The report, published in the Journal of the American Medical Association, was immediately hailed by outside researchers for its comprehensive treatment of a still-enigmatic trend: the reversal of historical patterns in longevity.
Despite spending more on health care than any other country, the United States has seen increasing mortality and falling life expectancy for people ages 25 to 64, who should be in the prime of their lives. In contrast, other wealthy nations have generally experienced continued progress in extending longevity. Although earlier research emphasized rising mortality among non-Hispanic whites in the U.S., the broad trend detailed in this study cuts across gender, racial and ethnic lines. By age group, the highest relative jump in death rates from 2010 to 2017 — 29 percent — has been among people ages 25 to 34.
The findings are sure to fuel political debate about causes and potential solutions, because the geography of rising death rates overlaps to a significant extent with states and regions that are hotly contested in the run-up to the 2020 presidential election.
About a third of the estimated 33,000 “excess deaths” that the study says occurred since 2010 were in just four states: Ohio, Pennsylvania, Kentucky and Indiana — the first two of which are critical swing states in presidential elections. The state with the biggest percentage rise in death rates among working-age people in this decade — 23.3 percent — is New Hampshire, the first primary state.
“It’s supposed to be going down, as it is in other countries,” said the lead author of the report, Steven H. Woolf, director emeritus of the Center on Society and Health at Virginia Commonwealth University. “The fact that that number is climbing, there’s something terribly wrong.”
He said many factors are at play. The opioid epidemic is a major driver of the worrisome numbers, but far from the sole cause. The study found that improvements in life expectancy, largely because of lower rates of infant mortality, began to slow in the 1980s, long before the opioid epidemic became a national tragedy.
The 33,000 excess deaths are an estimate based on the number of all-cause midlife deaths from 2010 to 2017 that would be expected if mortality was unchanged vs. the number of deaths actually recorded by medical examiners.
“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. Given the breadth and pervasiveness of the trend, “it suggests that 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.”
The all-cause death rate — meaning deaths per 100,000 people — rose 6 percent from 2010 to 2017 among working-age people in the United States.
Men, overall, have higher all-cause mortality than women, but the report pulls out some disturbing trends. Women are succumbing to diseases once far more common among men, even as men continue to die in greater absolute numbers.
The risk of death from drug overdoses increased 486 percent for midlife women between 1999 and 2017; the risk increased 351 percent for men in that same period. Women also experienced a bigger relative increase in risk of suicide and alcohol-related liver disease.
Increasing midlife mortality began among whites in 2010, Hispanics in 2011 and African Americans in 2014, the study states.
Outside researchers praised the study for knitting together so much research into a sweeping look at U.S. mortality trends.
“This report has universal relevance. It has broad implications for all of society,” said Howard Koh, a professor of public health at Harvard University who was not part of the research team.
The report reveals a broad erosion in health, with no single “smoking gun,” said Ellen Meara, a professor at the Dartmouth Institute for Health Policy and Clinical Practice.
“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,” she said. “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.”
The JAMA report looked at life expectancy and mortality across the country from 1959 through 2017. Final life expectancy numbers for 2018 will soon be released by the U.S. Centers for Disease Control and Prevention. The general trend: Life expectancy improved a great deal for several decades, particularly in the 1970s, then slowed down, leveled off, and finally reversed course after 2014, decreasing three years in a row.
The average life expectancy in the United States fell behind that of other wealthy countries in 1998 and since then, the gap has grown steadily. Experts refer to this gap as America’s “health disadvantage.”
There are some factors that manifest themselves only gradually, such as the effects of smoking. For example, in the late 1960s and early ’70s, cigarette companies aggressively marketed to women, and the health effects of that push may not show up for decades.
Princeton professors Anne Case and Angus Deaton, whose much-publicized report in 2015 highlighted the death rates in middle-aged whites, published a paper in 2017 pointing to a widening gap in health associated with levels of education, a trend dating to the 1970s. Case told reporters their research showed a “sea of despair” in the United States among people with only a high school diploma or less. She declined to comment on the new report.
Obesity is a significant part of the story. The average woman in America today weighs as much as the average man half a century ago, and men now weigh about 30 pounds more. Most people in the United States are overweight — an estimated 71.6 percent of the population ages 20 and older, according to the CDC. That figure includes the 39.8 percent who are obese, defined as having a body mass index of 30 or higher in adults (18.5 to 25 is the normal range). Obesity is also rising in children; nearly 19 percent of the population ages 2 to 19 is obese.
“These kids are acquiring obesity in their early teen years, sometimes under the age of 10,” said S. Jay Olshansky, a professor of public health at the University of Illinois at Chicago. “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,” he added. “It’s going to echo through time.”