December 2, 2019

'There's something terribly wrong': Why more Americans are dying in middle age

Daily Briefing

    Americans for decades had seen improvements in average life expectancy, but the trend reversed in 2014—with more U.S. residents dying at middle age from drug overdoses, diseases, obesity, suicide, and dozens of other causes, according to a study published Tuesday in JAMA.

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    Study details

    For the study, researchers examined U.S. life expectancy and mortality rates to identify potential factors contributing to trends in the nation's lifespan. They reviewed:

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    • Data on cause-specific mortality rates from 1999 to 2017 using CDC WONDER;
    • Data on U.S. life expectancy from 1959 to 2016 using the U.S. Mortality Database; and
    • Research on mortality trends and potential contributing factors from January 1990 through August 2019.

    The researchers also calculated excess death rates using expected mortality rates and actual numbers of recorded deaths for each year from 2010 to 2017.

    The researchers focused their analysis on midlife deaths, or deaths among adults aged 25 to 64. They examined life expectancy and mortality trends by geography, race/ethnicity, sex, and socioeconomic status.

    Researchers find declines in US life expectancy

    The researchers found U.S. life expectancy had been increasing for several decades, rising from 69.9 years in 1959 to 78.9 years in 2014. However, the researchers found improvements in life expectancy began to slow down in the 1980s, then leveled off and started to reverse after 2014. According to the researchers, U.S. life expectancy declined for three consecutive years, falling from 78.9 years in 2014 to 78.6 years in 2017.

    The researchers noted U.S. life expectancy has declined as life expectancy in other developed countries has increased. According to the researchers, U.S. life expectancy "by 1998, had declined to a level below the average life expectancy" in other developed countries, according to the study. The researchers found the gap in average life expectancy between the United States and other wealthy countries—which researchers refer to as the U.S. "health disadvantage"—has increased steadily since 1998.

    What's driving the declines?

    The researchers found the recent decreases in U.S. life expectancy occurred after cause-specific mortality began to increase in the 1990s among U.S. adults ages 25 to 64. According to the researchers, the increase in cause-specific mortality led to a rise in all-cause mortality beginning in 2010.

    The all-cause mortality rate among adults ages 25 to 64 increased from 328.5 deaths per 100,000 in 2010 to 348.2 deaths per 100,000 in 2017, the researchers found. The increase was particularly notable among adults ages 25 to 34, with the all-cause mortality rate spiking by 29% among the group from 2010 and 2017, representing the largest increase in all-cause mortality among any age group. The researchers estimated the increase in the all-cause mortality rate from 2010 to 2017 was linked to an estimated 33,307 excess deaths in the United States.

    The researchers noted that all-cause mortality had increased across all racial groups by 2014. Specifically, the researchers found increases in midlife mortality began among whites in 2010, Hispanics in 2011, and African Americans in 2014. According to the researchers, the increases in mortality rates largely stemmed from rising rates of deaths related to:

    • Alcohol misuse;
    • Drug overdoses;
    • Obesity;
    • Organ-system diseases—including Alzheimer's disease, diabetes, heart and lung diseases, hypertension, and stroke—and injuries; and
    • Suicides.

    The researchers also found that all-cause mortality rates were higher among men than women, though the data shows more women are beginning to die from diseases that once were more common among men. For example, the researchers found the risk of death from drug overdoses increased by 485.8% among women ages 25 to 64 between 1999 and 2017, and by 350.6% among men in the same age group. In addition, the researchers found women experienced a higher relative increase in risk of death by suicide and from alcohol-related liver disease when compared with men.

    According to the researchers, the increases in mortality rates also varied by state. The researchers found the largest increase in mortality rates among U.S. adults ages 25 to 64 occurred in New Hampshire, which experienced a 23.3% relative increase in midlife mortality rates between 2010 and 2017. Other states with comparatively high increases in mortality rates among midlife adults included:

    • West Virginia, which experienced a 23% relative increase in midlife mortality rates between 2010 and 2017;
    • Ohio, which experienced a 21.6% relative increase in midlife mortality rates between 2010 and 2017; and
    • Maine, which experienced a 20.7% relative increase in midlife mortality rates between 2010 and 2017.

    Discussion

    Steven Woolf, the study's lead author and director emeritus of the Center on Society and Health at Virginia Commonwealth University, said the U.S. mortality rate is "supposed to be going down, as it is in other countries." Woolf said, "The fact that that number is climbing, there's something terribly wrong."

    Woolf noted that many factors are driving down life expectancy, including the opioid epidemic, which he said is a major contributing factor. However, the researchers noted improvements in life expectancy began to decline in the 1980s, before the opioid epidemic had become a national issue.

    "Some of it may be due to obesity, some of it may be due to drug addiction, some of it may be due to distracted driving from cellphones," Woolf said. He added that the trends in declining life expectancy and mortality rates "suggest … the cause has to be systemic, that there's some root cause that's causing adverse health across many different dimensions for working-age adults."

    S. Jay Olshansky, a professor of public health at the University of Illinois at Chicago, said obesity likely is playing a large role. "[K]ids are acquiring obesity in their early teen years, sometimes under the age of 10. When they get up into their 20s, 30s and 40s, they're carrying the risk factors of obesity that were acquired when they were children. We didn't see that in previous generations. This isn't a one-time phenomenon. It's going to echo through time," Olshansky said.

    Ellen Meara, a professor at the Dartmouth Institute for Health Policy and Clinical Practice, said the study demonstrates a broad decline in health with no single "smoking gun." She said, "There's something more fundamental about how people are feeling at some level—whether it's economic, whether it's stress, whether it's deterioration of family. People are feeling worse about themselves and their futures, and that's leading them to do things that are self-destructive and not promoting health" (Achenbach, Washington Post, 11/26; Coleman, The Hill, 11/26; Healy, Los Angeles Times, 11/26; Carroll, Reuters, 11/26; Kolata/Tavernise, New York Times, 11/26; Woolf et al., JAMA, 11/26). 

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