Why Aren’t Americans Living Longer?

Despite major advances in medicine, US life expectancy barely budged in the 2010s, and it still lags that of other wealthy nations.

Researchers have pointed to rising “deaths of despair”—drug overdoses, suicides, and alcohol-related deaths—and stalled progress against heart disease as potential causes, but no single explanation seemed to account for this troubling trend.

In a new study in the journal Proceedings of the National Academy of Sciences, Leah Abrams, an assistant professor of community health at Tufts University, and her collaborators from The University of Texas Medical Branch and several research European institutions examined death certificate data for US residents born between the 1890s and 1980s. The team analyzed changes in mortality from 1979 through 2023 across age groups and over time.

The researchers analyzed deaths from all causes and from three of the most common ones in the United States: cardiovascular disease, cancer, and so-called external causes, which include drug overdoses, suicides, homicides, and accidents. This allowed the researchers to see whether shortened life expectancy has a single driver or if multiple, overlapping crises are unfolding across generations.

The research reveals that some birth cohorts, particularly late Gen Xers and early Millennials, are already experiencing worse outcomes than their predecessors, including dying from diseases once rare in the young.

Here, Abrams digs into what the findings reveal about what we can learn from past decades of US mortality—and what they may signal for the country’s future:

Q Why was it important to conduct this research?

A US life expectancy has been stalled or declining for over a decade now, putting the country further behind its peer nations. These trends can reflect events that affect everyone at once, like COVID-19, or they can reflect differences between generations—when people born in certain years experience worse health than those born before or after them.

We plotted 40 years of data on mortality increases or decreases across multiple ages and major causes of death to understand how these forces are shaping US mortality.

QDid you see any trends that applied broadly across the US population?

A For years, many assumed that drug overdoses in midlife explained stalled US life expectancy. But our findings show that the problem is much broader.

The 2010s was a bad decade for mortality across ages. There’s a clear period pattern, but it’s not just due to deaths from drug overdoses. It’s also due to suicides, homicides, traffic accidents, and cardiovascular disease.

That pattern points to deeper, systemic forces shaping health. We talk a little bit in the study about social and economic conditions that could result in a lot of stress. Stress is bad for heart disease. Stress is also something that can result in drug use. And so if people are feeling they can’t make it economically or if they don’t have social institutions or communities to support them, and their life’s gotten stressful, that can affect all these causes of death.

Q What are the mortality differences seen among the age groups? What does the study reveal about Baby Boomers, Gen Xers, and Millennials?

A One of our key findings is that Baby Boomers born between 1950 and 1959 mark a turning point. Before that group, each successive birth cohort seemed to have lower mortality than the one before it. This group has experienced worse outcomes than the generations before them. And the generations that followed them had mortality improvements that weren’t as strong as prior generations had.

In addition, we see concerning trends for those born from around 1970 to 1985—the late Gen Xers and “Elder Millennials.” These cohorts are trending worse than their predecessors in all-cause mortality; deaths from cardiovascular disease and cancer, especially colon cancer; and external causes.

Q What stood out most in the data for you?

A The most surprising finding was the rise in colon cancer deaths among younger generations. There has been a lot in the news these past few years about people younger than 50 increasingly being diagnosed with colon cancer. Greater cancer prevalence can indicate that we’re simply catching cancer sooner; if you do more screenings at younger ages, more younger people will be diagnosed. But our study shows increased mortality, and it’s never good to have more deaths at young ages. This is a genuinely alarming trend.

QWhat trends do you find most troubling?

A The increase in deaths among those born from 1970 to 1985 is cause for concern because cancer and cardiovascular disease tend to be relatively rare in individuals who are in their 30s and 40s. So if these cohorts are showing worse mortality trends already, what’s going to happen when they’re in their 60s if nothing gets turned around? That’s one of the looming implications of these findings.

Q Do the data show where past public health interventions had a positive effect?

A Yes, we saw reductions in mortality as a result of tobacco control. Deaths from cancer overall, lung cancer specifically, and cardiovascular disease all declined from reductions in smoking across subsequent cohorts. That was a huge public health win.

Deaths from cardiovascular disease also previously saw significant decreases as a result of improved diet and medical advances.

Q Do these findings suggest how we may reverse these negative trends?

A Although this study does not provide direct evidence, we can speculate about some interventions to explore. To reduce deaths from cardiovascular disease, we may want to address risk factors such as diabetes, hypertension, and obesity. Addressing colon cancer mortality among younger individuals may involve related factors and benefit from improving diet.

For deaths from drug overdoses, we could promote the use of naloxone—a drug given in emergencies to rapidly reverse an opioid overdose—to save more lives, as well as improve economic opportunities to reduce the risk of people turning to substance use.

Prior evidence, combined with our findings, shows that we really need to think holistically if we are to improve US life expectancy. Reducing social inequalities and improving resources for socioeconomically disadvantaged groups could help lessen stress and its harmful effects on health, improve dietary behavior, and reduce substance use.

Q What are the next steps for this research?

A Our primary analysis ends in 2019, because COVID-era mortality overwhelmed prior trends, but we did look at the post-COVID years in our supplementary materials.

Obviously, there was a huge uptick in infectious disease mortality during the COVID-19 pandemic. But it was a bad period for mortality overall, for a lot of different causes of death. This included heart disease, because people were avoiding hospitals and not getting the care they needed.

It is possible that some older people who had COVID may not have directly died from COVID but ended up dying soon after from some sort of lung or heart complication because their body was so stressed by the virus. There were people struggling from being unemployed or isolated and perhaps higher drug and alcohol use during 2020 and 2021.

The CDC just released the 2024 mortality data, and it looks like we’re finally getting back to pre-pandemic levels. We’re now turning to these newer data to understand how the pandemic may have reshaped mortality trends in the US.

Source: Tufts University

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This post was previously published on FUTURITY.ORG and is republished here under a Creative Commons license.

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