By Joel Achenbach Jan.
29, 2020 at 11:01 p.m. CST
The number of
fatal drug overdoses declined for the first
time in 28 years, and U.S. life expectancy at birth ticked upward
for the first time since 2014, according to long-awaited numbers for 2018
published Thursday by the U.S. Centers for Disease Control and Prevention.
A decline in the death rate from cancer is
the single largest driver of the small increase in life expectancy, the
CDC reported. Five of the other nine leading causes of death also showed
declines in death rates, including the top cause, heart disease, as well as
unintentional injuries (which include overdoses), chronic lower respiratory
diseases, stroke and Alzheimer’s disease. Two more, diabetes and kidney
disease, were essentially unchanged. Deaths from suicide and influenza and
pneumonia increased.
Despite the
encouraging elements of the CDC mortality report, the broader pattern for
American health remains sobering. Life expectancy improved by the tiniest of
increments, from 78.6 to 78.7 years. That figure remains lower than the peak in U.S. life
expectancy, at 78.9 years, in 2014.
It is also identical
to life expectancy in 2010, and it appears unlikely that U.S. longevity will
show any significant improvement over the entire decade of the 2010s. The
United States is continuing to fall behind similarly wealthy countries — a
phenomenon that experts refer to as the U.S. “health disadvantage.”
“It’s good news that
there was an increase in life expectancy. That’s what we want to see, but it
doesn’t really alter the long-term picture. We still have a very bleak
situation at this point,” said Steven H. Woolf, director emeritus of the Center
on Society and Health at Virginia Commonwealth University.
Woolf was the
co-author of a report published in November in the
JAMA, the American Medical Association’s journal, that revealed a long-term
increase in death rates in the United States for people in the prime of life —
from 25 to 44. That study was based on mortality data from 1959 to 2017, and
showed that improvements in life expectancy and a lowering of death rates
peaked in the 1970s, with more gradual increases after that. In 1998, the
United States for the first time fell behind the average life expectancy in
peer nations, Woolf said.
“As a country, we are
not doing as well as we should, and other high-income countries are outperforming
us and continue to outperform us. There is a lot of American exceptionalism at
work here. The U.S. is on a very distinct path when it comes to our health, our
well-being and our survival,” said Laudan Aron, senior fellow at the Urban
Institute, a Washington-based nonpartisan research organization.
She said the
long-term health trends are driven by socioeconomic factors “that are really
proving to make life very challenging for many Americans.”
Another new overview
of American health, released early Thursday by the Commonwealth Fund, a
health-care research organization based in New York, noted that the United
States has a lower life expectancy than 10 peer nations — Germany, Britain,
Canada, Australia, France, the Netherlands, New Zealand, Norway, Sweden and
Switzerland — despite spending far more per capita on health care than any of
them. The suicide rate, at 14 per 100,000 people, is twice that of Britain, the
report said.
“We live sicker and
die younger than our counterparts around the world — despite spending around
twice as much as other nations on health care,” said Roosa Tikkanen, a research
associate at the Commonwealth Fund and the lead author of the report.
“We can do better,”
she added.
David Blumenthal,
president of the Commonwealth Fund, said Wednesday that the poor health
outcomes are due to a “very inadequate primary care system” in which too few
people have access to medical care, with costly consequences such as trips to
the emergency room and preventable illnesses. The report said the United
States, compared with peer countries, has the highest rate of hospitalization
from preventable causes and the highest rate of “avoidable deaths.”
In recent years,
obesity has increased death rates for heart disease, diabetes and other
ailments: About 4 out of 10 adults age 20 and older in the United States are
considered obese, and another 3 out of 10 are overweight, according to the CDC.
The CDC’s annual
report on life expectancy had been dismaying the previous three years, with the
number dropping or remaining flat each year as the United States dealt with a
wave of drug overdoses from illicit fentanyl flooding communities with high
levels of opioid addiction.
Secretary of Health
and Human Services Alex Azar issued a statement early Thursday highlighting the
drop in drug overdoses. “This news is a real victory, and it should be a source
of encouragement for all Americans who have been committed to connecting people
struggling with substance abuse to treatment and recovery,” Azar said.
The CDC has
linked the addiction epidemic of the past two
decades to the widespread marketing and distribution, starting in the late
1990s, of prescription opioids.
As the epidemic blew
up into a national crisis, doctors in 2013 began prescribing fewer painkillers,
and deaths from pill overdoses gradually declined. But deaths from street drugs
soared.
Governments and
public health groups have dramatically increased the amount of naloxone, an
anti-overdose medication, in communities across the nation. Billions of dollars
have been poured by federal, state and local governments into drug treatment
and other support services. The new report shows the first drop in the death
rate per 100,000 people from overdoses since 2012 and the first decline in the
raw number of deaths since 1990 — from 70,237 in 2017 to 67,367 in 2018.
That remains a
staggering death toll, higher than the fatalities from motor vehicle accidents.
The figure includes deaths from opioids, 46,802, a slight drop from the
previous year’s total of 47,600. By comparison, a decade earlier, in 2008,
fatal opioid overdoses had not yet topped 20,000.
Still rising: fatal
fentanyl overdoses, a subset of the opioid number. There were 31,335 in 2018,
up from 28,466 in 2017 and a 10-fold increase from the number five years
earlier.
Also up are overdose
deaths from cocaine and psychostimulants such as methamphetamine — 14,666 and
12,676, respectively. The latter number is about triple the number from just
four years earlier.
The American drug
abuse crisis continues to evolve, with meth a growing cause of fatalities.
There are ominous indications that the downward trend in fatal overdoses will
not hold when the 2019 mortality data comes out. (The CDC usually takes about
one year to produce final mortality data.) Earlier this month, the CDC released
provisional drug overdose data — numbers that include “predicted” deaths, using
an algorithm that adjusts for likely undercounts — that showed a slight
increase nationally in drug deaths over the first six months of 2019.
Most of that increase
has been seen in states west of the Mississippi. Experts on drug use in the
West say that fentanyl, which became widespread initially in the eastern United
States, has begun to play a bigger role in the western U.S. drug supply.
Drug overdoses play
an outsize role in life expectancy because they often claim the lives of young
people, cutting off many years of life, whereas a disease such as cancer
typically affects people who are much older, noted Otis Brawley, an oncologist
at Johns Hopkins University School of Medicine. “The average age of someone who
dies from cancer is in their early 70s,” he said.
Life expectancy at
birth for females in 2018 remained five years greater than that of males: 81.1
and 76.1, respectively. That gap narrows with age because men are more likely
than women to die young. At the age of 65, men have a life expectancy of 18
additional years and women 20.6.
Lenny Bernstein
contributed to this report.
