American Life Expectancy Stagnant as Chronic Illness Takes Center Stage: Study
THURSDAY, Oct. 12, 2023 (HealthDay News) — American life expectancy has remained stagnant for more than a decade, with much of the blame placed on “deaths of despair” among middle-aged adults. However, a new study suggests that chronic illness among older Americans is actually the most important factor.
After a century of steady improvement, gains in American life expectancy nearly stopped around 2010. By 2019, the average life expectancy for a newborn in the United States was just under 79 years, according to the US Centers for Disease Control and Prevention. This was virtually no different from the outlook in 2010, a surprising reversal of previous trends.
Since 1900, life expectancy in the US had grown almost three years, on average, every decade.
Research into the “why” has often focused on worrying trends among working-age adults: More middle-aged Americans, especially those with less education, have been dying from drug overdoses, alcohol abuse, and suicide, leading to which some researchers call deaths of despair.
But while that issue grabs the headlines, another trend has taken shape at the same time.
A 2020 study found that stalling progress against cardiovascular diseases, including heart attacks and strokes, has actually had a greater impact on life expectancy in the US since 2010.
“We found a slow decline in the rate of heart-related death that outpaced the increase in drug-related deaths,” said researcher Leah Abrams, an assistant professor of community health at Tufts University in Medford, Massachusetts.
That, she said, raised the question of what might be happening among Americans of different ages: Older adults suffer from heart disease at a higher rate than younger people, so it made sense that deaths among older Americans could play a role.
In the new study, Abrams and her colleagues found just that.
Between 2000 and 2009, the average life expectancy of Americans at age 25 grew by about 1.4 years for women and 1.7 years for men. From 2010 to 2019, those gains dropped considerably, to just 0.4 and 0.17 years, respectively.
Meanwhile, death rates among Americans ages 65 to 84 showed a similar pattern, declining at a slower pace between 2010 and 2019 compared to the previous decade.
If that hadn’t happened, Abrams and her colleagues estimate that life expectancy in the US would have continued to grow, by about a year.
Experts said the findings, published Oct. 9 in the Proceedings of the National Academy of Sciences, do not discount the impact of those tragic and preventable deaths of despair.
But chronic diseases like heart disease, which have long been the leading cause of death for Americans, are simply much more prevalent, Abrams said. Therefore, even a slowdown in progress against those diseases has a big impact on life expectancy in the US.
Why has that progress stalled? This study can’t answer that, Abrams said.
But she and other experts pointed to some likely suspects: an increase in disease risk factors such as obesity and physical inactivity; social factors, such as problems accessing healthy, affordable food and stable housing; social isolation and loneliness among Americans in general and older adults in particular; a deteriorating social safety net for the elderly; and a broken healthcare system.
“Life expectancy is determined both by health care and by things that happen outside the health care system,” said David Radley, who studies health system performance at the nonprofit Commonwealth Fund in New York.
In a recent analysis, he and his colleagues found that Americans, regardless of which state they live in, generally die younger than people in similarly wealthy countries, including Canada, Japan, and much of Europe.
The reasons, he said, are probably varied, but one obvious difference is that those countries have universal healthcare and generally prioritize primary care.
The United States, Radley noted, invests more in specialized care, where the focus is on treating diseases rather than preventing them.
“We need to do a better job building a strong primary care system,” Radley said.
Dr. Asaf Bitton, a physician and researcher at Harvard Medical School and Brigham and Women’s Hospital, agreed.
“We do ‘sick care’ very well if you have health insurance,” Bitton said. Where the U.S. often fails, she added, is in health promotion and disease prevention.
In a 2021 study, Bitton and colleagues found a clear relationship between the local availability of primary care providers and life expectancy. Americans living in counties with few providers — fewer than one doctor for every 3,500 residents — had an average life expectancy nearly a year shorter than people living in counties with more providers.
Unfortunately, Bitton said, the national shortage of primary care providers has only worsened with the pandemic.
The pandemic has also further affected life expectancy in the US, something this study does not reflect, Abrams said. And older Americans, she added, have been responsible for the majority of COVID deaths.
According to the CDC, life expectancy in the US fell to 76 years in 2021, its lowest level since 1996.
More information
Peterson-KFF has more on American life expectancy.
SOURCES: Leah Abrams, PhD, MPH, assistant professor, community health, Tufts University, Medford, Massachusetts; Asaf Bitton, MD, MPH, associate professor, medicine and health care policy, Brigham and Women’s Hospital/Harvard Medical School, Boston; David Radley, PhD, MPH, Senior Scientist, Health System Performance Tracking, Commonwealth Fund, New York; Proceedings of the National Academy of Sciences, October 9, 2023, online.