US Life Expectancy Down, Deaths Among Young Largely to Blame

US life expectancy has decreased since 2014 after increasing for most of the past 60 years, according to a report published today in JAMA.

Major factors include an increase in deaths from drug overdoses, suicides, and organ system diseases among young and middle-aged adults of all racial groups.

Steven H. Woolf, MD, MPH, and Heidi Schoomaker, MAEd, with the Virginia Commonwealth University School of Medicine in Richmond, note that the increasing rate of deaths in midlife affect working-age adults, and consequently, the economy and national security.

"The trends also affect children, whose parents are more likely to die in midlife and whose own health could be at risk when they reach that age, or sooner," they write.

The increase in deaths in midlife from 2010 to 2017 was linked with an estimated 33,307 excess US deaths.

There were statistically significant rises in midlife mortality in 37 states in the years leading to 2017 but they were concentrated in several states. The largest increases in mortality were in New England (New Hampshire, 23.3%; Maine, 20.7%; Vermont, 19.9%; Massachusetts, 12.1%) and the Ohio Valley (West Virginia, 23.0%; Ohio, 21.6%; Indiana, 14.8%; Kentucky, 14.7%).

Life Expectancy Down 3 Consecutive Years

Life expectancy in the United States had increased by almost 10 years, from 69.9 years in 1959 to 78.9 years in 2016, but the pace slowed and life expectancy decreased for 3 consecutive years after 2014 to reach 78.6 years in 2017.

"The decrease was greater among men (0.4 years) than women (0.2 years) and occurred across racial-ethnic groups; between 2014 and 2016, life expectancy decreased among non-Hispanic white populations (from 78.8 to 78.5 years), non-Hispanic black populations (from 75.3 to 74.8 years), and Hispanic populations (from82.1 to 81.8 years)," the authors explain.

Researchers used data for 1959 to 2017 from the Centers for Disease Control and Prevention and the US Mortality Database to analyze changes. They also studied published research from January 1990 through August 2019 on mortality trends and potential contributors. The study was partially funded by the National Institute on Aging.

United States Behind Other High-Income Countries

The numbers "represent a US health disadvantage compared with peer high-income nations, despite the United States having the highest per capita healthcare spending in the world," Howard K. Koh, MD, MPH, of the Harvard T.H. Chan School of Public Health and Harvard Kennedy School, Boston, Massachusetts, and colleagues write in an accompanying editorial.

Concentrating efforts on fighting obesity, hypertension, and tobacco use will be key in stemming the losses, the authors say, adding that although tobacco use in the United States has decreased, higher smoking rates in previous decades may have a delayed effect on mortality, especially in older adults.

"The negative effects of obesity on life expectancy were first predicted nearly 15 years ago and are linked to diabetes and prediabetes, as well as ischemic heart disease, cancer, stroke, and kidney disease, with minorities disproportionately affected," Koh and colleagues write. "Furthermore, about 80% of US adults do not meet physical activity guidelines (for both aerobic exercise and muscle strengthening)."

Additionally, they continue, "Rising suicide rates and mental health challenges, such as depression and anxiety for youth in the social media age, signal the urgency for better ways to boost resilience, including earlier risk identification and support in schools and the workplace, an expanded clinical workforce, and strategies to reduce self-harm associated with firearm access at times of emotional crisis."

Between 1999 and 2017, midlife deaths from drug overdoses increased by 386.5%. By age group, they increased by 531.4% among those aged 25 to 34 years, by 267.9% among those aged 35 to 44 years, and by 350.9% among those aged 45 to 54 years.

The biggest relative rise in overdose deaths (909.2%) occurred among those aged 55 to 64 years.

Expanding access to medication-assisted treatment and harm reduction programs, such as needle exchange programs, and improving naloxone access will be important in curbing deaths from opioid overdoses, Koh and colleagues explain.

JAMA. Published online November 26, 2019. Study, Editorial

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