ARE WE BETTER OFF THAN OUR PARENTS? NO!

Small Towns Offer Clues to Life Expectancy Drop



Years of Gains Halted

A drop in national life expectancy hasn’t happened in this country since the AIDS epidemic exploded in the early 1990s, Benjamin says.


The signs are alarming:
The national opioid crisis is a major part of the current downturn. Overdose deaths, especially those of younger adults and men, have doubled since 2010, ballooning to more than 40,000 in 2016.
The national suicide rate has doubled during the last 10 years.
Rising mortality from drugs, suicides, and alcoholism -- particularly for white, middle-aged Americans without a college degree -- make up what researchers Anne Case and Angus Deaton call “deaths of despair.” Case and Deaton found that those deaths have increased since the late 1990s, in both rural and urban areas.

Several counties with the largest declines are clustered in eastern Kentucky -- the nucleus of the national opioid epidemic, which has decimated many of those counties. But the opioid epidemic is only one part of a complex group of reasons across the country. Ali Mokdad, PhD, a professor of health metrics science at the University of Washington, helped design and supervise the IHME county-level study and found four general causes for the life expectancy decline:
Socioeconomic factors like income and education
Access to health care, affected by under- or uninsured people
The quality of health care, including how long it takes to get treatment
And, most importantly, preventable things that can lead to health problems, like smoking, obesity, and high blood pressure

“As a country, we are improving, but we are not improving at the same rate of other rich countries, and we're falling behind,” Mokdad says. “In our country, there are many counties and communities that are getting left behind.”

U.S. life expectancy declines again, a dismal trend not seen since World War I

Drug overdoses set another annual record in 2017, cresting at 70,237 — up from 63,632 the year before, the government said in a companion report. The opioid epidemic continued to take a relentless toll, with 47,600 deaths in 2017 from drugs sold on the street such as fentanyl and heroin, as well as prescription narcotics. That was also a record number, driven largely by an increase in fentanyl deaths.

Since 1999, the number of drug overdose deaths has more than quadrupled. Deaths attributed to opioids were nearly six times greater in 2017 than they were in 1999.

Deaths from legal painkillers did not increase in 2017. There were 14,495 overdose deaths attributed to narcotics such as oxycodone and hydrocodone and 3,194 from methadone, which is used as a painkiller. Those totals were virtually identical to the numbers in 2016. The number of heroin deaths, 15,482, also did not rise from the previous year.

Robert Anderson, chief of the mortality statistics branch at the Center for Health Statistics, said the leveling off of prescription drug deaths may reflect a small impact from efforts in recent years to curb the diversion of legal painkillers to users and dealers on the streets. Those measures include prescription drug monitoring programs that help prevent substance abusers from obtaining multiple prescriptions by “doctor shopping.”

Others noted programs that may also have helped: The overdose antidote naloxone has been made more widely available in many places; Rhode Island has made efforts to educate substance abusers as they leave jail, a time when they are particularly vulnerable to overdose; and Vermont and other states have bolstered treatment programs. States that have expanded their Medicaid programs are also able to offer more treatment for users.

Other factors in the life expectancy decline include a spike in deaths from flulast winter and increases in deaths from chronic lower respiratory diseases, Alz­heimer’s disease, strokes and suicide. Deaths from heart disease, the No. 1 killer of Americans, which had been declining until 2011, continued to level off.

Deaths from cancer continued their long, steady, downward trend.

The CDC issues its health statistics report each December. The 2017 report is the third in a row to show a decline in life expectancy.

Nearly a year later, the agency combines each year’s data with additional information from Medicare. In the past two years, that has resulted in tiny adjustments to the overall life expectancy number.

By the revised measure, life expectancy in 2015 and 2016 was flat, at 78.7, a decline from 78.9 in 2014. Any revision for 2017’s estimate of 78.6 years will come next year.

In a third report, the government detailed the ongoing growth of deaths from suicide, which has climbed steadily since 1999 and grown worse since 2006.

Most notable is the widening gap between urban and rural Americans. Suicide rates in the most rural counties are now nearly double those in the most urban counties.

Overall, suicides increased by a third between 1999 and 2017, the report showed. In urban America, the rate is 11.1 per 100,000 people; in the most rural parts of the country, it is 20 per 100,000.

A variety of factors determine suicide rates, but one that may help explain its greater prevalence in rural areas is access to guns, said Keith Humphreys, a professor of psychiatry and behavioral sciences at Stanford University.

“Higher suicide rates in rural areas are due to nearly 60 percent of rural homes having a gun versus less than half of homes in urban areas,” Humphreys wrote in an email. “Having easily available lethal means is a big risk factor for suicide.”

Sharfstein said the most lamentable aspect of the crises is that policymakers know which approaches make a difference, such as medically assisted treatment for drug abusers and increased availability of mental health services in states where they are lacking.

“So the frustration that many of us feel is that there are things that could save many lives,” he said, “and we are failing to make those services available.”