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. 

Quick Follow-up to: US life expectancy has not kept pace with that of other wealthy countries and is now decreasing

I wanted to do a quick update and share a few of my findings on this topic. I compared US life expectancy to our peer countries. These countries or wealthy portions of countries (such as Hong Kong and Macao) in 1960 would have been considered "first world" or "industrialized." 

Comparison list of countries include:

1. Hong Kong SAR, China
2. Japan
3. Macao SAR, China
4. Switzerland
5. Spain
6. Italy
7. Singapore
8. Luxembourg
9. Korea, Rep.
10. Israel
11. France
12. Norway
13. Australia
14. Malta
15. Sweden
16. Canada
17. Iceland
18. Ireland
19. New Zealand
20. Austria
21. Netherlands
22. Belgium
23. Finland
24. Greece
25. United Kingdom
26. Portugal
27. Denmark
28. Germany
29. Puerto Rico
30. United States

I added Puerto Rico and South Korea (Republic of Korea) because Puerto Rico is part of the US but geographically, culturally and linguistically separate as well as significantly poorer and as such provides an interesting comparison. In 1960 South Korea would not have been considered to be a "first world country" but it has grown into one. It's transformation and what that has meant for the citizens of South Korea is interesting as well.

Here's what I found:

1. Since 1983, US life expectancy never again rose above the median. Before 1983, US life expectancy was generally above the median. 
2. In 2012 Puerto Rican life expectancy was higher than the US and has remained higher since.
3. Here's a table of life expectancy for Puerto Rico, US and the median life expectancy for the countries listed above from 2013 to 2017:

                                  

	2013	2014	2015	2016	2017
Puerto Rico	79.03	79.20	79.35	79.49	79.63
United States	78.74	78.84	78.69	78.54	78.54
Group Median	81.75	81.92	81.96	82.24	82.28

Of the listed countries, the US ranks last and has ranked last since 2005. And not only that, US life expectancy has been declining -- at least during the last three years where we have records. I should mention that the country ordering shown above is from highest life expectancy to the lowest based on data collected in 2017.

Finally, if you graph the data, the first 28 countries fall into a fairly cohesive grouping, the Puerto Rico and the US clearly fall outside of that group into a lower grouping since 2011.

From a personal standpoint, the fact that US life expectancy in 2017 is a year lower than Puerto Rico and 3 3/4 year lower than the median is a stunning result. (The highest is over 84 years.)

More to follow on this topic.  

US life expectancy has not kept pace with that of other wealthy countries and is now decreasing

I've analyzed US suicide and drug-related death data. And the results have been striking and concerning. In fact with respect to drug related deaths, I performed a worst case analysis to predict the deaths for 2017. As it turned out, my worst case analysis wasn't nearly bad enough. That was a shocking and saddening realization.

However this is one of the saddest and most concerning studies I have seen regarding indicators regarding life in the US. 

When it comes to life expectancy, the US does better than the world average. But, US life expectancy rate is falling when life expectancy around the world is in virtually every case, increasing. Furthermore, when you look at life expectancy of other countries, the US ranks with Poland and the Czech Republic, not with Japan, Switzerland, the UK, Canada, Spain, Norway, France and others in the EU. Puerto Ricans have a higher life expectancy than those in the US.

Here's the link to the recently published study from the Journal of the American Medical Association (JAMA) that discusses the recent findings.


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.

I wanted to get this out as soon as a saw it. I'll have more to say about this article in a later blog article. I'll add specific comparisons to data from other countries. 

If you're a US health care professional, it's worth your time just to scan the article.