CDC: Life ex­pectancy in the U.S. de­clines

Re­ports show na­tion plagued by the crises of sui­cide, over­doses

Houston Chronicle Sunday - - HEALTH | SCIENCE - By Lenny Bern­stein

Life ex­pectancy in the United States de­clined again in 2017, the gov­ern­ment said Thurs­day in a se­ries of bleak re­ports that showed a na­tion in the grip of es­ca­lat­ing drug and sui­cide crises.

The data con­tin­ued the long­est sus­tained de­cline in ex­pected life span at birth in a cen­tury, an ap­palling per­for­mance not seen in the United States since 1915 to 1918. That four-year pe­riod in­cluded World War I and a flu pan­demic that killed 675,000 peo­ple in the United States and per­haps 50 mil­lion world­wide.

Pub­lic health and de­mo­graphic ex­perts re­acted with alarm to the re­lease of the Cen­ters for Dis­ease Con­trol and Pre­ven­tion’s an­nual sta­tis­tics, which are con­sid­ered a re­li­able barom­e­ter of a so­ci­ety’s health. In most de­vel­oped na­tions, life ex­pectancy has marched steadily up­ward for decades.

“I think this is a very dis­mal pic­ture of health in the United States,” said Joshua Sharf­stein, vice dean for pub­lic health prac­tice and com­mu­nity en­gage­ment at the Johns Hop­kins Bloomberg School of Pub­lic Health. “Life ex­pectancy is im­prov­ing in many places in the world. It shouldn’t be de­clin­ing in the United States.”

“Af­ter three years of stag­na­tion and de­cline, what do we do now?” said S.V. Subra­ma­nian, a pro­fes­sor of pop­u­la­tion health and ge­og­ra­phy at Har­vard’s T.H. Chan School of Pub­lic Health. “Do we say this is the new nor­mal? Or can we say this is a tractable prob­lem?”

Over­all, Amer­i­cans could ex­pect to live 78.6 years at birth in 2017, down a tenth of a year from the 2016 es­ti­mate, ac­cord­ing to the CDC’s Na­tional Cen­ter for Health Sta­tis­tics. Men could an­tic­i­pate a life span of 76.1 years, down a tenth of a year from 2016. Life ex­pectancy for women in 2017 was 81.1 years, un­changed from the pre­vi­ous year.

Drug over­doses set an­other an­nual record in 2017, crest­ing at 70,237 — up from 63,632 the year be­fore, the gov­ern­ment said in a com­pan­ion re­port. The opi­oid epi­demic con­tin­ued to take a re­lent­less toll, with 47,600 deaths in 2017 from drugs such as fen­tanyl and heroin, as well as pre­scrip­tion nar­cotics. That was also a record num­ber, driven largely by an in­crease in fen­tanyl deaths.

Since 1999, the num­ber of drug over­dose deaths has more than quadru­pled. Deaths at­trib­uted to opi­oids were nearly six times greater in 2017 than they were in 1999.

Pre­ven­tion show re­sults

Deaths from le­gal painkillers did not in­crease in 2017. There were 14,495 over­dose deaths at­trib­uted to nar­cotics such as oxy­codone and hy­drocodone and 3,194 from methadone, which is used as a painkiller. Those to­tals were vir­tu­ally iden­ti­cal to the num­bers in 2016. The num­ber of heroin deaths, 15,482, also did not rise from the pre­vi­ous year.

Robert An­der­son, chief of the mor­tal­ity sta­tis­tics branch at the Cen­ter for Health Sta­tis­tics, said the lev­el­ing off of pre­scrip­tion drug deaths may re­flect a small im­pact from ef­forts to curb the di­ver­sion of le­gal painkillers to users and deal­ers on the streets. Those mea­sures in­clude pre­scrip­tion drug mon­i­tor­ing pro­grams that help pre­vent sub­stance abusers from ob­tain­ing mul­ti­ple pre­scrip­tions by “doc­tor shop­ping.”

But Sharf­stein, a for­mer sec­re­tary of health in Mary­land, said the heroin num­bers re­veal fen­tanyl is push­ing heroin out of the il­licit mar­ket in some places.

“The opi­oid mar­ket has been com­pletely taken over by fen­tanyl,” Sharf­stein said.

In­deed, the new data shows il­licit fen­tanyl-re­lated deaths surged again, from 19,413 in 2016 to 28,466 in 2017.

As large as it was, that 47 per­cent in­crease was smaller than the jump be­tween 2015 and 2016, when the num­ber of deaths from fen­tanyl and its ana­logues more than dou­bled. (The to­tal num­ber of opi­oid deaths is smaller than the sum of the cat­e­gories be­cause some peo­ple die with mul­ti­ple drugs in their sys­tems.)

The geo­graphic dis­par­ity in over­dose deaths con­tin­ued in 2017. West Vir­ginia again led the na­tion with 57.8 deaths per 100,000 peo­ple, fol­lowed by Ohio, Penn­syl­va­nia and the District of Columbia. Ne­braska, by con­trast, had just 8.1 drug over­dose deaths per 100,000 res­i­dents.

Other fac­tors in the life ex­pectancy de­cline in­clude a spike in deaths from flu last win­ter and in­creases in deaths from chronic lower res­pi­ra­tory dis­eases, Alzheimer’s dis­ease, strokes and sui­cide. Deaths from heart dis­ease, the No. 1 killer of Amer­i­cans, which had been de­clin­ing un­til 2011, con­tin­ued to level off.

Deaths from can­cer con­tin­ued their steady down­ward trend.

The CDC is­sues its health sta­tis­tics re­port each De­cem­ber. The 2017 re­port is the third in a row to show a de­cline in life ex­pectancy.

Ur­ban vs. ru­ral sui­cides

In a third re­port, the gov­ern­ment de­tailed the on­go­ing growth of deaths from sui­cide, which has climbed steadily since 1999 and grown worse since 2006.

Most no­table is the widen­ing gap be­tween ur­ban and ru­ral Amer­i­cans. Sui­cide rates in the most ru­ral coun­ties are now nearly dou­ble those in the most ur­ban coun­ties.

Over­all, sui­cides in­creased by a third be­tween 1999 and 2017, the re­port showed. In ur­ban Amer­ica, the rate is 11.1 per 100,000 peo­ple; in the most ru­ral parts of the coun­try, it is 20 per 100,000.

A va­ri­ety of fac­tors de­ter­mines sui­cide rates, but one that might help ex­plain its greater preva­lence in ru­ral ar­eas is ac­cess to guns, said Keith Humphreys, a pro­fes­sor of psy­chi­a­try and be­hav­ioral sciences at Stan­ford Uni­ver­sity.

“Higher sui­cide rates in ru­ral ar­eas are due to nearly 60 per­cent of ru­ral homes hav­ing a gun ver­sus less than half of homes in ur­ban ar­eas,” Humphreys wrote in an email. “Hav­ing eas­ily avail­able lethal means is a big risk fac­tor for sui­cide.”

David Maialetti / As­so­ci­ated Press

Sui­cides and drug over­doses, in­clud­ing fen­tanyl, helped lead a surge in U.S. deaths last year and drove a con­tin­u­ing de­cline in how long Amer­i­cans are ex­pected to live.

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