東京日和＠元勤務医の日々

米の平均寿命、アジア系と黒人で１４歳の差

　米国人は人種や地域によって平均寿命の異なる「８つのグループ」に分けられ、最も長寿の約１０４０万人のアジア系と、約７５０万人の都市部に住む黒人では１４歳近くの開きがある―。こんな報告をハーバード大の研究グループが１３日までにまとめた。

　報告は平均寿命が異なる原因について言及していないが、１２日付の米紙ワシントン・ポストは都市部の黒人の場合、劣悪な治安状況などが一因と推定した。

　研究グループは２００１年のデータを基に分析を行い、収入レベルが高かったり、医療サービスを多く利用しているグループの平均寿命が長いとは限らないと指摘。一方で、日系人などアジア系の長寿ぶりが際立つ結果となっている。（共同）

(09/13 20:27)

http://www.sankei.co.jp/news/060913/kok008.htm

----------------------

　ワシントンポストの分析は、劣悪な医療環境のせいではなく、劣悪な治安状況のせいとされています。オリジナルを探して読んでみたけど、中年層が治安の悪さゆえ…という結論ですが…それにしても均寿命がこんなに大きいとはびっくりですね。てっきりこんなことわざのせいかと思ってしまいました。

・ The purse of the patient protracts the disease. 《諺》患者の財布が病気を長引かせる。

平均寿命の比較と推移については下記がくわしく、興味深くよみました。

（５）世界一の長寿国

　とりあえず、ワシントンポストの分析について知りたければ原文をチェックしましょう(色つきがそのあたりですが…)。

その前にランキングにご協力を☆ポチっと！→

 http://www.washingtonpost.com/wp-dyn/content/article/2006/09/11/AR2006091101297.html

Wide Gaps Found In Mortality Rates Among U.S. Groups

Washington Post Staff Writer
Tuesday, September 12, 2006; Page A01

Even between groups that appear quite similar there are wide differences in the risk of early death. A farmer from a Great Plains state such as North Dakota is likely to live four years longer than a farmer living in Appalachia or the Mississippi Valley.

Those are among the observations of the study, which examines death in the United States through an unusual lens that refracts the population into eight demographic groups, or "Eight Americas."

The differences in life expectancy across that spectrum are as wide as the difference between Iceland and Uzbekistan. The study, based on 2001 data, reveals a United States that is pocked by places where millions of adults face a risk of premature death like that in Angola, Mexico, Nigeria and other parts of the developing world. Furthermore, those differences -- the most obvious sign of the health disparities that have captured the attention of policymakers -- have not changed in two decades.

"I think it's pretty fair to say we're failing," said Christopher J.L. Murray, a researcher at the Harvard School of Public Health. "The score card on the macro level has been failure."

One of the reasons for the persistence of the disparities, Murray says, is that the biggest difference in mortality is seen among people in middle age. That part of the population has not been a major focus of new investment in government health programs in the past two decades.

Instead, children and the elderly -- among whom the disparities are less severe -- have been the principal targets of new and innovative health spending. Those include free vaccines for poor children, the state and federal governments' Children's Health Insurance Program (CHIP), and the drug benefit (Part D) recently added to the Medicare program.

A decade ago, Murray and his colleagues looked at life expectancy county by county. In this study, they began with 2,000 geographical units -- counties or groups of counties. They then divided them into eight groupings based on ethnicity, race and income. Some were broad geographical areas, while others were essentially demographic archipelagos stretching across the nation.

The Eight Americas were: Asians, scattered throughout the country; rural whites in the Northern Plains and the Dakotas; white Middle America, consisting of 214 million people not assigned to other categories; low-income whites in Appalachia and the Mississippi Valley; Western Indians (the smallest group, with 1 million people); black Middle America; low-income rural Southern blacks; and high-risk urban blacks -- those living in places where a person has a 1 percent or greater risk of being killed between 15 and 74 years of age.

The study, by Majid Ezzati, also of Harvard, along with Murray and five other researchers, is published in the Public Library of Science's online journal, PLoS Medicine. It includes a list of the counties with the highest and lowest life expectancies in the nation.

Montgomery County is tied for first (81.3 years), with Fairfax County not far behind at 80.9. Baltimore City is next to last (68.6). The District, at 72 years, is also among the 50 jurisdictions with the shortest life expectancies.

