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 Midlife all-cause mortality rates were increasing between 2010 and
2017, driven by higher numbers of deaths due to drug overdoses,
alcohol abuse, suicides and organ system diseases, such as
hypertension and diabetes, according to the report published in JAMA.
"There has been an increase in death rates among working age
Americans," said Dr. Steven Woolf, director emeritus of the Center
on Society and Health at Virginia Commonwealth University. "This is
an emergent crisis. And it is a uniquely American problem since it
is not seen in other countries. Something about life in America is
responsible."
The rising rates of midlife mortality hit some regions of the
country harder than others, Woolf and his coauthor found. Increases
were highest in northern New England and the Ohio Valley.
Economic hardship and the resulting despair may be to blame in those
regions, Woolf suggested. "While it's a little difficult to place
the blame on despair directly, the living conditions causing despair
are leading to other problems," he explained. "For example if you
live in an economically distressed community where income is flat
and it's hard to find jobs, that can lead to chronic stress, which
is harmful to health."
Noting that a pattern of increasing mortality in middle age is not
seen in other high income countries, Woolf said this might be
because "in other countries there are more support systems for
people who fall on hard times. In America, families are left to
their own devices to try to get by."
Data for the study came from the National Center for Health
Statistics and the U.S. Mortality Database for 1959 to 2017. The
researchers also scoured the medical literature for studies of U.S.
life expectancy and mortality trends.
Based on the data, life expectancy had increased by almost 10 years
over the course of nearly 6 decades - from 69.9 years to 78.9 years
- but had been declining since 2014. And the overall decline was
explained by increased mortality among the middle aged.
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Death rates among the middle aged weren't uniform across the
country. The largest relative increases in midlife mortality rates
occurred in New Hampshire, 23.3%, West Virginia, 23.0%, Ohio, 21.6%,
Maine, 20.7%, Vermont, 19.9%, Indiana, 14,8% and Kentucky, 14.7%.
Life expectancy actually increased or plateaued in some Western
states, the researchers reported.
"The current problems we are seeing are decades in the making,"
Woolf said. "We used to have the highest life expectancy in the
world. The pace at which life expectancy was increasing in the U.S.
started to fall off relative to other countries in the 80s."
The new findings highlight some distressing trends, said Dr. John
Rowe, a professor in Columbia University's Mailman School of Public
Health in New York City.
"It is depressing," Rowe said, "but I don't think it's much of a
surprise. We knew the opioid epidemic was taking a major toll with
250,000 who have overdosed and died."
What's striking is that the decline in life expectancy isn't the
same for all age groups. "This is really evidence that mortality
rates are increasing only in middle age while they're continuing to
decline in children, adolescents and people over 65," Rowe said,
noting that it's occurring as mortality rates from cancer and stroke
are declining.
Part of the problem may be that middle aged people are getting
squeezed by health care costs because they are less likely to have
coverage than children and people over 65. In fact, another recent
study found out-of-pocket costs were more likely to prompt middle
aged people to cut back on heart disease medications than people
over 65.
SOURCE: http://bit.ly/2pX1VfU JAMA, online November 26, 2019.
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