Hmmm.

Life expectancy has long been growing steadily for most Americans. But it has not for a significant minority, according to a new study, which finds a growing disparity in mortality depending on race, income and geography.

The study, published Monday in the online journal PLoS, analyzed life expectancy in all 3,141 counties in the United States from 1961 to 1999, the latest year for which complete data have been released by the National Center for Health Statistics. Although life span has generally increased since 1961, the authors reported, it began to level off or even decline in the 1980s for 4 percent of men and 19 percent of women.

“It’s very troubling that there are parts of the wealthiest country in the world, with the highest health spending in the world, where health is getting worse,” said Majid Ezzati, the lead author and an associate professor of international health at Harvard. It is a phenomenon, he added, “unheard of in any other developed country.”

Counties with significant declines were concentrated in Appalachia, the Southeast, Texas, the southern Midwest and along the Mississippi River. Life expectancy increases were mainly in the Northeast and on the Pacific Coast.

Also, places where, well, they get there.

This lack of progress among the worst off was caused by a slowing or halt of reductions in cardiovascular disease, combined with increases in lung cancer and diabetes for women and in H.I.V. infection and homicide for men.

This rise in mortality for chronic diseases runs counter to trends in other developed countries, and the geographical differences are consistent with regional trends in smoking, high blood pressure and obesity. Dr. Ezzati speculates that data after 1999 will show more decreases in life span for the worst-off women. He expects to see a slight increase for men, with improved treatment for H.I.V. and AIDS.

In other words, it’s our smoking, drinking, eating and fucking that are killing us.