Life expectancy in US is declining as working-age Americans are dying at higher rates
Deaths among working-age Americans -- 25 to 64 years -- are increasing, which is causing a decrease in life expectancy in the US.
According to researchers from Virginia Commonwealth University (VCU), compared to the 1990s, working-age adults are now more likely to die before the age of 65. Calling this trend a “distinctly American phenomenon,” the research team says that the leading causes of death among working-age adults are drug overdoses, alcohol abuse, and suicides, besides a long list of diseases affecting various organs.
Their analysis shows that during 2010-2017, midlife death rates increased from 328.5 deaths per 100,000 people to 348.2 deaths per 100,000 people in the US. This has been associated with an estimated 33,307 excess US deaths, 32.8% of which occurred in four Ohio Valley states.
“A leading cause is drug overdoses, fueled by the opioid epidemic, but death rates for alcoholism and suicides have also increased, leading many to call these “deaths of despair.” However, our study also shows that midlife death rates have increased for 35 causes of death, including deaths from hypertensive heart disease, obesity, and a long list of other organ system diseases. This suggests that something systemic might be to blame, causing poor health that expresses itself clinically in multiple ways,” lead author Dr. Steven Woolf, director emeritus of the VCU Center on Society and Health, told MEA WorldWide (MEAWW).
The analysis
The research team used data from the US Centers for Disease Control and Prevention (CDC) and the US Mortality Database to analyze changes in life expectancy and death rates in the US, from 1959 to 2017. The analysis focused on midlife deaths (ages 25-64 years). The trend of increasing death rates goes back decades, says the team. Life expectancy in the US lost pace with other wealthy countries in the 1980s, stopped rising in 2011 and has been falling since 2014.
The researchers found that between 1959 and 2016, US life expectancy increased from 69.9 years to 78.9 years, but declined for three consecutive years after 2014. By 2014, midlife death was increasing across all racial groups, caused by drug overdoses, alcohol abuse, suicides, and organ system diseases. According to the analysis, the largest relative increases in midlife death rates occurred in New England -- New Hampshire, 23.3%; Maine, 20.7%; Vermont, 19.9%, and the Ohio Valley -- West Virginia, 23.0%; Ohio, 21.6%; Indiana, 14.8%; Kentucky, 14.7%.
“Thirty-seven states experienced statistically significant increases in midlife mortality in the years leading up to 2017. However, the trend was concentrated in certain states. Between 2010 and 2017, the largest relative increases in mortality occurred in New England (New Hampshire, 23.3%; Maine, 20.7%; Vermont, 19.9%, Massachusetts 12.1%), the Ohio Valley (West Virginia, 23.0%; Ohio, 21.6%; Indiana, 14.8%; Kentucky, 14.7%), as well as in New Mexico (17.5%), South Dakota (15.5%), Pennsylvania (14.4%), NorthDakota (12.7%), Alaska (12.0%), and Maryland (11.0%),” says the study published in JAMA.
In contrast, the nation’s most populous states -- California, Texas, and New York -- experienced relatively small increases in midlife mortality.
“The study shows that the risk of Americans dying before age 65 is rising. Working-age adults are more likely to die in the prime of their lives, and children are more likely to lose their parents. The US already spends more on health care than any other country, but its life expectancy has ranked below its peers for many years,” Dr. Woolf, who is a professor in the Department of Family Medicine and Population Health in the VCU School of Medicine, told MEAWW.
Dr. Woolf says: "The notion that US death rates are increasing for working-age adults is particularly disturbing because it is not happening like this in other countries. This is a distinctly American phenomenon."
The study shows that some of the largest increases in working-age deaths since 2010 occurred among women and adults without a high school diploma. The industrial Midwest and other regions -- which have been hard-hit by changes in the economy since the 1980s, such as job losses in manufacturing and other sectors -- are experiencing the largest increases in mortality.
According to the analysis, deaths are particularly increasing in Rust Belt states and Appalachia. Eight of the 10 states with the largest number of excess deaths for ages 25 to 64 were in the Rust Belt or Appalachia, says the team, and the 13 Appalachian states accounted for half of the excess deaths.
“Those are two regions with a large increase in death rates, but they are not the only affected regions. For example, northern New England and states like New Mexico and South Dakota were also affected. However, the concentrated impact in the Industrial Midwest and central Appalachia is noteworthy because those regions have been deeply affected by changes in the US economy that, beginning in the 1980s, led to the closure of auto plants, steel mills, and coal mines,” Dr. Woolf told MEAWW.
He explains, “The economic and social stresses on families and communities have been long-standing over many years, and the adverse health impact may have taken many forms. Americans, who lack universal health care, are more likely than people in other countries to forego health care due to costs, especially if they are struggling economically. Chronic stress is itself harmful to the body, and it can cause people to take up unhealthy coping behaviors, including drug abuse. It’s therefore not surprising that people in these regions would see their health deteriorate.”
A major cause of increasing midlife death was a large increase in fatal drug overdoses, beginning in the 1990s. Between 1999 and 2017, midlife death from drug overdoses increased by 386.5%, from 6.7 deaths per 100,000 to 32.5 deaths per 100,000, shows analysis.
“Midlife mortality rates also increased for chronic liver disease and cirrhosis during 1999-2017, age-adjusted death rates for alcoholic liver disease increased by 40.6% (from 6.4 deaths/100,000 to 8.9 deaths/100,000). The age-adjusted suicide rate at ages 25 to 64 years increased by 38.3% (from 13.4 deaths/100,000 to 18.6 deaths/100,000).
The increase in deaths caused by drugs, alcohol, and suicides was accompanied by significant increases in midlife mortality from organ system diseases and injuries, some beginning in the 1990s.
"For example, between 1999 and 2017, age-adjusted midlife mortality rates for hypertensive diseases increased by 78.9% (from 6.1 deaths/100,000 to 11.0 deaths/100,000) and for obesity increased by 114.0% (from 1.3 deaths/100,000 to 2.7 deaths/100,000," says the study.
What are the implications?
The researchers say this trend means that children are losing their parents, and “our children are destined to live shorter lives.”
According to Dr. Woolf, aside from the human toll on working-age adults and their children, the trend has implications for employers and the US economy as it means that their workforce is dying prematurely. For example, he says, a sicker workforce puts the US at a competitive disadvantage with businesses in other countries with healthier, more productive workers.
“If the problem is not solved, the next generation of Americans face shorter lives in poorer health, and this could have long-term implications for the future of the US,” he explains.
The researchers say the implications for public health and the economy are substantial. The experts call for a better understanding of the underlying causes of these deaths, including the role of drugs, obesity, the healthcare system, stress, and the economy.
“Spending more on healthcare is not the answer. The message for US policymakers is the need to address the root causes of this decline in health. Many living conditions in America could be to blame. Among them, income inequality has widened greatly in the US, and with it has come a widening health gap between the haves and the have nots. While a small subset of the population has enjoyed growing wealth and better health, the vast majority of the population has been left behind by the economy, and working-age Americans are now seeing their health deteriorate,” Dr. Woolf told MEAWW.