In the Journals

Life expectancy plummets in US fueled by drugs, alcohol, suicide

Steven H. Woolf

Life expectancy continues to fall at an alarming rate in the United States largely because of drug overdose, alcohol abuse and suicides, especially among middle-aged white Americans and people living in rural communities, according to an editorial published in BMJ.

“The factors responsible for the drop in U.S. life expectancy are of central concern to mental health professionals,” Steven H. Woolf, MD, MPH, director, Center on Society and Health, Virginia Commonwealth University, told Healio Psychiatry. “The rise in death rates from drug overdoses, alcohol abuse and suicide signal not only the need for substance abuse counseling and suicide prevention efforts, but also the larger challenge of caring for a population suffering from rising distress.”

Although Americans had the highest life expectancy in 1960, life expectancy dropped below the Organization for Economic Cooperation and Development average in 1998 and is now 1.5 years lower than the average, according to the authors.

“Life expectancy in the U.S. has fallen for the second year in a row. This is alarming because life expectancy has risen for much of the past century in developed countries, including the U.S.,” Woolf and Laudan Aron, MA, senior fellow, Urban Institute, wrote in BMJ. “The decline in U.S. health relative to other countries, however, is not new; it has been unfolding for decades.”

In 2013, a joint expert panel from the National Research Council and Institute of Medicine reported that the rate of fatal drug overdose increased by 137% between 2000 and 2014 and more than 64,000 Americans died from drug overdoses in 2015 alone.

To combat the opioid crisis in the U.S., there are national efforts to reduce access with prescription drug monitoring and drug take-back programs, improve emergency responses to reverse overdoses and enhance access to effective addiction treatment like medication-assisted treatment. However, death rates from alcohol abuse and suicides have also been on the rise. According to the report, suicide rates have increased by 24.6% between 1999 and 2014 and disproportionately affect white Americans — especially adults aged 25 to 59 years, people with limited education and women — and people living in rural areas with social and economic challenges.

Why these people are dying at higher rates from drugs, alcohol and suicides remains uncertain and cannot be explained by the increase in opioids alone, according to Woolf and Aron.

“Possibilities include the collapse of industries and the local economies they supported, the erosion of social cohesion and greater social isolation, economic hardship and distress among white workers over losing the security their parents once enjoyed,” they wrote. “By contrast, greater resilience might explain why black Americans — who have contended with longstanding structural disadvantages, discrimination, and higher all-cause mortality — have not experienced a surge in drug deaths or suicides.”

The panel also found that over the 3 decades in which life expectancy decreased in the U.S., educational performance lagged, social divides and income inequality grew larger and poverty rates increased to exceed those of most rich countries, according to the authors.

“Patients and families struggling with the challenges of difficult living conditions, some of whom are pushed to the edges of hopelessness, need help in finding healthy ways of coping with stress, anxiety and depression,” Woolf told Healio Psychiatry. “This, of course, underscores the need to strengthen our nation’s behavioral health care system — which suffers from inadequate funding, personnel and infrastructure — and the grave consequences of current proposals that might undermine such care.”

Seeing the shortening lifespan of Americans, policy makers should have strengthened health care and behavioral health systems; however, recent legislation and regulations jeopardize access to health care and safety net programs, according to Woolf and Aron.

“Ironically, leaders are outspoken about ending the opioid epidemic and bemoan spiraling and unsustainable health care costs. Solutions to both problems — which involve investment to support struggling families and communities and thereby improve public health — are often rejected, usually by leaders with competing self-interests or ideological objections,” they wrote. “The consequences of these choices are dire: not only more deaths and illness but also escalating healthcare costs, a sicker workforce, and a less competitive economy. Future generations may pay the greatest price.” – by Savannah Demko

Disclosures: Woolf reports acting as chair and Aron as study director of the joint panel from the National Research Council and the Institute of Medicine.

Steven H. Woolf
 

Life expectancy continues to fall at an alarming rate in the United States largely because of drug overdose, alcohol abuse and suicides, especially among middle-aged white Americans and people living in rural communities, according to an editorial published in BMJ.

“The factors responsible for the drop in U.S. life expectancy are of central concern to mental health professionals,” Steven H. Woolf, MD, MPH, director, Center on Society and Health, Virginia Commonwealth University, told Healio Psychiatry. “The rise in death rates from drug overdoses, alcohol abuse and suicide signal not only the need for substance abuse counseling and suicide prevention efforts, but also the larger challenge of caring for a population suffering from rising distress.”

Although Americans had the highest life expectancy in 1960, life expectancy dropped below the Organization for Economic Cooperation and Development average in 1998 and is now 1.5 years lower than the average, according to the authors.

“Life expectancy in the U.S. has fallen for the second year in a row. This is alarming because life expectancy has risen for much of the past century in developed countries, including the U.S.,” Woolf and Laudan Aron, MA, senior fellow, Urban Institute, wrote in BMJ. “The decline in U.S. health relative to other countries, however, is not new; it has been unfolding for decades.”

In 2013, a joint expert panel from the National Research Council and Institute of Medicine reported that the rate of fatal drug overdose increased by 137% between 2000 and 2014 and more than 64,000 Americans died from drug overdoses in 2015 alone.

To combat the opioid crisis in the U.S., there are national efforts to reduce access with prescription drug monitoring and drug take-back programs, improve emergency responses to reverse overdoses and enhance access to effective addiction treatment like medication-assisted treatment. However, death rates from alcohol abuse and suicides have also been on the rise. According to the report, suicide rates have increased by 24.6% between 1999 and 2014 and disproportionately affect white Americans — especially adults aged 25 to 59 years, people with limited education and women — and people living in rural areas with social and economic challenges.

Why these people are dying at higher rates from drugs, alcohol and suicides remains uncertain and cannot be explained by the increase in opioids alone, according to Woolf and Aron.

“Possibilities include the collapse of industries and the local economies they supported, the erosion of social cohesion and greater social isolation, economic hardship and distress among white workers over losing the security their parents once enjoyed,” they wrote. “By contrast, greater resilience might explain why black Americans — who have contended with longstanding structural disadvantages, discrimination, and higher all-cause mortality — have not experienced a surge in drug deaths or suicides.”

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The panel also found that over the 3 decades in which life expectancy decreased in the U.S., educational performance lagged, social divides and income inequality grew larger and poverty rates increased to exceed those of most rich countries, according to the authors.

“Patients and families struggling with the challenges of difficult living conditions, some of whom are pushed to the edges of hopelessness, need help in finding healthy ways of coping with stress, anxiety and depression,” Woolf told Healio Psychiatry. “This, of course, underscores the need to strengthen our nation’s behavioral health care system — which suffers from inadequate funding, personnel and infrastructure — and the grave consequences of current proposals that might undermine such care.”

Seeing the shortening lifespan of Americans, policy makers should have strengthened health care and behavioral health systems; however, recent legislation and regulations jeopardize access to health care and safety net programs, according to Woolf and Aron.

“Ironically, leaders are outspoken about ending the opioid epidemic and bemoan spiraling and unsustainable health care costs. Solutions to both problems — which involve investment to support struggling families and communities and thereby improve public health — are often rejected, usually by leaders with competing self-interests or ideological objections,” they wrote. “The consequences of these choices are dire: not only more deaths and illness but also escalating healthcare costs, a sicker workforce, and a less competitive economy. Future generations may pay the greatest price.” – by Savannah Demko

Disclosures: Woolf reports acting as chair and Aron as study director of the joint panel from the National Research Council and the Institute of Medicine.