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Smoking Taking Toll

Women in nearly a quarter of Arkansas counties and large sections of the United States are expected to die younger than they were a generation ago, a sign of the toll of smoking cigarettes and rising obesity, a new study shows.

Nationwide, more than 300 counties - including 19 in Arkansas - saw female life expectancy fall, a part of a setback that has not happened in the U.S. since the Spanish influenza epidemic of 1918, according to demographers.

In some parts of Arkansas, men and women are dying younger on average than their counterparts in nations such as Syria, Panama and Vietnam, according to numbers from the United Nations and the research by the Institute for Health Metrics and Evaluation at the University of Washington in Seattle.

"It used to be that each generation lived longer than the previous one. Now with the obesity epidemic the concern is that that's not going to be the case anymore- children won't live as long as their parents, and I think we're seeing that," said Dr. Jennifer Dillaha, an Arkansas Department of Health special adviser who is a geriatric medicine specialist.

Areas of the state with declines in average life expectancy between 1987 and 2007 - the time period of the study - correspond to those with high obesity rates, particularly in the state's Delta counties, Dillaha said.

In the Delta's heart, Phillips County posted the eighth-lowest life expectancy for men in the nation, and the life expectancy for women there ranks 13th-lowest, according to the study.

Elsewhere in the state, only Benton County had a higher life expectancy than the national average for both sexes, with men living an average of 76.8 years and women living 81.8 years in the state's northwestern-most county.

All other counties fell below the national life expectancy of 75.6 for men and 80.8 for women, according to the study.

"In Arkansas ... we have very high rates of heart disease, stroke, cancer, lung diseases - all of these so-called causes of death really are impacted by health behaviors like smoking cigarettes and nutrition and physical activity," Dillaha said.

The study highlights other research forecasting that, as members of the baby boomer generation age into their 70s and 80s, they will be less healthy than those currently of that age largely because of unhealthy lifestyle choices,said Dr. Larry Wright, director of the Schmieding Center for Senior Health and Education in Springdale.

"We as a country are living longer, but we're not necessarily living better. ... We're going to live longer to have disability longer, and that's a little scary," Wright said.

In Arkansas, the study found troubling declines in life expectancy in some counties for women, who typically live longer than men. For life expectancy to decline at all in a developed nation is rare.

Of the 19 counties with declines in female life expectancy, two - Lincoln and Drew - saw drops of a year between 1987 and 2007, the study found.

"Women are bearing the brunt of this decline in life expectancy," said Dr. Jeanne Wei. "Is it related to obesity? It sure is."

Thirty-four percent of American adults were classified as obese, according to a report from the federal Centers for Disease Control and Prevention released in 2010. That rate was double what it was in 1980.

Obese women are at greater risk to develop diabetes faster than obese men, and obesity increases risk for a number of life-shortening conditions including high blood pressure and heart disease, said Wei, the director of the Donald W. Reynolds Institute on Aging at the University of Arkansas for Medical Sciences.

Nationally, the backsliding in life expectancy for women began before 1997, but researchers found it had accelerated in the past decade. Only 227 counties saw women's life expectancy decline between 1987 and 1997, according to the study.

One reason may be smoking cigarettes rates, said Samuel Preston, a University of Pennsylvania demographer who was co-chairman of a 2011 National Academy of Sciences panel that looked at life expectancies in high-income countries.

Historically, American women smoked more heavily than women in other countries, particularly after World War II, Preston said.

That had a delayed effect that drove up lung-cancerrates among women as those who were young adults in the 1950s aged, he said.

The trend may ease as that age group passes and the effects of more recent efforts to reduce smoking cigarettes are felt, Preston said.

But Preston cautioned that other unhealthful lifestyle choices may undermine that progress.

In Arkansas, men outpaced women in life-expectancy growth. Male life expectancy grew from 70.3 years in 1987 to 73 years in 2007. Female life expectancy grew only a little less than five months, rising from 78.1 years to 78.5 over the same time period.

Life expectancy for men grew in all counties in the state, even where women saw nearly a year decline, the study found.

Wei said a possible reason behind the trend is that it's harder for doctors to catch signs of heart disease in women than men. Women are less likely to experience chest pains and other overt signs of heart disease, which can lead doctors to the wrong diagnosis, Wei said, citing recent studies.

"When that happens, these women are at a greater risk for dying," she said.

While no Arkansas counties were within the top 200 in life expectancy for either sex, the study found the state mirrored a national trend of growing disparity between healthy and unhealthy areas, with Phillips County being a clear example.

There, male life expectancy was the lowest in the state and behind only seven other counties in the nation, the study found.

Men are expected to live to 66.8 in Phillips County, 10 years shorter than in Benton County. The disparity is about seven years for women, with an expected lifetime of 75 years in Phillips County.

A decade ago the gap was 8.7 years for men, and in 1987 it was only 6 years. For women, the gap was about the same a decade ago but less in 1987, when it was 4.7 years.

"It doesn't surprise me. Diabetes, hypertension, COPD, heart disease ... it's all here," said Dr. Thomas Bailey, who sees 40 to 50 patients a day at his Helena-West Helena clinic. Chronic obstructive pulmonary disease, commonly referred to as COPD, is a common lung disease that makes breathing difficult.

Bailey grew up in Phillips County and has practiced family medicine there for 11 years. He went back after studying at UAMS in Little Rock to try to stem the lack of medical care in his home county that he says is another major factor in explaining the shorter lives.

"They just can't afford it, and by the time you see them, it's too late," he said.

"(Residents) don't have any resources, no jobs - they don't have insurance. They just don't have any way to access the health care," Bailey said.

Wright, of the Schmieding Center, said that's true for several areas of the state and makes the largest impact in limiting access to preventative medical care - perhaps the most important way of stemming life-expectancy declines.

Preventative care is "about breaking long-held lifestyle habits," Wright said. "The basic lifestyle is pretty unhealthy in Arkansas." Information for this article was contributed by Noam N. Levey of the Tribune Washington Bureau.

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