After decades of steady increase, U.S. life expectancy declined for three consecutive years following 2014. The drop occurred despite numerous, well-publicized breakthroughs in medical science and steady increases in medical expenditures. A valuable, detailed analysis of this disturbing trend appeared in the November 26th issue of the Journal of the American Medical Association (doi:10.1001/jama.2019.16932). The conclusion is clear: our health care systems now lag those of other developed nations, which spend a much smaller percent of their gross domestic product on health care, while providing universal access.
Life expectancy rose from 69.9 years in 1959 to a peak of 78.9 in 2014, before steadily falling to 78.6 in 2017. Most of the decline is attributed to rising all-cause mortality rates in young and middle-aged adults. These rates began to rise in 2010.
Increases in mortality rates were higher in men than in women and extended across all racial and ethnic categories.
The sharpest increase in mortality was attributed to fatal drug overdoses, where, in the interval from 1999 to 2017, the death rate increased from 6.7 to 32.5 deaths per 100 thousand population. Authors of the study considered this data in three "waves:" an interval beginning in the 1990s when prescription opioids were over-prescribed, the first decade of the new century when heroin moved into the picture to sustain addiction, and more recent years when fentanyl entered the illicit drug market. This epidemic has not been checked.
The next four leading causes of our rising death rates are alcoholic liver disease (6.4 to 8.9 deaths per l00 thousand), suicide (13.4 to 18.6), diseases related to high blood pressure (6.1 to 11.0), and obesity (1.3 to 2.7). Homicides, injuries, chronic kidney and lung disease, diabetes, and heart disease also contribute to the worsening mortality figures.
Health outcomes are worse in persons who have not completed high school. The gap in health outcomes has widened between financially secure and poor individuals.
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Geography also plays a role. The largest increase in midlife mortality is seen in Maine, New Hampshire, and Vermont and in the four states of the Ohio River Valley - West Virginia, Ohio, Indiana, and Kentucky. Florida also has exhibits a striking mortality rate. California, Texas, and New York showed the smallest increases in midlife mortality.
Mortality rates are generally higher in rural counties; although the relative death rate due to opioid overdose was higher in suburbs of large cities.
The authors cite several causes of rising mortality beyond the opioid epidemic. Tobacco use, which occurred years earlier, accounts for rising mortality from chronic lung disease today. Obesity is linked to increases in the incidence of diabetes, high blood pressure, and fatty liver disease. Despair from social or economic setbacks can lead to drug and alcohol dependence and suicidal thoughts. Health outcomes are predictably worse in areas where there is no ready access to health care.
This important data can either be ignored or used as a challenge to address the multiple causes underlying our nation's worsening health. There are no simple or inexpensive solutions. The opioid epidemic will require years of investment in interdiction of smuggled drugs, reversal of excessive opioid prescription, and prolonged treatment of addicted persons. Alcohol abuse, with its attendant risks of liver disease, obesity, injuries and violence, will require years to reverse. Patterns of overeating across the age spectrum will need sustained programs of public education. Hope for economically depressed areas of the country will depend upon improved education and durable jobs with living wages.
Realistic solutions to this smoldering crisis must be highlighted in every political campaign of 2020.
Dr. Cliff Cleaveland / Staff file photoContact Clif Cleaveland at ccleaveland@timesfreepress.com.