Americans are dying younger
Life expectancy is trending downward, driven by suicides and drug overdoses.
New data confirm that U.S. life expectancy is declining, unique among wealthy nations. The trend is driven in part by suicides and drug overdoses.
It’s official: Americans are dying much sooner in life.
Preliminary signals of declining health were neither a false alarm nor a statistical f luke. A reversal of American life expectancy, a downward trend that has now been sustained for three years in a row, is a grim new reality of life in the United States.
New research establishes that after decades of living longer and longer lives, Americans are dying earlier, cut down increasingly in the prime of life by drug overdoses, suicides and diseases such as cirrhosis, liver cancer and obesity.
The ills claiming the lives of Americans between the ages of 25 and 64 vary widely by geography, gender and ethnicity. But the authors of the new study suggest that the lifespan reversal is being driven by diseases linked to social and economic privation, a healthcare system with glaring gaps and blind spots, and profound psychological distress.
The twin trends — an increased probability of death in midlife and a populationwide reversal of longevity — set the United States in stark contrast to every other affluent country in the world. Those trends are detailed in a study published Tuesday in the Journal of the American Medical Assn., known as JAMA.
In an editorial accompanying the new report, a trio of public health leaders said the study’s insight into years of cumulative threats to the nation’s health “represents a call to action.”
If medical professionals and public health experts fail to forge partnerships with social, political, religious and economic leaders to reverse the current trends, “the nation risks life expectancy continuing downward in future years to become a troubling new norm,” wrote Harvard University public health professors Dr. Howard K. Koh, John J. Park and Dr. Anand K. Parekh of the Bipartisan Policy Center in Washington.
The study is co-written by Dr. Steven H. Woolf and Heidi Schoomaker. Woolf directs the Center on Society and Health at Virginia Commonwealth University in Richmond. Schoomaker conducts research at Eastern Virginia Medical School in Norfolk.
The research offers some new insights into a U.S. epidemic of so-called deaths of despair. Long thought to be a phenomenon limited to rural white America, the study reveals that these premature deaths have gained ground in the nation’s suburbs. And it suggests they are making inroads into African American and Latino communities.
From 1959 to 2013, driven strongly by improvements in injury prevention, cancer treatments and heart health, the lifespan of the average American rose by almost a decade, from 69.9 years to 78.9 years. But in 2011, Americans’ lifespans stopped growing.
By 2014, this vital sign of a nation’s health tipped downward. That was followed by another drop in 2015 and, the new study shows, a further decline in 2016.
Looking back over close to two decades of cause-ofdeath statistics, the new research makes clear that the nation’s slide has been many years in the making. Beginning in the 1990s, Americans between the ages of 25 and 64
— years in which good health and a low risk of death have long been a statistical good bet — began dying at an increasing rate.
And the causes of their deaths were not random. New laws and regulations were reducing some of the leading causes of death in midlife Americans, making cars safer, and reducing air pollution and occupational hazards. New medications were reducing deaths resulting from HIV/AIDS. And prevention efforts, including statin medications and a national anti-tobacco campaign, were reducing heart attack deaths among those under 64.
But other causes of death were climbing among young and middle-age adults.
Between 1999 and 2017, the rate of drug overdose deaths among Americans between 25 and 64 increased about fourfold, from 6.7 per 100,000 in this age group to 32.5 per 100,000. Rates of suicide in these Americans began to rise in the early 1990s, increasing 38.3% — from 13.4 per 100,000 to 18.6 per 100,000 — between 1999 and 2017.
Midlife death rates also increased for illnesses that are strongly linked to drug use and alcoholism. Between 1999 and 2017, midlife deaths from alcoholic liver disease grew 40%. Deaths from liver cancer in this age group bucked a trend of decline in virtually all cancer deaths to grow 60%. And alcohol poisoning deaths among those 25 to 64 rose almost fourfold.
Also on the rise in that period were midlife deaths with less obvious links to psychological distress, including diseases related to high blood pressure, obesity or overeating; and “organic mental disorders,” a category that includes such ills as vascular dementia. Deaths resulting from pregnancy complications went up nearly 200% between 1999 and 2017, and 60% between 2010 and 2017.
These deaths were happening nationally, across the lines of gender, age and ethnicity. But some have afflicted populations that had previously been little affected by such ills.
In 1999, rates of drug overdose deaths among nonLatino whites between 25 and 64 were below those of all other ethnic groups. But by 2017, rates of drug fatalities in this group had risen almost sevenfold, ending higher than among Native Americans, blacks and Latinos.
Women, who have always lagged well behind men in suicide rates, have begun taking their lives at a growing rate since the 1990s. Their rate of death from liver disorders, long a rarity among females, climbed too. And liver failure has been killing even young adults, a group among whom such conditions had been virtually unknown.
It took several years for these deaths to cancel out the gains from life-saving progress in other areas of health, Woolf and Schoomaker wrote. But by 2010, the burden of these deaths was becoming evident. Between 2010 and 2017, they calculated that 33,307 deaths resulted directly from this 6% rise in mortality among young and middleaged adults.
These “excess deaths” don’t nearly reflect the number of Americans who have succumbed in midlife to suicide, overdoses and chronic conditions during this period. They are instead a tally of how many more-than-expected deaths happened because midlife mortality rose between 2010 and 2017.
Why are lives in the U.S., with higher per capita healthcare spending than any other country on Earth, growing shorter?
The timing of those excess deaths may offer clues, Woolf said. During the 1980s and ’90s and accelerating into the 2000s, middle-class incomes stagnated. Rates of child poverty grew and the rolls of the uninsured swelled. The distribution of wealth began to concentrate densely at the top of the economic ladder.
Those excess deaths were also geographically concentrated in ways that might offer insights, Woolf said.
Woolf and Schoomaker found that the rise in premature deaths was often most evident in regions with steep job losses, population outflows and a consequent hollowing out of local civic and social institutions. Many states that have suffered most had a less-educated workforce, and are not magnets for immigrants, whose arrival might compensate for population loss.