By Dennis Thompson
Deaths among working-age adults, especially, have been increasing in the United States for decades, particularly in economically struggling parts of the nation such as the "Rust Belt" and Appalachia, the researchers reported.
These early deaths are causing average life expectancy to decline in the United States. U.S. life expectancy dropped between 2014 and 2017, even while citizens in more than a dozen other industrialized nations continue to enjoy ever-longer lives.
The U.S. trend is being driven not just by the widely publicized "deaths of despair" -- drug overdoses, alcoholism and suicide -- but also by a diverse list of diseases affecting organs throughout the body, said lead researcher Dr. Steven Woolf. He's director emeritus of the Virginia Commonwealth University School of Medicine's Center on Society and Health.
The root cause of all this illness and death could be economic stress. Woolf and his colleagues suspect that the decline of the middle class in America is contributing to an average shorter lifespan across the country.
"It might turn out that investment in the middle class, and helping to bring jobs and economic development to those communities, might do more to save lives than adding another wing onto the hospital," Woolf said.
Average U.S. life expectancy stood at 78.6 years in 2017, down from a peak of 78.9 in 2014, the researchers said in background notes.
The increase in working-age death rates has tracked closely with major shifts in the U.S. economy dating back to the 1970s and 1980s, when the country began to lose manufacturing jobs and the middle class started shrinking, Woolf said.
The largest relative increases in midlife mortality rates have occurred in the Ohio Valley (West Virginia, Ohio, Indiana, Kentucky) and in northern New England (New Hampshire, Maine, Vermont), according to the researchers' analysis of federal data.
"In our analysis, we estimated how many excess deaths occurred in the United States due to this problem between 2010 and 2017," Woolf said. "One-third of those deaths occurred in those four states in the Ohio Valley."
Life expectancy in the United States rose at a steady rate in the 1960s and 1970s, but began to lose pace in the 1980s, Woolf said.
"By 1998, we had fallen below the average increase of the other industrialized countries. We plateaued in 2011, and now we're falling," Woolf said. "That it's decreasing at all speaks volumes, because it continues to climb at a healthy rate in other industrialized countries."
Declining life expectancy has been fueled by a "sharp increase in deaths among the working-age population," Woolf said.
There's been a 6% increase in death rates among people 25 to 64, and in young adults 25 to 44 it's more like a 25% increase, Woolf said.
"It's noteworthy that the Rust Belt is where we're seeing the largest number of excess deaths in this pattern," Woolf said. "You have people and communities that have gone through a long period of economic stress. If you're a family that's been struggling for many years with these kind of stresses, that might lead to a set of consequences that could affect your health in multiple ways."
It's not just that economic stress makes one more likely to turn to drink, drugs or suicide, Woolf said.
This falls in with a school of thought called the "social determinants of health," said Dr. Howard Koh, a professor at the Harvard T.H. Chan School of Public Health, in Boston.
"I like to say health starts where people live, labor, learn, play and pray," said Koh, co-author of an editorial accompanying the new study.
"You can't be healthy if you're living in poverty. You can't really be healthy if you don't have stable housing. It's difficult to be healthy without stable employment. Spirituality and social engagement are critical to well-being," Koh explained.
"We are really in an important point in our public health history where medical experts are realizing that health is much more than what happens to you in the doctor's office," he continued.
Woolf pointed out that this decline has occurred even though the United States spends more than any other nation on health care. That could mean this nation needs to consider a solution outside medicine for its poor health.
"Policies we don't typically think of as health policies -- like living wages and affordable housing and broadening access to a good education -- actually may be more effective in improving our health than investments in medical care," Woolf said.
Koh noted that without a broader view of health, people in the United States are likely to continue to die at younger and younger ages on average.
"It has long been assumed that rising life expectancy would always be the norm. The nation now risks life expectancy going downward as a troubling new norm. That's something we desperately need to avoid," Koh said.
The findings were published Nov. 26 in the Journal of the American Medical Association.