Friday, December 13, 2019

Updated: US life expectancy has not kept pace with that of other wealthy countries and is now decreasing: What appears to be causing this?

Here's the reference to the article I that has prompted my analysis into the data that they have collected and a brief summary of their results:

https://jamanetwork.com/journals/jama/fullarticle/2756187?guestaccesskey=c1202c42-e6b9-4c99-a936-0976a270551f&utm_source=for_the_media&utm_medium=referral&utm_campaign=ftm_links&utm_content=tfl&utm_term=112619

Here's a summary of their conclusions: 

US life expectancy increased for most of the past 60 years, but the rate of increase slowed over time and life expectancy decreased after 2014. A major contributor has been an increase in mortality from specific causes (eg, drug overdoses, suicides, organ system diseases) among young and middle-aged adults of all racial groups, with an onset as early as the 1990s and with the largest relative increases occurring in the Ohio Valley and New England. The implications for public health and the economy are substantial, making it vital to understand the underlying causes.

Life expectancy data for 1959-2016 and cause-specific mortality rates for 1999-2017 were obtained from the US Mortality Database and CDC WONDER.

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In my previous two articles that reference this study, I examined data from other countries and in my most recent article, I examined US mortality rates in comparison to US peer countries. If you read that article you'll know that my findings showed that the US is at the bottom of the group. The US life expectancy is even lower than for Puerto Rico. 

The JAMA article referenced above examined US mortality data only, but performed a careful analysis to examine why people died. I think that we can agree that US life expectancy in comparison to other peer countries is lower than it should be. And the fact that it appears to have begun to drop is unacceptable. My question is why? Why is US life expectancy dropping instead of rising? What appears to be the major driver or drivers for this phenomena?

I pulled two figures from the study that appear to show why US life expectancy appears to be dropping over the last three years and why in earlier years the increases in US life expectancy had not kept up with its peer countries. 

Figures 4 and 6 from the JAMA article



Figure 4 clearly shows that the major increasing cause of death in all age categories is drug related -- Drug poisoning. All the other curves remain reasonably flat with one exception, hypertensive diseases for those 55 to 64 years old. One might expect that diabetes would be a contributor given that more and more people in the US are obese, but this is not the case. In each age group, diabetic related deaths are either flat or dropping. (The increase in hypertensive deaths are likely related to the overall increase in obesity.)

Figure 6 breaks down the drug poisoning deaths by Race/Ethnicity from 1999 to 2017. White Americans and American Indians & Alaska Natives show a steady increase in death from a drug overdose. African-American drug overdose deaths appear to have been relatively flat until 2014 when they showed a dramatic and unsettling rise. Both US Hispanics and Asian/Pacific-Islanders show an increase in drug related deaths, but nothing like the others. 

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Looks like we have more evidence of the level of significance of the impact of the opioid crisis. 

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I've seen references to one of the reasons for the decrease in life expectancy for the from 2015 to 2017 is the increasing rate of suicide. While suicides have been increasing, they've been increasing at a reasonably steady rate from 1999 -- which is the earliest date found from the CDC Wonder database. Suicides have not shown the dramatic and curvilinear rise that drug related deaths have shown. So yes, an increase in suicides is clearly a contributor to the reduction in the US life expectancy, but not a major contributor. 

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