Life expectancy is a measure of the health and wellbeing of a
population. Widespread or sustained declines in life expectancy may
signal problems in a nation's social and economic conditions or in
the provision or quality of its healthcare services, researchers
write in The BMJ.
The first study looked at trends across 18 high-income countries and
found that most countries experienced declines in life expectancy in
2015. This is the first time in recent decades that so many
high-income countries simultaneously experienced declines in life
expectancy for both men and women.
Out of 18 countries in the study, 12 experienced life expectancy
declines among men and 11 experienced life expectancy declines among
women.
"This hasn't occurred in decades, and the size of these most recent
declines were larger than prior declines," said study co-author
Jessica Ho of the University of Southern California in Los Angeles.
A particularly severe influenza season drove declines outside the
U.S. in 2014-2015, primarily among adults 65 and older, the study
found. In addition to flu and pneumonia, the main causes of death in
these countries were associated with an aging population and
included other respiratory diseases, cardiovascular disease and
Alzheimer's disease as well as other mental and nervous system
disorders.
Most of these countries reversed their life-expectancy decline in
the 2015-2016 period, but in the U.S. and the UK, the declines
continued, the authors note.
In the U.S., the source of reduced life-expectancy was concentrated
at younger ages, particularly deaths among those in their 20s and
30s, and largely driven by increases in drug-overdose deaths related
to the nation's ongoing opioid epidemic.
A second study in The BMJ suggests, however, that the problems
driving life expectancy declines in the U.S. are broader than just
the opioid crisis and may extend to a wide range of causes unrelated
to drug use or substance abuse.
"A leading cause is fatal drug overdoses - fueled by the opioid
epidemic - but we make a mistake if we focus only on the drug
problem, which is just the tip of the iceberg," said lead study
author Dr. Steven H. Woolf of Virginia Commonwealth University in
Richmond.
"Deaths from alcoholism and suicides have also increased, what some
call deaths of despair," Woolf said by email.
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Even worse, the study found rising midlife death rates from dozens
of diseases of the heart, lungs, digestive systems and other organs.
It even found rising death rates during pregnancy and early
childhood, Woolf said.
"Something far-reaching is affecting the health of Americans in the
prime of their lives," Woolf said.
Neither study was a controlled experiment designed to prove what
specific factors might be influencing declines in health or life
expectancy in the U.S. and other countries.
Still, taken together, these studies highlight a need for
high-income countries to invest more in preventing disease outbreaks
and addressing persistent social and health inequalities, said
Domantas Jasilionis of the Max Planck Institute for Demographic
Research in Rostock, Germany.
"Although a part of this health disadvantage of lower socioeconomic
classes is explained by 'traditional' risk factors such as poor
diet, alcohol and smoking, the question remains why these people
have a higher risk of choosing such health damaging behaviors,"
Jasilionis, author of an editorial accompanying the studies, said by
email.
"There is strong evidence that psychological factors, often having
social origins including social exclusion, poor prospects for social
mobility, and high income inequality are the main contributors to
these 'bad choices,' especially in the lowest socioeconomic groups,"
Jasilionis added.
At the population level, maintaining steady gains in life expectancy
is challenging because it requires reductions in mortality at
increasingly advanced ages, Jasilionis writes in the editorial.
"At the individual level, life span also depends on a range of
lifestyle choices, including continuous education throughout the
whole life," Jasilionis added by email. "Good knowledge of health
risks and awareness about our own health status is a key for a
longer life."
SOURCE: https://bit.ly/2wgHAkN, https://bit.ly/2Mtl57a and https://bit.ly/2N9EMgA
The BMJ, online August 22, 2018.
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