The Centers for Disease Control and Prevention (CDC) released a statement on November 29, 2018 stating that the U.S. life expectancy had declined again for second time in three years. According to CDC Director, Robert R. Redfield, MD:
The latest CDC data show that the U.S. life expectancy has declined over the past few years. Tragically, this troubling trend is largely driven by deaths from drug overdose and suicide.
Life expectancy gives us a snapshot of the Nation’s overall health and these sobering statistics are a wakeup call that we are losing too many Americans, too early and too often, to conditions that are preventable.
CDC is committed to putting science into action to protect U.S. health, but we must all work together to reverse this trend and help ensure that all Americans live longer and healthier lives.
According to the most recent statistics (the full report is available on the CDC website), the average U.S. citizen will live to about the age of 78 years (though the average life expectancy declined from 78.9 years in 2014 to 78.7 years in 2015 through 2016, with a further decrease to 78.6 years from 2016 to 2017, the most recent year for which these statistics are available). The age-adjusted death rate increased overall by 0.4% from 728.8 deaths per 100,000 population to 7321.9 deaths per 100,000 population (see CDC brief), with the age-specific death rate increasing in the 25-34, 35-44, and 85 and over age groups (there was a decline in the age-specific death rate for those 45-54 years of age). Notably, the decrease in life expectancy is occurring at a time when the life expectancy in almost every other country in the world is increasing!
These statistics should be alarming to everyone who calls the United States home. We are, after all, the United States of America, the world's largest economy (a position that the U.S.A. has occupied since 1871) with a Gross Domestic Product (GDP) of approximately $19 trillion in Purchasing Power Parity (PPP). Unfortunately, we rank 45th for average life expectancy out of more than 200 countries for which this statistic is available (of interest, the U.S. territories of Guam, Puerto Rico, and the U.S. Virgin Islands rank higher than the U.S.A. as a whole). If you want to live a long life, move to Hong Kong which ranks first overall with an average life expectancy of 84.5 years.
There is another side to the story that Dr. Redfield calls out in the CDC's press release above. The number of Americans who are losing their lives to opioid-related deaths and suicides continues to increase rapidly. The age-adjusted death rates from drug overdoses increased by 9.6% compared to 2016, while the age-adjusted suicide rate increased by 33%!
We should be embarrassed by these statistics. What is concerning is that these trends really aren't all that new - the opioid crisis has received incredible attention in both the lay press and medical literature for the past few years, while suicide has been the 10th most common cause of death since at least 1980. Consider also that accidental deaths have held a solid place in the top 10 list of causes of death. Moreover, many of the most important risk factors for the top four causes (heart disease, cancer, stroke, and COPD) can be modified with changes in lifestyle (see an important article from Dr. Ralph Keeney at the Fuqua School of Business at Duke University, "Personal Decisions Are the Leading Cause of Death"). For all of the criticisms against the U.S. health care system (some that are completely justified), we could find as much fault with our (lack of) social safety net and an insufficient focus on the social determinants of health.
So what is the take-home message? While two data points does not make a trend, our nation and our industry should be very concerned about these statistics. Here is our rally point, where we begin to look to turn things around before the numbers become a trend. Health care organizations can't do it alone, but we certainly need to do a better job investing in the social determinants of health. As Major Dick Winters (from one of my favorite TV series "Band of Brothers") said, "If you're a leader, you lead the way. Not just on easy ones, you take the tough ones too." Health care organizations need to "lead the way" on this issue. We will need to work with the local, state, and federal government, as well as nonprofit organizations and other advocacy groups to address these issues. It will take work, but the rewards will be worth it.
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