Female death rates before age 75 actually rose in 43% of U.S. counties - including a forested swath of west-central and northern Wisconsin - between 1992 and 2006, according to a UW-Madison Population Health Institute study published Monday in the journal Health Affairs.
Meanwhile, death rates among men declined in every Wisconsin county, and throughout much of the country.
Female mortality rates increased in 1,224 counties nationwide, compared with an increase in 108 counties for men.
The study raises more questions than it answers, but it's the first to examine the relationship between socioeconomic and behavioral factors and mortality at a county level.
A college degree, higher median household income, Hispanic ethnicity, not smoking, and living in a higher population density area were among the factors the study associated with lower mortality rates for both men and women.
Which part of the country you live in may matter, too. For women, liv ing in counties in the South and West was associated with a 6% higher mortality rate than living in the Northeast, according to the study.
Focusing broadly on death rates tied to cancer and heart disease doesn't address other underlying issues driving mortality rates among men and women, said study author David Kindig, professor emeritus of population health sciences and founder of the Population Health Institute at the UW-Madison School of Medicine and Public Health.
"In general, we assume people are getting healthier and living longer, but that's not necessarily true for women," added study co-author Erika Cheng, a doctoral candidate and research assistant in the Department of Population Health Sciences.
"We were shocked," Kindig said of their findings of increased mortality among women. "We think mortality rates gradually are getting better, but that's largely because we look at state and national data. . . . We were surprised at the extent of the worsening when you look at it by county, and that it was so much stronger for females."
There isn't an obvious common thread among counties in Wisconsin that saw increased female mortality rates, based on health outcomes reported in the institute's annual County Health Rankings, which is due to be updated March 20 and is supported by the Robert Wood Johnson Foundation.
Lower education levels, higher adult smoking rates, motor vehicle crash death rates and excessive drinking may be among the factors, though the County Health Rankings does not break out those rates by sex.
Milwaukee County
Surprisingly, Milwaukee County was not among the counties with increased female mortality. Rather, the county saw substantial improvement in mortality rates for both men and women.
Increased female mortality was noted in a swath of contiguous counties in west-central and northern Wisconsin.
In Langlade County in northern Wisconsin, for example, 26% of adults self-reported that they smoked (the national benchmark is 14%), the motor vehicle crash death rate was 29 per 100,000 population (the national benchmark is 12 per 100,000) and 22% self-reported excessive drinking (compared with 8% nationwide), according to the latest County Health Rankings.
In Juneau County, 28% of adults reported they smoked, the motor vehicle crash death rate was 21 per 100,000 population, and 26% self-reported excessive drinking.
The UW-Madison researchers recommend targeted approaches, tailored to each county, based on county health outcome rankings.
Investments in all determinants of health - including health care, public health, health behaviors, and social and physical environment - will be required to improve mortality rates, the researchers concluded.
"Every county is different," they wrote. "Each one needs to examine its outcomes to determine what set of cross-sectional policies would address its own situation most effectively and quickly."
A county's health may affect its economy, Kindig said, if businesses decide where to locate or relocate based on the county's health outcomes.
The county-by-county study published Monday found that medical care variables, such as proportions of primary care providers, were not associated with lower death rates.
"There's not one silver bullet" to improving life expectancy, Kindig said. "Social factors such as income, education and social support are harder to explain."
Possible factors for higher mortality rates
Lower education levels
Higher adult smoking rates
Motor vehicle crash death rates
Excessive drinking
 study says Women's mortality rates worsen in parts of north, central Wisconsin.){kind=link}
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