Study shows health is declining in younger generations

Physiological and mental health is worsening among late Generation X and Generation Y cohorts compared with Baby Boomers, according to an investigation published in the American Journal of Epidemiology.

“Morbidity and mortality have been increasing among middle-aged and young-old Americans since the turn of the century,” Hui Zheng, PhD, an associate professor in the department of sociology at Ohio State University, and colleagues wrote. “It is essential to investigate whether the unfavorable trend in morbidity and mortality in recent decades should be attributed to health behavior changes driven by psychological distress or deterioration of innate physiological functioning, or both.”

Zheng and colleagues conducted a comprehensive analysis of data from the National Health and Nutrition Examination Survey (NHANES) and National Health Interview Survey (NHIS). The final analysis included 625,221 adults from NHIS and 62,833 adults from NHANES. The participants were categorized by race, ethnicity, gender, birth cohort and other demographic characteristics.

The researchers analyzed participants for biological risk factors and physiological status, including physiological dysregulation, metabolic syndrome and low urinary albumin, as well as mental health factors, including anxiety, depression and other health behaviors.

Zheng and colleagues reported a general increase in physiological dysregulation from Baby Boomers (born 1943-1945) through late-Generation X adults (born 1973-1980) and Generation Y adults (born 1981-1999) for all gender and racial groups. The increase was higher in white men; although, Black men had the sharpest increase in low urinary albumin, according to the researchers.

There was also an increase in mental illness and unhealthy behaviors among late-Generation X and Generation Y, with white individuals having a higher degree of anxiety, depression and heavy drinking. The researchers also noted that the increased prevalence of disability and limited physiological status among those approaching middle and old age may particularly reflect pronounced drug use.

“The worsening physiological and mental health profiles among younger generations imply a challenging morbidity and mortality prospect for the United States, one that may be particularly inauspicious for whites,” the researchers wrote.

Using data from the NHANES and NHIS, this study demonstrates worsening physiological and mental health profiles that will likely result in increasing morbidity and mortality for younger generations in the United States. Interestingly, this trend was pervasive across male and female sexes and the three races/ethnicities included in this study, though the magnitude of increase varied.

A major implication of this study is that all physicians need to screen for metabolic syndrome, mental health disorders and substance abuse in younger patients. And now with the effects of the COVID-19 pandemic superimposed on the preexisting trends identified in this study, including increased rates of alcohol consumption, substance use, anxiety, depression and newly diagnosed diabetes, it is even more urgent for primary care physicians to intervene before patients’ morbidity and mortality rates escalate and overwhelm our already-strained health care infrastructure.

The worsening health statuses of Generation X and Y individuals should be of concern to all physicians, but family physicians may be uniquely positioned to address this impending crisis. Clinically, primary care physicians will need to be increasingly vigilant about ensuring patients in this age range (25 to 56 years old as of 2021) are receiving regular preventive health services and not just acute care, because prevention of physiologic distress and metabolic syndrome in addition to screening for mental health disorders and substance abuse will be the most effective method of preventing worsening morbidity and mortality.

Unfortunately, many young adults who feel healthy do not present for health care until much later in the course of a disease. However, family physicians are able to offer continuity of care for individual patients from birth to death and during unique stages of their adult lives, including pregnancy. Family physicians may be able to capture this cohort of young to middle-aged adults to counsel on health behavior modifications, screen for diseases and offer medical management instead of losing contact with these patients after they transition from pediatric to adult care. Family physicians are also able to screen for and treat the mental health disorders addressed in this study: depression, anxiety and substance abuse. Given the paucity of mental health providers in the United States and the increasing demand for these services, family physicians are essential for diagnosis and treatment of routine cases and reservation of referrals for patients who may need more specialized care, ultimately reducing the burden on mental health professionals.