Almost all of us want to live longer, but perhaps only if it's a long and healthy life - and the two are not necessarily the same. Globally, life expectancy in 2015 was 71.4 years (78.7 year in the US), 66.2 years in India, 91.5 years in the UK) but healthy life expectancy is just 63.1 years. In the last fifty years, life expectancy has increased by a decade in the UK, by nine years in the USA and by a remarkable 20 years in India.
But statistics are complicated things, and life and death can be broken down in many ways. New research in the USA shows that age adjusted death rates - a technique used to compare expected death rates among very different groups - stopped dropping in 2010 and actually started increasing in 2015, bucking worldwide trends. Are Americans being carried off more often at the end of their days, or being cut down in their prime? A new study gives us some clues.
What was the study about and why?
Reducing premature mortality is a UN Sustainable Development goal. Recent decades have seen dramatic improvements in treatments for conditions such as HIV/AIDS, with most specialists now describing HIV with the right treatment as a 'long-term health condition' rather than a death sentence. Similar advances have been since in cancer - for breast cancer, for instance, five-year survival rates have moved from 50% to 80% in just a few decades.
So something else must be responsible for rising age-adjusted US death rates. The aim of the study was to look at trends in US death rates across different ages, to try and tease out why, after years of ever-increasing life expectancy, Americans are starting to die, on average, younger. By pinpointing possible hot spots of disease and high death rates, the study aimed to highlight whether the areas where increasing death rates are potentially avoidable. This in turn could help guide policy on where American health priorities could be targeted.
How did they do it?
The researchers examined data from death certificates and health/demographic information from the US National Center for Health Statistics, and population estimates from the US Census Bureau, between 1999 and 2014. They compared data from earlier years to this data to come up with annual percentage changes in death rates across all ages. They also mapped these death rates by racial characteristics, sex and cause of death.
The results give a picture of how death rates compare over time between the sexes, between ethnic groups and across the age spectrum.
What did the results show?
The overall increase in age-specific mortality is driven by very clearly identified groups. Among Hispanics of all ages, premature mortality reduced by up to 3.2%. Black individuals also saw a drop in mortality across all age groups, this time of up to 3.9% a year, while among Asians the drop was also consistent across all groups by up to 2.6% a year. The main diseases where reductions in death rates have been seen are HIV, cancer and heart disease. Overall, in the 15 years up to 2014, there were 311,000 fewer deaths among black men and women, 112,000 fewer in the Hispanic population and 34,000 fewer among those of Asian and Pacific Island ancestry.
In contrast, increases in death rates were driven by preventable deaths - chronic liver disease, cirrhosis of the liver, suicide and accidental death, mostly drug poisoning. The main victims were young - aged 25-49 years and particularly those aged 25-30 years - and among defined ethnic groups. Among 30-year-olds, the size of the increase in annual mortality were as follows:
- 2.3% for white women
- 0.6% for white men
- 4.3% for American Indian and Alaska Native women
- 1.9% for American Indian and Alaska Native men.
During the period studied, there were an extra 111,000 premature deaths among white men and women and 6,600 excess deaths among American Indians and Alaska Natives.
What does it mean for patients?
The editorial which accompanied this study points to an urgent need to reassess mental health and substance misuse services. Often viewed as 'Cinderella' services, budgets for UK mental health trusts fell by 2% between 2013/4 and 2014/5. Mental health problems including drug and alcohol addiction are often chronic, and until the full implementation of the Affordable Care Act in 2014, were routinely excluded from coverage in the USA.
Those with these problems are less likely to be employed, and thus less likely to have insurance through an employer. While individual state-run programs called high-risk pools provide some coverage, their range was limited; in 2011, high-risk pools covered just over 226,000 people across 35 states. Dismantling the Affordable Care Act is likely to have a much greater impact on those with mental health or addiction problems than other members of the US population - and they are the very people who are driving the rising death rates in the USA. This article does not provide solutions - but it paints a very bleak picture for the most vulnerable in US society.
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. EMIS has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.