One way to measure progress in health and health care is life expectancy. Better nutrition, sanitation, and health care have led to dramatic life expectancies in developed countries in the 20th and 21st centuries. Research published in the Journal of the American Medical Association examines trends in life expectancy from 1959 to 2017. (JAMA Article) Life expectancy generally refers to how long a person born in a certain year might expect to live. It is impacted by mortality rates and causes of death. Life expectancy in the United States has actually declined since 2014. This is largely due to greater mortality early in life, particularly due to opioid abuse and suicide. But the trends have been building for three decades, as life expectancy trends in the United States began to diverge from those in other developed countries. From a big picture perspective, it looks pretty good (ignoring quality of life issues), as life expectancy rose from 70 years in 1959 to 80 years in 2016. Most of the gain occurred from 1969 to 1979 and it plateaued in 2011 before beginning the decline to 78.6 years in 2017. The decline affected men more than women, but was relatively equivalent across races. The decrease in life expectancy was due to increased mortality among young and middle-aged adults, those 25 to 64 years old. The rise in the causes of death which led to decline in life expectancy were present before the actual decline showed up, but that rise was masked by ongoing declines in common mortality causes like cardiovascular disease and cancer. Fatal drug overdoses increased from 6.7 deaths per 100,000 in 1999 to 32.5 in 2017 among those midlife cohorts. Rates of death also rose rapidly for alcoholism-linked diseases and suicides. Hypertension and obesity also played a role. Increased mortality affected almost all groups, but was higher among those with lower incomes and education. The greatest increases in mortality were in the Midwest, but the trends were apparent everywhere, in rural America, the suburbs and cities.
What does this all mean? It is clearly a concerning trend, but it may not tell us anything about health care quality. The underlying causes appear to be social in origin. People are distressed, for a variety of reasons, and many respond with feelings of despair and hopelessness. From there it is not far to trying to obliterate those feelings with drugs or alcohol, and ultimately suicide. But the health system does bear a heavy cost burden due to these issues. Spending on drug and alcohol abuse is increasing rapidly. I don’t expect that we will see much of a change until people feel more optimism about their lives.