27 Nov Decrease in Life Expectancy Concentrated in Rust Belt and Appalachia

MedicalResearch.com Interview with:

Dr. Woolf

Steven H. Woolf, MD, MPH
Director Emeritus and Senior Advisor, Center on Society and Health
Professor, Department of Family Medicine and Population Health
C. Kenneth and Dianne Wright Distinguished Chair in Population Health and Health Equity
Virginia Commonwealth University School of Medicine
Richmond, Virginia 23298-0212

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Life expectancy in the US has decreased for three years in a row, the first time this has occurred in this country since the Spanish flu epidemic a century ago. Meanwhile, life expectancy in other countries continues to climb.

Our study found that the trend is being driven by an increase in death rates among working-age adults (ages 25-64 years), which began as early as the 1990s. The increase has involved deaths from drug overdoses—a major contributor—but also from alcoholism, suicides, and a long list of organ diseases. We found increases in 35 causes of death.

We analyzed the trends across the 50 states and discovered that the trend is concentrated in certain regions, especially the Industrial Midwest (Rust Belt) and Appalachia, whereas other regions like the Pacific states were least affected. Increases in midlife mortality in four Ohio Valley states (Ohio, Pennsylvania, Indiana and Kentucky) accounted for one third of the excess deaths between 2010 and 2017.

MedicalResearch.com: What should readers take away from your report?

Response:  An increase in mortality spanning 35 causes of death is difficult to blame on a single cause, such as the opioid epidemic or obesity. The pervasive trend suggests a systemic cause,
something distinct that is causing this to occur in the United States and not other wealthy nations.

Our paper discusses the role of health care, psychosocial distress, or the changes that have occurred in the US economy since the 1980s, when the decline in US health began. Job losses in manufacturing and other sectors, stagnant incomes, and widening income inequality could contribute to poor health in multiple ways and would explain the disproportionate impact we observed in the Rust Belt and other areas hit hard by the economy.

This suggests that, while it is important to treat the “symptoms” of this trend (addressing drug abuse, the obesity epidemic, etc.), social and economic policies to improve education, create good jobs, and invest in communities may be even more important in reversing this trend. If we fail to act, the trend is likely to continue, and that will mean that our children will live shorter lives than ours.   

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: Convincing theories to explain this trend require more definitive evidence, and this will require not only sophisticated research methods but also the involvement of multiple disciplines. Understanding why this is occurring requires input not only from medicine and public health but also from social scientists, economists, and others who have insights about the history of these trends.

MedicalResearch.com: Is there anything else you would like to add?

Response: Comparisons between the United States and other countries are often dismissed because our population is more racially diverse and therefore not comparable to that of Japan, Sweden, and other peer countries. However, the largest increase in midlife deaths have occurred among non-Hispanic whites. Just recently, mortality has begun increasing among African Americans and other people of color. We also noted that, for certain causes of death, the relative increase was higher among women than men. Explanations for this trend must explain why it is happening in this country and not others and why it is disproportionately impacting certain regions of the country. Other countries have done more to create support systems for families and communities in need, and this may cushion the blow in ways that are not available to many American families. If we do not want the health of Americans to continue to decline, we may need to take more concerted action to help the middle class, promote economic opportunity, and increase social mobility.

Citation:

Woolf SH, Schoomaker H. Life Expectancy and Mortality Rates in the United States, 1959-2017. JAMA. 2019;322(20):1996–2016. doi:https://doi.org/10.1001/jama.2019.16932

Last Modified: [last-modified]

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Last Updated on November 27, 2019 by Marie Benz MD FAAD