New Data Details Historic Rise and Fall of US Life Expectancy

A new analysis from the Virginia Commonwealth School of Medicine is illustrating the impact of medicine, healthcare, and societal have had on life expectancy and mortality rates in the United States over the past 60 years.

Analyzing data obtained from the US Mortality and CDC WONDER database investigators found US life expectancy increased for most of the past 60 years, but plateaued over time and eventually began to decrease starting in 2014—mostly driven by increases in all-cause mortality among young and middle-aged adults.

In an effort to further describe changes in life expectancy and mortality rates—as well as potential underlying causes and factors—investigators conducted an analysis of data from the aforementioned databases and performed an analysis focused on midlife deaths stratified by sex, race/ethnicity, economic status, and geography. Specifically, investigators used life expectancy data for 1959 through 2017 and mortality rate information for 1999 through 2017.

Analyses of life expectancy data revealed life expectancy increased by nearly a decade between 1959 and 2016 from 69.9 years to 78.9 years. The fastest increase in terms of annual percent change (APC) took place during the decade lasting from 1969 to 1979 (APC=0.48, P<0.01).

The plateau effect began in the 1980s as life expectancy increases began to slow—and they eventually plateaued in 2011. Investigators pointed out National Center for Health Statistics report life expectancy peak at 78.9 years in 2014 and decreased significantly for the following 3 years until expectancy reached 78.6 years in 2017.

When examining the decline in life expectancy across different population groups, investigators noted the decrease was twice as great among men than women occurred across multiple racial-ethnic groups, including non-Hispanic white populations (78.8 to 78.5), non-Hispanic black populations (75.3 to 74.8), and Hispanic populations (82.1 to 81.8 years).

Investigators found the decrease in life expectancy was caused, in large part, by increases in all-cause mortality among young and middle-aged adults. Between 2010 and 2017, the age-adjusted all-cause mortality rates increased by 6% in adults between the ages of 25 and 64 years old (from 328.5 deaths per 100,000 to 348.2 deaths per 100,000). Furthermore, investigators noted age-specific mortality rates increased by 29% for adults 25 to 34 years old during that time period.

In regard to regional impact, the largest relative increases in midlife mortality rates were observed in New England (New Hampshire, 23.3%; Maine, 20.7%; Vermont, 19.9%) and the Ohio Valley (West Virginia, 23.0%; Ohio, 21.6%; Indiana, 14.8%; Kentucky, 14.7%). Additionally, analyses revealed the increase in midlife mortality from 2010 through 2017 was associated with an estimated 33,307 excess deaths and 32.8% of these were attributable to the Ohio Valley.

When examining cause, analyses revealed the midlife mortality from drug overdoses increased by 386.5% from 1999 to 2017 from 6.7 deaths per 100,000 to 32.5 deaths per 100,000. While age-specific increases were significant among those aged between 25 and 34 years (531.4% increase) the largest relative increase occurred in those aged 55 to 64 years (909.2%).

In a related editorial published in JAMA, physicians from the Harvard T.H. Chan School of Public Health and the Bipartisan Policy Center said the results of the study highlight the need to address these issues on a nationwide level.

“The study by Woolf and Schoomaker, detailing years of cumulative insults to the nation’s health, represents a call to action. Further research must explore how income inequality, unstable employment, divergent state policies, and other social dimensions affect disease,” wrote Howard K. Koh, MD, MPH, Anand K. Parekh, MD, MPH, and John J. Park, MBChB, MPH.

This study, titled “Life Expectancy and Mortality Rates in the United States, 1959-2017,” was published online in JAMA.