New data released by the Centers for Disease Control and Prevention (CDC) this month showed that Americans’ life expectancy fell from 2014 to 2015, from 78.9 years to 78.8 years. Though this may sound like a trivial change, declines in life expectancy are rare in the developed world outside of periods of war or national crisis. For the United States, last year’s was the first such decline since the height of the AIDS epidemic.
Much of the attention given to this phenomenon has understandably focused on rising rates of drug overdoses, particularly opioids. The opioid epidemic led to more than 33,000 deaths last year alone and has devastated families and communities in every corner of the country. Sadly, suicide and alcohol-related deaths also have become more common in recent years—part of a rise in what Princeton economist Anne Case has called “deaths by despair.”
However, drugs, alcohol, and suicide do not, on their own, explain our declining life expectancy. As the new CDC data show, these factors accounted for only about 30 percent of the overall rise in mortality from 2014 to 2015.1 Death rates also rose for eight of the top 10 causes of death—including heart disease, America’s number-one killer.“Deaths by despair” simply aren’t enough to tell the whole story.
This observation holds true when looking at mortality trends for the working-age white population, where the epidemic of overdoses and suicide has largely been concentrated. For this group, after decades of steady decline, all-cause mortality rates essentially flatlined after 1999 (Exhibit 1). (Mortality continued to fall for black Americans and Hispanics.) If whites’ mortality had continued to improve at its previous rate, about 100,000 deaths would have been avoided in 2015 alone.
When we examine this “mortality gap,” we find that the rise in overdoses and suicide plays a significant but minority role (Exhibit 2). Most of the deaths that would have been avoided were the result of other causes: heart disease, cerebrovascular diseases, chronic lung disease, and many other conditions.
So what can we take away?
First, the epidemic of opioid abuse is an ongoing tragedy that requires a sustained response from policymakers, law enforcement, community organizations, professional societies, and individual clinicians.
Second, the rise in overdoses and other “deaths by despair” has coincided with adverse mortality trends for a wide variety of diseases and conditions. The broad nature of these phenomena may indicate a general deterioration in the health of the U.S. public, particularly among working-age whites, rather than a specific clinical cause.
Third, it is possible that these phenomena are rooted in factors such as economic dislocation, cultural fragmentation, and social isolation, but more research is needed to confidently draw these potential connections.
Finally, it remains important to look not just at mortality trends but also at the enormous mortality disparities that plague our society. Black Americans continue to die at much higher rates than whites, though the gap has narrowed in recent years (largely because white rates have stopped improving). And income-based disparities in life expectancy are large and rapidly growing. Targeting improvement efforts at our most vulnerable groups remains the most promising approach to confronting our national mortality crisis.
1 From 2014 to 2015, the age-adjusted mortality rate for the whole U.S. population increased from 724.6 to 733.1 deaths per 100,000. Deaths resulting from suicide and substance abuse increased from 37.1 to 39.6 per 100,000.