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Mortality Is On The Rise For White Women In Rural Kentucky

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Life expectancy in the United States has declined for the third year in a row, driven in part by a rise in mortality among working-aged white Americans.

A new report from the Robert Wood Johnson Foundation sought to pinpoint where mortality was worsening, and why. Researchers found higher rates of mortality among rural white women who live in Kentucky, as well as in Appalachia and other states across the south and central part of the country.


The higher rates of death among these women can be attributed to respiratory diseases and lung cancer, drug overdoses, suicide, and nervous system disorders such as Alzheimer’s disease and dementia.

“If you look by trends by state … Kentucky should be very concerned,” said the report’s co-author Samuel Preston, a demographer at the University of Pennsylvania.

U.S. Life Expectancy Trends Are Shifting Downward

When the Centers for Disease Control and Prevention released its latest life expectancy report this June, it showed another slight decline that bucks a decades-long trend of rising U.S. life expectancy. Overall U.S. life expectancy has decreased every year from 2014 to 2016.*

“I’ve been studying mortality for probably close to half a century, and we have become accustomed to steady improvements, but the U.S. in the last four or five years has been a real exception to that pattern,” said Preston.

The report out this week that he co-authored examined mortality rates and causes of death among non-Hispanic whites across gender, age, geographic region and urban status (defined as large metro, metro suburban, small metro and non-metro areas). When comparing the change in life expectancy among white Americans between the early 90’s and the mid-2010s, the report found decreases only among white women in non-metropolitan areas.

Kentucky White Female Mortality Likely Tied To Smoking

Kentucky’s high rates of smoking may be a factor in the declining life expectancy for women in rural areas. According to the CDC, Kentucky has the second highest rate of smoking among U.S. states, second only to West Virginia in 2017. Smoking is linked to lung cancer and respiratory diseases, two of the  causes of death the report identified as major contributing factors in the mortality rise among white rural women.

Preston said historically, women in rural areas began smoking decades later than other women, and are now hanging on to the habit longer than other women and men. He blames that trend in part for the difference in mortality rates between women in urban and rural areas.

“The rest of the country has had falling death rates from lung cancer, but women in non-metropolitan areas are the only exception to that,” Preston said.

President of the Foundation for a Healthy Kentucky Ben Chandler said he is not at all surprised by the results of the report, nor Preston’s analysis in regard to smoking.

“This is in line with other reports that we’ve seen, particularly relative to the enormous cancer rate in the eastern part of the state,” Chandler said.

He said the Foundation for a Healthy Kentucky endorses cigarette tax increases and smoke-free laws, in the hope of cutting both smoking rates and cancer rates in Kentucky.

*United States Life Tables 2014, 2015 and 2016 from the CDC’s National Center for Health Statistics, published in 2017, 2018 and 2019.


Liz Schlemmer is WUNC's Education Policy Reporter, a fellowship position supported by the A.J. Fletcher Foundation. She has an M.A. from the UNC Chapel Hill School of Media & Journalism and a B.A. in history and anthropology from Indiana University.
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