Death in America, in 5 maps

Despite overall increases in U.S. life expectancy over the last two decades, in some states, the odds of dying young have actually increased, according to a study published Tuesday in JAMA

Study details

According to the Wall Street Journal, the latest report is part of the Institute for Health Metrics and Evaluation's ongoing Global Burden of Disease epidemiological study. The broader project looks at illnesses and death from diseases and conditions throughout the world, the Journal reports.

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The paper published Tuesday looks at life expectancy among U.S. residents from different states between 1990 and 2016, with a particular focus on death rates among individuals ages 20 to 55. According to the Journal, the paper follows recent research that finds "deaths of despair," such as those from drug overdoses, have increased, particularly among white U.S. residents.

Overall life expectancy increases

Overall, the study found the U.S. death rate declined from 745 fatalities per 100,000 individuals in 1990 to 578 fatalities per 100,000 individuals in 2016. The study also identified regional variation in overall life expectancy, with Hawaii reporting the longest life expectancy at birth, at 81.3 years, and Mississippi reporting the shortest, at 74.7 years.

Premature death rate varies significantly by state, study finds

According to the researchers, the overall decline in the U.S. death rate was largely attributable to reductions in death rates among children and adults—but while the death rate among individuals ages 20 to 55 dropped in 31 states and Washington, D.C., it increased in several others over the period studied.

In total, the researchers identified 21 states where the premature death rate for individuals ages 20 to 55 rose, including five states—Kentucky, New Mexico, Oklahoma, West Virginia, and Wyoming—where the rate for increased more than 10%.

Overall, the 10 states with the highest rate of premature death among that age group included:

  • Alabama;
  • Arkansas;
  • Kentucky;
  • Louisiana;
  • Mississippi;
  • New Mexico;
  • Oklahoma;
  • South Carolina.
  • Tennessee; and
  • West Virginia.

By contrast, the 10 states with the lowest rate of premature death among the 20- to 55-year-old population included:

  • California;
  • Connecticut;
  • Hawaii
  • Massachusetts;
  • Minnesota;
  • New Hampshire;
  • New Jersey;
  • New York;
  • Washington; and
  • Vermont.

State-by-state disparities on key risk factors

The study also looked into the risks for "disability adjusted life years" (DALYs)—or years lost to poor health, disability, or premature death

The researchers identified smoking, obesity, and alcohol and drug use as leading risk factors. Ischemic heart disease and lung cancer were the leading causes of DALYs in 1990 and 2016, while opioid use disorder jumped from the 11th-leading cause to the 7th during that time period.

Below are three maps depicting the state-by-state disparities on ischemic heart disease, diabetes, and drug use disorders:

Discussion

Christopher Murray, director of the IHME at the University of Washington, who led the analysis, said the increased likelihood of death among the 20-to-55 population was due largely to substance misuse, mental health conditions, and diabetes. However, citing the state-by-state differentiation for that age group's mortality trend, Murray continued, "We get this very divergent pattern in that middle-age area .... We're seeing how different it is by state."

When it comes to differences in life expectancy overall, Murray said, "Our analysis ... confirms that an important part of the [state-by-state] difference is related to the levels of the major risk factors: tobacco, overweight and obesity, diet, and alcohol and drug use."

Ali Mokdad, an epidemiologist at the University of Washington and study co-author, added, "Overall, the nation and some of our states are falling behind other, less developed countries. … The strain on America's health resources is getting worse, and the need for prevention services and greater access to and quality of medical care is increasing."

But Murray noted that improvement is possible, pointing out that the big risk factors are ones people can control. "The leading risk factors—tobacco, overweight and obesity, diet, alcohol and drug use—are highly amenable to individual action supported by effective primary care." The disparity in morbidity and mortality among states "indicate the need for greater investment in preventive and medical care across the life course," the authors concluded.

Howard Koh of the Harvard T.H. Chan School of Public Health, who co-authored an editorial accompanying the study, said the findings show that the "national burden of modifiable risk factors is still unacceptably high." He added, "In the midst of so much suffering, prevention as a major health strategy remains overlooked and underappreciated. Too many people are not reaching their full potential for health" (McKay/Rigdon, Wall Street Journal, 4/10;  Rappaport, Reuters, 4/10; Khazan, The Atlantic, 4/10; Drum, Mother Jones, 4/10; JAMA, 4/10).

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