As previous studies have shown, Asians have by far the longest life expectancy -- 87.4 years for women and 82.1 for men. Black urban men have the shortest (66.7), followed by Southern rural black men, at 67.7. Indian men in the West are next, at 69.4.

Curiously, Asian women in the United States -- many of whom are second-generation and have spent their whole lives here -- have a life expectancy that is three years longer than Japanese women, who, as a national group, are the longest-living in the world. Previous research suggests that Asians lose their "survival advantage" after they are in the United States for a long time and have adopted an American diet and habits, but the new study suggests that is not happening with Asian women.

Among the more interesting comparisons, however, are those among whites.

Northern Plains whites have a per capita income below that of Middle America whites (about $18,000 vs. $25,000), and essentially the same percentage who are high school graduates (83 vs. 84). But they live longer -- 79 years vs. 77.9 years.

The comparison is even more dramatic with the Appalachian and Mississippi Valley group. The latter has a per capita income only $1,400 less than the Northern Plains group, but a markedly lower high school graduation rate, at 72 percent.

The gap in life expectancy between those groups in 2001 was 4.2 years for men and 3.8 years for women. This is not far off the overall gap of 6.4 years between black men and white men, and the 4.6-year gap between white women and black women.

The paper did not examine the causes of death between the groups. But the researchers note that high mortality in urban black men persists even when homicide and AIDS are removed. Heart attack, stroke, diabetes, cirrhosis and fatal injuries are the major causes of reduced life expectancy in that group.

The huge strides in cutting infant mortality in the past 50 years are clearly evident in the findings. The risk of dying between birth and age 4 is extremely similar among all Eight Americas -- much more similar than at any other age.

While black inner-city men have a mortality risk similar to that of West Africans, that is true only once they reach their forties. West Africans have a risk of dying in childhood more than 10 times that of even the most disadvantaged African Americans.

Interestingly, there was less variation among the Eight Americas in the rate of health insurance coverage and the frequency of routine medical appointments than there was in life expectancy. That finding suggests that access to care does not explain most of the differences in mortality.

Others in the field found the study informative and not surprising -- and also somewhat frustrating.

"The magnitude of the life expectancy disparity is most striking and is perhaps a bit larger than I might have guessed," said Mitchell Wong of the University of California at Los Angeles, who has studied how various diseases contribute to disparities in mortality. "However, it is not surprising that by combining race and geography, disparities are even larger."

Richard Cooper, chairman of preventive medicine at Loyola University School of Medicine, said that "the problem with these sorts of analyses is that they don't tell you anything very illuminating about the underlying social process" that leads to differences in life expectancy.

　産婦人科外来を縮小　医師不足で７月から　浦添総合病院

　助産師外来の導入や母子同室の推進など、産科医療の先進的な取り組みを進める浦添総合病院（新里誠一郎院長）の産婦人科が、医師不足で７月から、外来時間の短縮や休診日を設けるなどの一部制限を始めている。別の民間病院でも医師が足りず、近年は当直から外れていた７０代の医師が再度、当直に加わったケースもあり、産婦人科医不足の影響は都市部や民間病院にも広がりをみせている。
　浦添総合病院産婦人科は琉球大学からの派遣医２人を含む医師３人体制だったが、同大の人員不足により７月から派遣医が１人になった。新たな医師確保も当面は難しく、外来診察の対応を（１）医師２人から１人に縮小（２）月、水、金曜日の午後と土曜日を休診―など外来の一部制限を始めた。
　一方、同病院では助産師が２１人と県内でも特に大人数が配置されており、医師と連携して正常分娩（ぶんべん）を支えている。伊波忠産婦人科部長は、医師２人でも対応できている側面があるとしながらも、「（従来の体制は）３人でやっと維持していた。２人では縮小せざるを得ない」と、継続した分娩体制を維持するための外来制限に理解を求めた。
　琉大からの派遣医の縮小については、新臨床研修医制度の導入で各大学病院の医局が全国的に人員不足になっている現状に触れ、「（縮小は）やむを得ない」と話した。

 （琉球新報） - 9月13日10時59分更新

http://ryukyushimpo.jp/news/storyid-17166-storytopic-1.html

--------------

　すごいですねぇ。７０歳すぎて当直ですか…ベテランの先生は、現場からの要請に応えてのことだと思いますが、自分が７０歳過ぎても、引き受けられるかな？

ランキングにご協力を☆ポチっと！→