Life expectancy in the US has dropped for the first time in decades

Last year, we learned about a troubling trend in the US population. Death rates were creeping up for middle-age white people, particularly women. The researchers who identified the problem in a blockbuster study attributed the change to economic struggles and accidental poisonings — mainly caused by prescription painkiller and heroin use.

But a new report from the Centers for Disease Control and Prevention has a more disturbing finding: It’s not just middle-age white folks who are dying sooner — it’s everyone.

Between 2014 and 2015, death rates crept up for the entire population, and the causes are more complex than the oft-cited rise in opioid use. Here are our three most important take-aways from the report:

1) Mortality is increasing for the entire population

Life expectancy for Americans was 78.8 years in 2015, a drop of 0.1 year in 2014. In the same period, the mortality rate in America increased by 1.2 percent — from 724.6 deaths per 100,000 in 2014 to 733.1 in 2015.

The change is small, but it represents a trend not seen in decades, said Jiaquan Xu, an epidemiologist with the National Center for Health Statistics at the CDC.

"In 1999, the [age-adjusted death rate] increased, but the last time life expectancy decreased for the total population was in 1993," Xu said. "After that, it sometimes decreased for specific age groups, but not the total population."

Zooming out to the big picture, Americans have clearly been living longer over time. And the chart (above) reveals that life expectancy doesn’t increase in a straight line — there are sometimes plateaus and even dips. But even small increases in mortality — at a relatively peaceful time when we know more about public health and medicine than ever before — are worrisome.

2) Eight of the 10 leading causes of death increased in 2015

What’s less clear is precisely what’s driving this downturn. Xu said researchers like himself need to do more to understand the trend, and get the 2016 mortality data to see if the downturn holds for a second year.

But the report shows that health outcomes in the US worsened on a number of fronts.

In 2015, the rates of eight of the top 10 leading causes of death in America increased — including heart disease, chronic lower respiratory diseases, unintentional injuries, stroke, Alzheimer’s disease, diabetes, kidney disease, and suicide. (The trends for flu and pneumonia didn’t change.) According to Xu, it’s unusual to see a negative trend for so many health measures.

"Mortality is rising across a wide variety of illnesses," wrote Dartmouth health economist Jonathan Skinner in an email, "so it's not just the opioid epidemic. And as a consequence, it's not entirely easy to figure out what to do about it."

The only outlier on the top-10 list was cancer, which has seen its death rate drop by 1.7 percent in the last year. That was no surprise: The cancer death rate has actually been declining since the early 1990s. These changes are mainly attributed gains in early detection and treatment advances, as well as declines in the smoking rate.

What’s troubling here is that many of these causes of death are preventable. We know how to stave off heart disease and diabetes, and yet more people are dying and at younger ages from these causes.

"[This] is about poor health care and health behaviors — smoking, obesity, exercise, exposure to toxins," said University of Maryland health inequality researcher Philip Cohen. "That means this is not about a failure of science to cure disease, but about people not having the wherewithal, or maybe the will, to take care of themselves and their family members." 

In the "unintentional poisonings" category, 97 percent of the deaths were caused by drug and alcohol poisonings, which can also be averted with better detection and treatment. Many of these affected younger folks, Xu said, noting that there was no change in life expectancy at age 65.

The infant mortality also rose — but the CDC said the change wasn't statistically significant. Still, the trend worried researchers. "Infant deaths should not be heading up, or even level, in this country, given our already poor record on maternal and infant health and our vast wealth," Cohen said.

"My read is that this is related to stress, insecurity, and lack of self-efficacy," he added. "That is, people don't know what their future holds, they have no confidence that their lives will move in a positive direction, and they don't feel they are in control of their own destinies. That is what leads to self-destructive behavior."

3) Whites are suffering — but there’s still a big black-white health gap

Much has been made about the fact that there’s been a stark uptick in the mortality rate for middle-aged white people in recent years. But this report makes it clear that it’s not just that group that’s doing worse.

According to the latest data, both black men and white men saw their death rates increase by about the same amount. (White females saw a bigger increase in mortality than black females: The death rate increased by 1.6 percent for white women while it stayed the same for black women.)

This is part of a larger trend. The gap between black and white mortality has narrowed in recent years. But in absolute terms, African Americans have worse health outcomes and a shorter life expectancy than white Americans. (I — Julia — wrote about that from Louisiana this week.)

Broken down by sex, the report shows a decline in life expectancy among men between 2014 and 2015 that was slightly steeper than among women: It dropped for males by 0.2 years (from 76.5 to 76.3), and for females by 0.1 years (from 81.3 to 81.2).

"That life expectancy hasn't risen for any of the groups — black, white, Hispanic, male, female — is concerning," Skinner said.

What will the future hold? Researchers are somber

We don't know what the future holds, but there are signs that health may be heading in the wrong direction in America — and that we're emphasizing the wrong fixes for the problem. 

President-elect Donald Trump has promised to dismantle the safety net and cut back Obamacare. That means millions of people may lose their health insurance in the coming years. 

What's more, we're entering a time where funding and political will is focused on medicine to cure people and not on public health to prevent illness before people get sick. In particular, the Senate passed the 21st Century Cures Act yesterday — the biggest health reform bill since Obamacare. The legislation promises to bring medical cures to patients faster. But nearly half of the funds for the legislation are going to be paid for cutting $3.5 billion from public health efforts like immunizations and obesity and tobacco prevention.

This new CDC report suggests that public health is exactly where our focus should be. 

"[The Cures Act] does many good things — more funding for mental health, better support for the NIH — but in return it makes it easier to get expensive and unproven drugs into the marketplace, a policy that is unlikely to budge overall life expectancy," Skinner said. The focus on "cures" — instead of changing health behaviors — is "missing the importance of addressing the behavioral factors in health that are most likely driving the rise in mortality."

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