Falling US life expectancy driven by drug abuse, suicide and CVDs
Life expectancy in the U.S. is lagging far behind that of other developed nations, according to a review published in the Journal of the American Medical Association—a phenomenon driven by an increase in drug overdoses, suicides and organ system diseases such as CVD.
Authors Steven H. Woolf, MD, MPH, and Heidi Schoomaker, MAEd, both of Virginia Commonwealth University School of Medicine, said in JAMA that while life expectancy in the U.S. was on a steady upward trajectory until 2010, it remained static through 2014 and began to fall shortly thereafter. For the past three years now, in spite of excessive healthcare spending, life expectancy in the country has been decreasing.
“This has attracted recent public attention, but the core problem is not new—it has been building since the 1980s,” the authors wrote. “Although life expectancy in developed countries has increased for much of the past century, U.S. life expectancy began to lose pace with other countries in the 1980s and, by 1998, had declined to a level below the average life expectancy among the Organization for Economic Cooperation and Development countries.”
Woolf and Schoomaker drew life expectancy data for 1959-2016 and cause-specific mortality rates for 1999-2017 from the U.S. Mortality Database and CDC Wonder registry, respectively. They studied “midlife” adults aged 25-64 and stratified them by sex, race, socioeconomic status and geography.
The duo found that between 1959 and 2016, U.S. life expectancy rose from 69.9 years to 78.9 years—a nine-point increase—but declined for three consecutive years after 2014. The decrease marked a period of increasing cause-specific mortality among midlife adults that began in the 1990s and ultimately contributed to a rise in all-cause mortality starting in 2010.
Between 2010 and 2017, midlife all-cause mortality rates increased from 328.5 deaths per 100,000 people to 348.2 deaths per 100,000 people. By 2014, midlife mortality was increasing across all racial groups, driven primarily by drug overdoses, alcohol abuse, suicides and a handful of organ system diseases. There was a major increase in fatal drug overdoses beginning in the 1990s that ultimately fed into a 386.5% increase in drug overdose deaths between 1999 and 2017.
Woolf and Schoomaker also noted a relative increase over time for other causes of death, including diabetes, hypertensive diseases, mental disorders, heart diseases, transport accidents and assault. Such increases were steeper in the older population—those aged 55-64—but were evident across the board. The authors reported that a decomposition analysis of the decline in U.S. life expectancy between 2014 and 2015 revealed that respiratory illnesses and CVDs contributed nearly as much to mortality as external causes, including drug overdoses, among women. Among men, drug overdoses explained almost all of the decline.
“Improving outcomes related to opioid overdoses necessitates expanded access to medication-assisted treatment, harm reduction services and strengthened collaborations with criminal justice professionals to improve naloxone access and affirm that public health, not arrest, serves as the main societal strategy,” Howard K. Koh, MD, MPH, and colleagues wrote in a related editorial. “National efforts to reduce stigma associated with substance use disorders and mental health conditions can encourage people to seek care, move toward recovery and begin to rebuild their lives.”
Koh and his colleagues said redoubling efforts against obesity, hypertension and tobacco use will be “critical” to reversing the life expectancy trend. Nearly half of U.S. adults have hypertension, they wrote, and most of it is uncontrolled, meaning we need better systems for team-based care, better education and better strategies for medication adherence.
“The study by Woolf and Schoomaker, detailing years of cumulative insults to the nation’s health, represents a call to action,” the editorialists wrote. “Broad and committed collaboration with sectors beyond health to reverse U.S. health disadvantage could restore well-being opportunities for millions. Otherwise, the nation risks life expectancy continuing downward in future years to become a troubling new norm.”
After graduating from Indiana University-Bloomington with a bachelor’s in journalism, Anicka joined TriMed’s Chicago team in 2017 covering cardiology. Close to her heart is long-form journalism, Pilot G-2 pens, dark chocolate and her dog Harper Lee.