As life expectancy in the United States has dropped for three years – a reduction in the high mortality rates of the largest living population – the focus has been on the plight of white American rural people who die for summoned. death of despair: excessive drinking of drugs, alcohol and suicide.
But a new analysis of more than half a century of federal death data, published on Tuesday JAMA, found that the number of deaths among people living in the middle has been increasing across all racial and ethnic groups, and in neighborhoods and cities. Although self-abuse, excessive alcohol and drugs are the main reasons, other medical conditions, including heart disease, stroke and obstructive lung disease, also helped, the authors reported.
Dr. Steven Woolf of the University of Virginia Commonwealth, said: "The entire nation is in a state of unhealthy conditions." We are losing people at the most productive time in their lives. The children of their parents will be lost. .
That some of the cost of living in the United States was low was well founded. But the level of detail in Tuesday's study was new, as well as the rich geographical analysis. Health experts say the full impact was shocking.
The increase in mortality among middle-class people has shown less declining health measures in the United States than in other wealthy nations, despite the fact that the United States has the highest health costs in the world. editor who followed the study.
"Deaths have risen from year to year in the 20th century," said Dr. Samuel Preston, a demographer at the University of Pennsylvania. The 21st century has to looga forbidden. Since 2010 there has been no significant increase in the number of working-age people.
While the total number of overdose deaths – meaning the number of deaths that would not have happened if the death rate continued to improve – is small, compared with 33,000, the death of young people has a significant impact. major in social life estimates for mortality estimates. people & # 39; debate in the 80s or 90s.
Mortality rates are really improving in children and adults in the United States, Dr. Woolf noted, perhaps, that they may have reliable health care – Medicaid for more children and Medicare for adults.
According to the new study, the number of deaths from 2010 to 2017 for all age groups increased from 328.5 per 100,000 people to 348.2 per 100,000 deaths. It clearly was not just statistics in 2014 that white is not affected, but all racial and ethnic groups, which are the main causes of excessive drug, alcohol and suicide.
Ellen R. Meara, a professor of health policy at Dartmouth College, says. "This is not limited to whites & # 39; middle."
The counties with the largest relative increase in the number of adult and middle-aged deaths were New Hampshire, Maine, Vermont, West Virginia and Ohio.
Dr. Woolf said one of the findings shows that overdose deaths are concentrated geographically, with a full third in only four states: Ohio, Pennsylvania, Kentucky and Indiana. .
"What we have lost is what is going on in these regions," he said. "The date when this health change began is exactly when these economic activities began – the disappearance of manufacturing jobs and the shutting down of steel mills and automobiles."
For demographers such as Kenneth Wachter, an associate professor at the University of California, Berkeley, the results of the study were not surprising because there were several similar reports. But, he says, "it is an expensive paper to bring about those changes."
The study leaves unanswered questions, including, Why is the death rate only increasing in the age group of 25 to 64 years?
"We need to look at the root causes," Dr. Woolf said. "Things have changed in the 1980s, which is when our lifestyles started to slow down compared to the rest of the wealthy."
Increasing mortality from drug overdoses indicates an increase in addiction opioids. But they also got up because of it Changes in medication supplies in the East and Midwest. In the last decade, the combination drug & # 39; fentanyl & # 39; has been mixed with heroin – or some places have been replaced. This has made medicine worse, as users find it difficult to know which dose to take.
This is not the first time that life has been confined to the United States. Dr. Preston says. She has raised it again, and what has been done since its inception.
Sam Harper, an epidemiologist at McGill University in Montreal, issued a warning.
"I'm not sure if the novel is, & # 39; there is something wrong with the whole country & # 39; its story is completely correct," Dr. Harper said. “Special groups, such as Hispanic and Asian, are doing O.K. It is not the way the whole country is reducing social phenomena that can explain all this. There are many moving parts. ”
He added: “The United States has made remarkable achievements in the life of hope over the last several years. It is important to remember that the people who live here are very tall compared to many places in the world. ”
John G. Haaga, director of the cultural and social research department at the National Institute for Aging, who sponsored the study, also saw a bright spot: Life expectancy in coastal areas – both east and west – is improving at an alarming rate. the same level as Canada.
"It is important because it means that this is not deeply rooted in our national or genetic heritage or something," he said. We know we can do better here in America. It proves to be reasonable. ”