Life expectancy among adults in the United States increased for nearly 6 decades but eventually slowed over time and then dropped for 3 straight years after 2014, according to a special communication published in JAMA.
“The implications for public health and the economy are substantial, making it vital to understand the underlying causes,” Steven H. Woolf, MD, MPH, professor of family medicine and population health at Virginia Commonwealth University, and colleagues wrote.
Researchers examined life expectancy data from the U.S. Mortality Database from 1959 to 2016, and cause-specific mortality rates from the CDC WONDER database, for individuals aged 25 to 64 years. During that time period, U.S. life expectancy increased from 69.9 years to 78.9 years.
Historically, they found that the increase in life expectancy in the U.S. was greatest from 1969 to 1979, but it eventually lost pace with other high-income countries. Life expectancy plateaued in 2011, and then decreased after 2014. Underlying these trends was an increase all-cause mortality among young and middle-aged adults, which began in 2010.
Specifically, midlife all-cause mortality rates increased between 2010 and 2017 — from 328.5 deaths per 100,000 to 348.2 deaths per 100,000, according to the researchers.
Woolf and colleagues also said there was an increase in cause-specific mortality rates that began as early as the 1990s.
“The increase in cause-specific mortality involved deaths from drug overdoses, alcohol abuse and suicides and from diverse organ system diseases, such as hypertensive diseases and diabetes,” they wrote.
Changes in life expectancy and midlife mortality were greatest in the Eastern U.S. — specifically, the Northeast, Appalachia and the Ohio Valley, according to the findings.
Woolf and colleagues said the increase in opioid-related deaths is “only part of a more complicated phenomenon and does not fully explain the increase in midlife mortality from other causes, such as alcoholic liver disease or suicides.”
Behavioral risk factors — like smoking or obesity — could also explain some of the trends, the researchers said, as well as deficiencies in the health care system.
Woolf and colleagues said it is not a coincidence that the timing of the increase in midlife mortality and economy shifts run parallel to each other.
“The U.S. health disadvantage and increase in midlife mortality began in the 1980s and 1990s, a period marked by a major transformation in the nation’s economy, substantial job losses in manufacturing and other sectors, contraction of the middle class, wage stagnation, and reduced intergenerational mobility,” they wrote.
“Income inequality widened, surpassing levels in other countries, concurrent with the deepening U.S. health disadvantage. ... Those most vulnerable to the new economy (eg, adults with limited education, women) experienced the largest increases in death rates [and] increases in death rates were concentrated in areas with a history of economic challenges,” Woolf and colleagues continued.
In a related editorial, Howard K. Koh, MD, MPH, the Harvey V. Fineberg Professor of the Practice of Public Health Leadership at the Harvard T.H. Chan School of Public Health, and colleagues wrote that the findings should serve as an impetus to examine how “income inequality, unstable employment, divergent state policies and other social dimensions affect disease.”
“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,” they said. – by Janel Miller
Disclosures : The authors report no relevant financial disclosures. Koh reports receiving grants from the Robert Wood Johnson Foundation outside the submitted work.
Koh HK, et al. JAMA. 2019;322(20):1963-1965.
Woolf SH, et al. JAMA. 2019;doi:10.1001/jama.2019.16932.