Massage clients mirror the larger U.S. population, with some in top physical condition and others presenting in ill health or with medical conditions. New research shows four risk factors, smoking, high blood pressure, high blood sugar and obesity, account for a substantial amount of the disparity in life expectancy among Americans.

These four preventable risk factors are responsible for hundreds of thousands of deaths in the United States each year through the chronic diseases they create, including cancer, diabetes and cardiovascular diseases, according to a statement from the Public Library of Science, which published the research. These risk factors are estimated to reduce life expectancy in the United States by 4.9 years in men and 4.1 years in women.

The researchers found that a person's place of residence and ethnicity are predictors of health and life expectancy. Among the results:
• The Asian American subgroup

had the lowest body mass index, smoking rates and blood sugar
• The white subgroups had the lowest blood pressure.
• Blood pressure was highest in the US black population, especially in the rural south
• Body mass index was highest in western Native American men and southern low-income rural black women
• Smoking was highest in western Native Americans and low-income whites in Appalachia and the Mississippi Valley.
• The effect on life expectancy of these factors was smallest in the Asian group and largest in low-income southern rural blacks.

The study was recently published in PLoS Medicine.

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