US life ex­pectancy de­clin­ing

Sui­cides and over­doses among fac­tors

Orlando Sentinel - - EXTRA HEALTH & FITNESS - By Melissa Healy

Re­cent 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 a re­cent study sug­gest that the na­tion’s life­span re­ver­sal is be­ing driven by dis­eases linked to so­cial and eco­nomic pri­va­tion, a health care sys­tem with glar­ing gaps and blind spots, and pro­found psy­cho­log­i­cal dis­tress.

The twin trends — an in­creased prob­a­bil­ity of death in midlife and a pop­u­la­tion-wide re­ver­sal of longevity — set the U.S. in stark con­trast to ev­ery other af­flu­ent coun­try in the world. Those trends are de­tailed in a study pub­lished in Novem­ber in the Jour­nal of the Amer­i­can Med­i­cal As­so­ci­a­tion.

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 pub­lic health pro­fes­sors Dr. Howard K. Koh, John J. Park and Dr. Anand K. Parekh of the Bi­par­ti­san Pol­icy Cen­ter in Washington, D.C.

The new 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 black and brown pop­u­la­tions, whose long history of ad­ver­sity were thought to have con­ferred some pro­tec­tion from de­spair.

From 1959 to 2013, driven strongly by im­prove­ments in in­jury pre­ven­tion, can­cer treat­ments and heart health, the life­span of the av­er­age Amer­i­can rose by close to 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, 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 tick­ing up­ward in young and mid­dle-age adults.

Be­tween 1999 and 2017, the rate of drug over­dose deaths among Amer­i­cans be­tween 25 and 64 in­creased close to 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.

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 and/or overeat­ing, and “or­ganic men­tal dis­or­ders,” a cat­e­gory that in­cludes such ills as vas­cu­lar de­men­tia. Deaths due to 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 bit­ten into pop­u­la­tions that had pre­vi­ously been lightly af­fected by such ills. In 1999, rates of drug over­dose death among non-Latino whites be­tween 25 and 64 stood be­low those of all other eth­nic groups. But by 2017, rates of drug fa­tal­i­ties in this group had risen al­most seven-fold, end­ing higher than those among Na­tive Amer­i­cans, black and Lati­nos.

Women, who have al­ways lagged well be­hind men in sui­cide rates, have be­gun tak­ing their lives at a grow­ing clip 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 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 mid­dle-aged adults.

These “ex­cess deaths” don’t nearly re­flect the num­ber of Amer­i­cans who have suc­cumbed in midlife to sui­cide, drug 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.

It may seem like a mod­est num­ber, said Dr. Woolf. But those “ex­cess deaths” are the equiv­a­lent of al­most three full Boe­ing 737s crash­ing ev­ery month for seven years. And they have made the U.S. the only high-in­come coun­try in which life ex­pectancy is mov­ing in the wrong di­rec­tion.

More­over, af­ter years dur­ing which mi­nor­ity pop­u­la­tions ap­peared to re­sist the trend of ris­ing midlife death rates, the scourge of opi­oid ad­dic­tion, at least, has be­gun to in­fect those groups. Be­tween 2010 and 2017, the nonLatino black pop­u­la­tion out­paced all other eth­nic groups in the rise of fa­tal drug over­doses (171.6%) among those be­tween 25 and 64, Woolf and Schoomaker found.

Why are lives is the U.S., with higher per-capita health care spend­ing than any other coun­try on earth, grow­ing shorter?

The tim­ing of those ex­cess deaths may of­fer clues, said Woolf. 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 in the U.S. 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 added.

Woolf and Schoomaker found that the rise in pre­ma­ture deaths was of­ten most ev­i­dent in re­gions and states that have weath­ered steep job losses, pop­u­la­tion out­flows, and a con­se­quent hol­low­ing out of lo­cal civic and so­cial in­sti­tu­tions.

GETTY

The United States is the only high-in­come coun­try in which life ex­pectancy is mov­ing in the wrong di­rec­tion.

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