What’s Happening to Death
Rates of Women of Reproductive
Age
Nan Marie Astone
URBAN INSTITUTE
Colleagues
•
•
•
•
•
Lauden Aron UI
Steven Martin UI
Stephen Woolf VCU
Steven Cohen VCU ***
Allison Phillips VCU
***PFRH alum
URBAN INSTITUTE
Two Troubling Results
• Relative ranking of Life Expectancy of U.S.
Women is falling
– Issue is differences in mortality before age 50
• Life Expectancy is going down and Age
Adjusted Death Rate is going up for some
groups of women
URBAN INSTITUTE
Two NAS Reports
• Explaining Divergent Levels of Longevity in
High Income Countries
– Crimmins, Preston and Cohen 2011
• Shorter Lives, Poorer Health: U.S. Health
in International Perspective
– Steven H. Woolf and Lauden Aron 2013
URBAN INSTITUTE
Life Expectancy at Birth
from Crimmins et al. 2011
Men
URBAN INSTITUTE
Women
Survival to Age 50
from Woolf and Aron 2013
Men
URBAN INSTITUTE
Women
Life Expectancy by Education
Olshansky et al. 2012
URBAN INSTITUTE
Change in Life Expectancy by
County in the U.S. 1983-1989
Ezzati et al. 2008
Men
URBAN INSTITUTE
Women
Change in Life Expectancy by
Country 1992-1996 to 2002-2006
Kindig and Cheng 2013
Men
URBAN INSTITUTE
Women
No one is looking by Age
• Turns out there is actually a lot of pressure
upward on women’s life expectancy
– Even European American women
URBAN INSTITUTE
Infant Mortality Went Down
European American Girls
URBAN INSTITUTE
African American Girls
Child and Adolescent Mortality Went
Down
European American Women
URBAN INSTITUTE
African American Women
Older Adult Mortality Went Down
European American Women
URBAN INSTITUTE
African American Women
Younger Adult Mortality Went Up For
European American Women Only
European American Women
URBAN INSTITUTE
African American Women
Who are these people?
• European American women of
reproductive age
–Minus 15-19
–Plus 50-54
URBAN INSTITUTE
Table 1. Deaths/100,000 for White Women 20 to 55
by Year.
2000Deaths/100000
2000
2010 2010
Alabama
175
234
-59
-5.6
Alaska
144
149
165
-10.7
Arizona
154
Arkansas
181
222
-41.4
1.1
California
151
150
127
136
-8.5
Colorado
0.8
125
Connecticut
126
Delaware
150
204
-54.3
44
40.3
District of Columbia
84
-30.2
Florida
176
206
183
-26.4
Georgia
157
-22
144
Hawaii
122
128
144
-16.2
Idaho
Illinois
130
136
-5.7
Indiana
150
181
-31.2
148
-20.9
Iowa
127
151
-20.6
Kansas
131
-58.2
Kentucky
174
232
-26.1
Louisiana
168
194
-20.9
Maine
132
153
Maryland
135
145
-10.5
122
3.9
Massachusetts
126
-28.5
Michigan
137
166
Minnesota
111
111
-0.6
232
-44.7
Mississippi
187
154
182
-28.4
Missouri
Montana
120
162
-41.7
-12.6
Nebraska
115
128
Nevada
210
221
-10.7
New Hampshire
124
130
-6.3
New Jersey
134
135
-0.8
165
199
-33.9
New Mexico
New York
123
121
2.8
170
-18.2
North Carolina
151
106
102
3.8
North Dakota
Ohio
-31.2
145
176
Oklahoma
193
230
-36.2
Oregon
148
156
-8.1
Pennsylvania
142
155
-12.9
Rhode Island
137
136
1.2
South Carolina
165
196
-31.4
South Dakota
117
112
5.5
171
223
-52.5
Tennessee
Texas
158
181
-22.3
Utah
119
132
-12.6
Vermont
142
131
10.8
Virginia
135
146
-10.9
Washington
132
142
-10
West Virginia
176
236
-59.6
Wisconsin
124
128
-4.3
Wyoming
150
192
-42
URBAN INSTITUTE
State Rates
• Death Rates for European American women
20 to 55 went up in 42 of 51 states
• Substantially in about a third of these
• Place where it declined (except DC) the
declines were very small
• It ain’t just in Appalachia anymore
URBAN INSTITUTE
Looking from 1980 by Age
European American Women Aged 20 to 54
URBAN INSTITUTE
Looking from 1980 by Age
European American Women Aged 20 to 54
URBAN INSTITUTE
Death rates for women 20-54 by Cause
European American
URBAN INSTITUTE
African American
Hypotheses
• Behavior
• Social Factors
• Public Policy
URBAN INSTITUTE
Behavior
• Smoking (awfully young)
• Obesity (young, but more
plausible)
• Violence
• Substance Use
URBAN INSTITUTE
Social
• Multiple Roles
– More like men
• Decline in Economic Well-Being
• Migration and other Selection
URBAN INSTITUTE
Public Policy
• Health Care
• Health Insurance
• Other Policies
URBAN INSTITUTE
What do you think?
URBAN INSTITUTE