New findings about longevity and screening for genetic disorders

By LEE BOWMAN
Scripps Howard News Service
Wednesday, July 11, 2007

Although age may largely be a state of mind, the state where we live seems to have more than a little to do with longevity.

The average life expectancy at birth in the United States was about 78 years in 2004, up more than two years just since 1991, but the pace of improvement has been uneven.

Life expectancy rose 4.3 years in New York, 3.4 years in California and 3.3 years in New Jersey, compared with just a third of a year in Oklahoma, 0.8 years in Tennessee and 0.9 years in Utah.

So why such a gap for increases?

Frank Lichtenberg, a medical economist at Columbia University, argues in a new study that the biggest factor in the gap is access to medical innovation -- specifically, the ability of the sickest to get the most up-to-date drugs approved by the Food and Drug Administration.

His report, released Wednesday by the Center for Medical Progress at the Manhattan Institute, found that longevity increased the most in states where access to newer drugs through the Medicaid and Medicare programs also increased the most.

The economist said two trends -- a more obese population and a growth in income -- actually kept life expectancy from rising 1-1/2 years more than it would have otherwise during 1991-2004. So the "potential life-expectancy increase at birth" over that time was 3.88 years.

Of that 3.88 years, Lichtenberg calculated that about 63 percent of the potential increase in life expectancy, or 2.43 years, was attributable to access to the newest drugs. Other factors, like a decline in smoking and the reduced incidence of AIDS, were responsible for the rest.

"While use of newer drugs has increased some types of medical spending, it has reduced other types," so there is a rough offset within a single year, he said.

Another report out Wednesday, this one from the March of Dimes, illustrated a different type of variability in health care among the states -- the screening of newborns for life-threatening genetic disorders.

The group has been pressing states to adopt standards set by the American College of Medical Genetics in 2004 to have babies screened for 29 genetic or functional disorders. But for now, the organization is calling for the screening of at least 21 conditions.

Two years ago, only 38 percent of infants were born in states that mandated screening for at least 21 conditions. This year, the percentage has risen to 87.5, meaning that about 3.6 million babies are getting at least 21 of the recommended tests.

"While this important expansion of newborn screening is very good news, the lives of 500,000 newborns who still aren't tested hang in the balance,'' said Dr. Jennifer Howse, president of the March of Dimes. "Babies must be screened to receive immediate treatment necessary to survive and lead healthy lives."

Howse noted that the federal government, despite years of pleas from parents and medical groups, has yet to set a national guideline for newborn screening, "which has made it difficult to get support in some states for legislation requiring the tests."

Only 13 states and the District of Columbia require screening for all 29 conditions. Ten states, accounting for about 12 percent of births nationally, require 10 or fewer of the tests.

The 13 states that mandate screening for all 29 conditions: Alaska, Colorado, Delaware, Iowa, Kentucky, Maryland, Minnesota, Mississippi, New Mexico, New York, Rhode Island, Virginia and Wyoming. The states requiring 10 or fewer of the tests: Arkansas, Kansas, Massachusetts, Montana, Nebraska, Oklahoma, Vermont, Washington, West Virginia and Wyoming.

Newborn screening is done by testing a few drops of blood, usually from a prick in the foot, before hospital discharge. Positive results are retested before any treatment begins for a disorder.

Howse said that no matter what requirements are in place for a particular state, expectant parents should be made aware of the benefits and availability of newborn screening by their obstetrician or pediatrician.

On the Net: http://www.marchofdimes.com

www.manhattan-institute.org