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PrintAll the warnings to stop smoking, eat more vegetables and take other basic steps to improve health are apparently paying off in ways that have left even experts surprised.
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Bill Wade, Post-Gazette Dr. Anne B. Newman, left, who specializes in geriatrics, talks with her patient Anita Lopatin Smolover, who maintains an active life in retirement and carefully manages her blood pressure and cholesterol. Click photo for larger image.  Graphic: Age-adjusted death rates, Pa. and Allegheny County, 1990-2004
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The recent drop in death rates "has been surprisingly large," said Dr. Lewis Kuller, a professor of epidemiology at the University of Pittsburgh Graduate School of Public Health.
He attributed much of the trend to efforts that began years ago to decrease smoking and lower cholesterol and blood-pressure levels.
Other experts suggested the decline may not last, in part because of the nation's problem with obesity.
In 2004, the state's age-adjusted death rate and rates for the three leading causes of death -- heart disease, cancer and stroke -- all reached their lowest levels since at least 1990. So did the rates for both sexes and for whites, blacks and Hispanics.
Trends in death rates varied among Western Pennsylvania counties, though Allegheny, Fayette and Indiana also reached 15-year lows in 2004.
Statewide, the age-adjusted death rate dropped to 843 per 100,000 residents that year, down from 870 in 2003 and 946 in 1990, according to the Pennsylvania Department of Health. State officials said they lacked comparable data for earlier years.
Nationwide, the age-adjusted rate in 2004 was even lower. It dropped to 801 per 100,000 people, the lowest on record, according to preliminary data reported last month by the National Center for Health Statistics.
Pennsylvania's death rates may be higher, in part, because of the greater incidence of smoking, high cholesterol and obesity in some areas of the state, said Dr. Anne B. Newman, a professor of epidemiology and geriatric medicine at Pitt.
The state's aging population also may be a factor, said Jerry Orris, the state health department's director of statistical support.
Age adjustment tries to minimize age differences to allow better comparisons among populations. But age-adjusted data may not account entirely for the fact that Pennsylvania residents are relatively old, and thus are more likely to die, compared to residents of other states, Mr. Orris said.
Along with a record low death rate, U.S. life expectancy rose to 77.9 years in 2004, a record but lower than in some other countries.
A mild flu season may have contributed to the exceptionally low death rate that year, said Arialdi Minino, principal author of the national report.
"I think we have to wait a couple more years to see if this is something that's sustained," he said.
More important than the single-year results, he said, are overall trends -- and age-adjusted death rates have been "trending downward for many years," he said.
Dr. Donald Lloyd-Jones, a cardiologist and assistant professor of preventive medicine at Northwestern University, said the nation is likely benefiting from "some extremely successful public-health programs in the 1960s, '70s and '80s," including initiatives that encouraged people to stop smoking and lower their cholesterol levels by changing their diets.
Dr. Kuller said those efforts have been the primary factors that have driven down death rates, but noted that improved therapies also have been developed to lower cholesterol and blood pressure and treat heart disease.
In part because of those developments, many people are not only living longer, but also are staying healthier, he said.
"We're probably pushing back the period of disability at the end of life," Dr. Newman said, noting that reducing cardiovascular risk factors appears to add about five years to healthy life expectancy.
Many older people remain "active and contributing to society," she said.
"Thank God, I'm really quite well," said Anita Lopatin Smolover, one of Dr. Newman's patients. She has high blood pressure and high cholesterol, but both are controlled by medication.
The 80-year-old Oakland resident said she worked more than 40 years for the Jewish Community Center, then for more than a decade as director of the Pittsburgh chapter of OASIS, which provides lifelong learning and service opportunities for older adults.
Though retired, she remains active in community affairs. She and her husband, Albert, also walk regularly for exercise, travel and have a wide circle of friends.
Older adults well into their 70s "need to understand there is still a tremendous potential that they'll live quite awhile," Dr. Newman said.
"It's a whole new world now, and it's a whole new retirement life that people need to think about having."
Besides an overall decline in death rates, rates also fell nationally in 2004 for both sexes and for major racial and ethnic groups. But the rates remained higher for African Americans, both in Pennsylvania and nationwide.
Factors contributing to the disparity include mistrust among blacks in the health care system and a "failure to target the message of health care promotion and disease prevention to the population in greatest need," said Dr. Stephen Thomas, director of Pitt's Center for Minority Health.
Though socioeconomic status is often a factor, some health disparities persist among blacks with higher incomes, said Dr. Judith Long, an assistant professor at the University of Pennsylvania School of Medicine and an investigator for the Center for Health Equity Research and Promotion. She said that in some cases, blacks may have less access to good specialty care.
Hispanics also appear to face greater health risks, Dr. Newman said, though their death rates are relatively low.
The reasons are not completely clear, Mr. Minino said. But he noted that Hispanic origin is underreported on death certificates and some Hispanics in later years return to their native countries, where their deaths would not be reflected in U.S. mortality data.
Gender differences also persist in death rates, with lower rates for women than for men. But Dr. Kuller noted that the gap has narrowed, primarily because of the adverse health effects that resulted as more women began smoking.
Some experts worry that the positive trends in death rates and life expectancy could be reversed by the nation's struggles with obesity.
"We've seen a marked increase in average weights, and we've seen it at all ages," said Dr. Murray B. Gordon, director of endocrinology at Allegheny General Hospital. "Kids and adults are less active and eating more, and weight is going up."
The problem has fueled an epidemic of diabetes and can lead to other health conditions, including high blood pressure, high cholesterol and vascular disease, he said.
While medical treatment can help, lifestyle changes are needed to head off those problems and the risk of increased mortality, he said.
In an article last year in the New England Journal of Medicine, researchers suggested that the increased prevalence of obesity could lead to lower life expectancy.
The recent announcement that major manufacturers plan to stop selling sugary soft drinks in schools is a hopeful sign, said Dr. S. Jay Olshansky, the article's principal author and a professor in the school of public health at the University of Illinois at Chicago.
Dr. Kuller remained optimistic that mortality rates will not increase, saying new research and greater application of existing knowledge could have significant benefits.
"We still have a way to go," he said, noting that health disparities and other challenges must be overcome. "But we're seeing a huge payoff right now in terms of advances in prevention."
Correction/Clarification: (Published June 1, 2006) The nation's age-adjusted death rates have been trending downward for many years, a trend more important than the rate in a single year, according to Arialdi Minino, principal author of a report released in April by the National Center for Health Statistics. This story as originally published on May 31, 2006 did not make this distinction clear.
