All-cause mortality increases in US, life expectancy stalls

From 1999 to 2016, all-cause mortality among adults aged between 25 years and 64 years in many different ethnic groups in the United States increased while life expectancy in the United States plateaued from 2010 to 2016, according to two studies published in BMJ.

All-cause mortality on the rise

“Few investigators have used a systematic approach to examine causes of death comprehensively,” Steven H. Woolf, of the Center on Society and Health at Virginia Commonwealth University, and colleagues wrote. “Mortality patterns in nonwhite populations are even less clear.”

Researchers examined trends in U.S. vital statistics among people aged between 25 and 64 years across racial and ethnic groups from 1999 to 2016.

Their findings among non-Hispanic blacks:

149.6% increase in drug overdoses;
120.7% increase in obesity;
49.5% increase in liver cancer;
21.4% increase in homicides; and
15.5% in hypertensive diseases.

Among Hispanics:

106.6% increase in obesity;
80% increase in drug overdoses;
60% increase in metabolic disorders;
41.8% increase in liver cancer;
40.6% increase hypertensive diseases; and
21.9% increase in suicide.

Among non-Hispanic American Indians and Alaskan Natives:

411.4% increase in drug overdoses;
269.3% increase in hypertensive diseases;
115.1% increase in liver cancer;
112.1% increase in viral hepatitis; and
99.8% increase in nervous system diseases.

Researchers also found non-Hispanic Asians and Pacific Islanders were least affected by the increased mortality trend but still experienced increases in drug overdoses (300.6%), alcohol related liver disease (62.9%), brain cancer (56.6%) and hypertensive diseases (28.3%).

Woolf and colleagues were unwilling to solely blame the opioid epidemic for the uptick in mortality.

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“Although drug overdoses accounted overwhelmingly for the excess deaths caused by increasing mortality rates, alcohol related diseases, suicides, unintentional injuries and organ diseases involving multiple body systems together accounted for even more excess deaths. No single factor, such as opioids, explains this phenomenon,” they wrote. “A more likely explanation is the systemic problems identified by the National Research Council and Institute of Medicine, which require upstream solutions. The prediction issued in 2013 — that conditions would worsen without bold policy action to tackle these root causes — was followed by higher premature mortality.”

The 2013 report identified nine areas of poor health in the U.S., creating a “U.S. health disadvantage.” They were: birth outcomes, injuries and homicides, adolescent pregnancy, HIV/AIDS, drug related mortality, obesity and diabetes, heart disease, chronic lung disease and disability. It attributed these areas to “deep systemic causes” not only within health care and behavioral risks, but socioeconomic inequality, unhealthy environmental conditions and detrimental public policies.

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Life expectancy stagnating

“Recent trends in the United States suggest that it has experienced a break from the trajectory of continued gains in life expectancy,” Jessica Y. Ho, PhD, of the department of sociology at the University of Southern California, and Arun S. Hendi, PhD, of the department of sociology at Princeton University, wrote in another study.

Ho and Yendel looked at the vital statistics systems of 18 members of the Organisation for Economic Co-operation and Development that had “high quality” all-cause and cause specific mortality data available.

The researchers found between 2010 and 2016, life expectancy in the U.S. stagnated while life expectancy in other high-income countries steadily increased. Specifically, life expectancy increased by 0.04 years for American men (from 76.36 to 76.4 years) and by 0.19 years for American women (from 81.21 years to 81.4 years). In addition, the U.S. posted the smallest life expectancy gains between 2010 and 2016 among all the countries studied.

“These increases in life expectancy gaps between the USA and other high-income countries are substantial,” Ho and Yendel wrote, adding the opioid epidemic is most to blame for the differences. “This recent stagnation in life expectancy in the USA has led to a further deterioration of its standing in international rankings. It is clear that the USA is falling further and further behind its peer countries, and this divergence has been particularly pronounced since 2010.”

They also found 12 countries experienced declines in life expectancy for women, and 11 countries had life expectancy declines for men during 2014 to 2015.

“This is the first time in recent decades that [this] many high-income countries simultaneously experienced such large declines in life expectancy for both men

and women,” Ho and Yendel wrote.

Reliability of data

In a related editorial that addressed both studies, Domantas Jasilionis, PhD, a research scientist, Max Planck Institute for Demographic Research in Germany, wrote that the collection of data is not universal worldwide, which may limit both studies’ findings.

“National mortality data are often published after substantial delays. Data are often incomplete, with migration-related errors in population denominators, or cause of death statistics that are incomparable among different countries,” he wrote.

“Reliable register-based or census linked data on socioeconomic disparities in mortality are even more scarce, forcing researchers to use nationally unrepresentative survey based or biased cross-sectional data. This kind of evidence should be treated with a great caution. More effort must be made to convince international and national agencies to invest in robust register-based systems that allow timely and accurate monitoring of changes in longevity,” Jasilionis concluded. – by Janel Miller

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References:

Ho JY, Hendi AS. BMJ. 2018;doi: 10.1136/bmj.k2562.

Jasilionis D. BMJ. 2018;doi:10.1136/bmj.k3399.

Woolf SH, et al. BMJ. 2018;doi:10.1136/bmj.k3096.

Disclosure: Please see the studies and accompanying editorial for the authors’ relevant financial disclosures.