US life expectancy stalls due to cardiovascular disease, not drug deaths
Neil K Mehta, Leah R Abrams, Mikko Myrskylä, Neil K Mehta, Leah R Abrams, Mikko Myrskylä
Abstract
After decades of robust growth, the rise in US life expectancy stalled after 2010. Explanations for the stall have focused on rising drug-related deaths. Here we show that a stagnating decline in cardiovascular disease (CVD) mortality was the main culprit, outpacing and overshadowing the effects of all other causes of death. The CVD stagnation held back the increase of US life expectancy at age 25 y by 1.14 y in women and men, between 2010 and 2017. Rising drug-related deaths had a much smaller effect: 0.1 y in women and 0.4 y in men. Comparisons with other high-income countries reveal that the US CVD stagnation is unusually strong, contributing to a stark mortality divergence between the US and peer nations. Without the aid of CVD mortality declines, future US life expectancy gains must come from other causes-a monumental task given the enormity of earlier declines in CVD death rates. Reversal of the drug overdose epidemic will be beneficial, but insufficient for achieving pre-2010 pace of life expectancy growth.
Keywords: cardiovascular disease; drug-related mortality; life expectancy; mortality; opioid epidemic.
Conflict of interest statement
The authors declare no competing interest.
Copyright © 2020 the Author(s). Published by PNAS.
Figures
References
- National Center for Health Statistics, Health, United States, 2005 With Chartbook on Trends in the Health of Americans. . Accessed 1 February 2020.
- Ford E. S., et al. , Explaining the decrease in U.S. deaths from coronary disease, 1980-2000. N. Engl. J. Med. 356, 2388–2398 (2007).
- Jemal A., Ward E., Hao Y., Thun M., Trends in the leading causes of death in the United States, 1970-2002. JAMA 294, 1255–1259 (2005).
- Barbieri M., The contribution of drug-related deaths to the US disadvantage in mortality. Int. J. Epidemiol. 48, 1026 (2019).
- Ho J. Y., Hendi A. S., Recent trends in life expectancy across high income countries: Retrospective observational study. BMJ 362, k2562 (2018).
- Woolf S. H., Schoomaker H., Life expectancy and mortality rates in the United States, 1959-2017. JAMA 322, 1996–2016 (2019).
- Mehta N. K., Abrams L. R., Myrskyla M., Additional information for the analysis of CVD and drug related mortality in the U.S. . Accessed 18 November 2019.
- Lopez A. D., Adair T., Is the long-term decline in cardiovascular-disease mortality in high-income countries over? Evidence from national vital statistics. Int. J. Epidemiol. 48, 1815–1823 (2019).
- Sidney S., et al. , Recent trends in cardiovascular mortality in the United States and public health goals. JAMA Cardiol. 1, 594–599 (2016).
- Shah N. S., et al. , Trends in cardiometabolic mortality in the United States, 1999-2017. JAMA 322, 780–782 (2019).
- Ma J., Ward E. M., Siegel R. L., Jemal A., Temporal trends in mortality in the United States, 1969-2013. JAMA 314, 1731–1739 (2015).
- Case A., Deaton A., Mortality and morbidity in the 21st century. Brookings Pap. Econ. Act. 2017, 397–476 (2017).
- Preston S. H., Ho J., Low Life Expectancy in the United States: Is the Health Care System at Fault? (National Academies Press, 2010).
- Rosinger A., Carroll M. D., Lacher D., Ogden C., Trends in total cholesterol, triglycerides, and low-density lipoprotein in US adults, 1999-2014. JAMA Cardiol. 2, 339–341 (2017).
- Dorans K. S., Mills K. T., Yang L., Jiang H., Trends in prevalence and control of hypertension according to the 2017 American College of Cardiology/American Heart Association (ACC/AHA) guideline. J. Am. Heart Assoc. 7, e008888 (2018).
- Case A., Deaton A., Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century. Proc. Natl. Acad. Sci. U.S.A. 112, 15078–15083 (2015).
- Nishimura M., et al. , The impact of substance abuse on heart failure hospitalizations. Am. J. Med. 133, 207–213.e1 (2019).
- Glei D. A., Preston S. H., Estimating the impact of drug use on US mortality, 1999-2016. PLoS One 15, e0226732 (2020).
Source: PubMed