WHERE YOU LIVE IS FACTOR IN LONGEVITY.

Byline: Staff and Wire Services

California ranks No. 10 in the nation for longevity, with the average Golden State resident living to age 78.2, slightly longer than those in Los Angeles County, a study released Monday found.

The study by the Harvard University Initiative for Global Health and the Harvard School of Public Health found that where you live, combined with race and income, plays a huge role in the nation's health disparities, differences so stark that it's as if there are eight separate Americas instead of one.

Among the 50 states, Hawaiians have the greatest life expectancy, a collective 80 years for men and women. Hawaiian women lead all state groups with a life expectancy of 83.2 years.

Other healthy states include California, Colorado, Connecticut, Massachusetts, Minnesota, North Dakota, New Hampshire, Vermont and Washington, all with a combined male and female life expectancy topping 78 years.

L.A. County

In Los Angeles County, men reach 75.4 and women, 80.7, for an average of 78.1.

Dr. Jonathan E. Fielding, the county's public health director, said the relatively long life spans in the state and county may have to do with the drop in smoking rates, healthy diets, good weather that make exercising year-round easier and the long life spans of the large Latino population.

``There is the Latino paradox,'' Fielding said. ``We have a higher percentage of Latinos than most other states and we know that despite getting less health care, Latinos have greater longevity and better health on average. Secondly, we have significantly reduced smoking in California. We're down below 15 percent and smoking remains the major preventable cause of death.

``The climate makes it easier to be more physically active most of the year. There is also a greater availability of fruits and vegetables all year-round than in some other parts of the country.''

The study, published in the online science journal PLoS Medicine, found more than 30 years separate Americans with the greatest life expectancies from those with the lowest.

It concluded that disparities seem to be caused by a number of chronic diseases, such as heart disease and cancer, and to injuries with well-established risk factors, such as alcohol-related traffic accidents. Income, infant mortality, violence, HIV/AIDS, and a lack of health insurance only explained a small percentage of the differences.

For example, Asian-American women living in Bergen County, N.J., lead the nation in longevity, typically reaching their 91st birthdays. Worst off are American Indian men in swaths of South Dakota, who die around age 58 -- three decades sooner.

Millions of the worst-off Americans have life expectancies typical of developing countries, concluded Dr. Christopher Murray of the Harvard School of Public Health.

Asian-American women can expect to live 13 years longer than low-income black women in the rural South, for example. That's like comparing women in wealthy Japan with those in poverty-ridden Nicaragua.

Compare those longest-living women with inner-city black men, and the life-expectancy gap is 21 years. That's similar to the life-expectancy gap between Iceland and Uzbekistan.

Complex issue

Health disparities are widely considered an issue of minorities and the poor being unable to find or afford good medical care. Murray's county- by-county comparison of life expectancy shows the problem is far more complex, and that geography plays a crucial role.

``Although we share in the U.S. a reasonably common culture ... there's still a lot of variation in how people live their lives,'' Murray said.

Consider: The longest-living whites weren't the relatively wealthy, which Murray calls ``Middle America.'' They're edged out by low-income residents of the rural Northern Plains states, where the men tend to reach age 76 and the women 82.

Yet low-income whites in Appalachia and the Mississippi Valley die four years sooner than their Northern neighbors.

He cited American Indians as another example. Those who don't live on or near reservations in the West have life expectancies similar to whites'.

``If it's your family involved, these are not small differences in life span,'' Murray said. ``Yet that sense of alarm isn't there in the public. If I were living in parts of the country with those sorts of life expectancies, I would want ... to be asking my local officials or state officials or my congressman, `Why is this?'''

The more precise measure of health disparities developed by the study will allow federal officials to better target efforts to battle inequalities, said Dr. Wayne Giles of the Centers for Disease Control and Prevention, which helped fund Murray's work.

The CDC has some county-targeted programs -- such as one that has cut in half diabetes-caused amputations among black men in Charleston, S.C., since 1999, largely by encouraging physical activity -- and the new study argues for more, he said.

``It's not just telling people to be active or not to smoke,'' Giles said. ``We need to create the environment which assists people in achieving a healthy lifestyle.''

The study also highlights that the complicated tapestry of local and cultural customs might be more important than income in driving health disparities, said Richard Suzman of the National Institute on Aging, which co-funded the research.

``It's not just low income,'' Suzman said. ``It's what people eat, it's how they behave, or simply what's available in supermarkets.''

Murray analyzed mortality data between 1982 and 2001 by county, race, gender and income. He found some distinct groupings that he named the ``eight Americas:''

Asian-Americans, average per capita income of $21,566, have a life expectancy of 84.9 years.

Northland low-income rural whites, $17,758, 79 years.

Middle America (mostly white), $24,640, 77.9 years.

Low-income whites in Appalachia, Mississippi Valley, $16,390, 75 years.

Western American Indians, $10,029, 72.7 years.

Black Middle America, $15,412, 72.9 years.

Southern low-income rural blacks, $10,463, 71.2 years.

High-risk urban blacks, $14,800, 71.1 years.

Longevity disparities were most pronounced in young and middle-age adults. A 15-year-old urban black man was 3.8 times as likely to die before the age of 60 as an Asian-American, for example.

That's key, Murray said, because this age group is left out of many government health programs that focus largely on children and the elderly.

Moreover, the longevity gaps have stayed about the same for 20 years despite increasing national efforts to eliminate obvious racial and ethnic health disparities, he found.

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Map:

Living longer in the Northern Plains

SOURCE: Harvard School of Public Health

Associated Press