SEATTLE - Depending on where you live, your life may be cut short by nearly two decades compared to others in your community, according to new census tract-level health analysis of Seattle and King County.
The study, a joint project between the Institute for Health Metrics and Evaluation (IHME) at the University of Washington and Public Health - Seattle & King County (PHSKC), finds geographic disparities in more than 150 causes of death, such as ischemic heart disease and drug use disorders.
Men face an 18-year life expectancy gap across the county (68.4 to 86.7 years). For women, the disparity is 14 years (73.6 to 88.4 years). The study's authors generated estimates of death rates and life expectancy from 1990 to 2014. Between those years, life expectancy in King County increased overall 5.4 years for men and 3.4 years for women.
"We did not expect to find gaps in health this large," said IHME Director Dr. Christopher Murray. "Similar analyses in other counties would give leaders on the state, local, and federal levels the most complete health roadmap in the nation for closing the gap on life expectancy."
These new findings offer detailed estimates of death rates by cause, year, and sex among the county's nearly 400 census tracts. Residents in census tracts on Mercer Island and in Bellevue have the highest life expectancy, while those in Auburn and other areas of southeast King County have the lowest. In 2014, the top causes of premature death were: ischemic heart disease, lung cancer, self-harm, Alzheimer's disease and other dementias, drug use disorders, cerebrovascular disease, cirrhosis and other chronic liver diseases, chronic obstructive pulmonary diseases, diabetes, and colon and rectum cancer.
Nationally, the average life expectancy in King County is in the 95th percentile among all US counties. With a population of more than 2 million, King County ranks among the top 5% of counties in household income and life expectancy.
"This study should be required reading for anyone concerned about the lives and livelihoods of people in King County," said John W. Stanton, the Chairman of the Board of the Seattle Mariners, and the philanthropist who funded the project. "All the findings -- both hopeful and disturbing -- inform our understanding of our community's needs and offer insights into ways we can raise our quality of life. This study doesn't just identify inequities within King County and where we can dedicate resources to address them, it illustrates how every other county throughout the United States can focus and prioritize at the neighborhood level. In a place with so much wealth and so many resources, there's no reason we should be experiencing the same health disparities that are seen between some of the richest and poorest nations in the world."
Geographic differences in life expectancy and risk factors have been at the center of public health and community efforts across the region. For example, PHSKC uses ZIP code analyses to determine which areas have a higher concentration of people without health insurance and then works with partners to provide outreach and enrollment assistance.
In addition, PHSKC has worked with community partners for more than a decade to help reduce health disparities by supporting access to healthy eating, smoke-free environments, and safe places.
"This study reinforces that our commitment and approach to reducing health and other inequities are critical to people's lives," said King County Executive Dow Constantine. "Through initiatives like Communities of Opportunity and Best Starts for Kids, we are providing new ideas and investments so that our entire region can prosper and thrive." The study is based on data from Washington State Department of Health Center for Health Statistics between 1990 and 2014. Census tracts are neighborhood-size areas defined by the US Census Bureau for analyzing populations and typically include between 1,200 and 8,000 people. Socioeconomic conditions and risk factors, such as smoking, may partially account for the wide range of health outcomes, according to health officials.
These estimates make it possible to:
- Describe health disparities across even smaller neighborhoods than Health Reporting Areas within King County,
- Identify neighborhoods where the burden of specific conditions is much higher than in the county as a whole,
- Examine the most significant causes of death in any particular neighborhood, and
- Evaluate the contributions of different causes of death to overall inequalities in premature mortality rates within King County.
"Reliable local data on the major causes of death and disability are critical to help communities, health care systems, and public health practitioners identify and address the causes of poor health, premature death, and health disparities," said Dr. Jeff Duchin, Health Officer for PHSKC. "This type of information helps us in our commitment to improve health and reduce unequal health outcomes for people living in all neighborhoods within King County."
The study, "Variation in life expectancy and mortality by cause among neighbourhoods in King County, WA, USA, 1990-2014: a census tract-level analysis for the Global Burden of Disease Study, 2015," was published today in the international medical journal, The Lancet Public Health. The journal included an accompanying editorial stating, "Public health science is now reaching a degree of precision that could provide us with street-level health outcomes and determinants of health.... With cities and local communities becoming the new unit of public health, it is time to think an act much more locally."
Editor-in-chief of The Lancet, Dr. Richard Horton, put the significance of the analysis in a global context.
"These findings have the potential to transform the way we think about advancing public health," Dr. Horton said. "We commonly discuss large global forces shaping the lives of those in our communities, forces that are hard to influence. What this study shows so clearly is that health also depends on powerful local forces that are very much within our range of control. As a result, these findings have important international implications."
For more information on the study, see a map of King County by census tract, and other data visualizations, visit http://www.healthdata.org.
Dean R. Owen
Public Health -- Seattle & King County (Public Health) works to protect and improve the health and well-being of all people in King County as measured by increasing the number of healthy years that people live and eliminating health disparities. PHSKC is the one of the largest metropolitan health departments in the United States with 1,500 employees, 40 sites, and a budget of $318 million. The department serves a resident population of more than 2 million people in an environment of great complexity and scale, with 19 acute care hospitals and over 7,000 medical professionals. For more information, visit http://www.kingcounty.gov/depts/health/about-us.aspx.
Established in 2007, the Institute for Health Metrics and Evaluation (IHME) is an independent research center within UW Medicine at the University of Washington in Seattle. IHME provides rigorous and comparable measurement of the world's most important health problems and evaluates strategies to address them. IHME makes this information available so that policymakers, donors, practitioners, researchers, and local and global decision-makers have the evidence they need to make informed decisions about how to allocate resources to improve population health. For more information, visit http://www.healthdata.org.
The Lancet Public Health