to growing income inequality. “We’ve had sluggish income growth at the bottom and rapid income growth at the top for the last three decades,” he told the Times.

Dr. Majid Ezzati, one of the Harvard report’s authors, said that few industrialized countries have seen declines over such a long duration of time. "This is a very unusual pattern," he said.

The Times reported that in a 2006 study, Ezzati and his colleagues concluded that “because policies aimed at reducing fundamental socioeconomic inequalities are currently practically absent in the U.S.,” life expectancy disparities would have to be addressed through public health strategies aimed at reducing the risk factors that cause chronic disease and injuries.

McNairy County, Tennessee, showed the greatest decline in male life expectancy among rural counties, dropping 3.3 years from 1983 to 1999. The second largest decline was in Union County, Florida, which saw a 2.2 year drop in male life expectancy.

The largest drop in female life expectancy in rural America was found in three Colorado counties, Dolores, Montezuma and San Juan. Each of these counties showed a 4.4 year decline between 1983 and 1999. Other large declines were found in Hardin County, Tennessee (4 years); Ashley County, Arkansas (3.9 years); Pontotoc County, Oklahoma (3.7 years); and Sunflower County, Mississippi (3.7 years).The Yonder has posted three charts showing all the rural counties with significant declines in life expectancy.

The landscape around Cortez, Colorado. The life expectancy for women in Montezuma County dropped from 80.8 years in 1983 to 76.4 years in 1999.
Photo: Dave SF

The list of rural counties where females showed a significant decline in life expectancy is posted here.

The rural counties with significant declines in male life expectancy are here.

And the rural counties with a significant decline in combined male and female life expectancy are posted here.