- Life expectancy in the United States has fallen since 2014 after six decades of increasing. The driving force is in middle-aged deaths from drug overdoses, suicides and organ system diseases, according to a wide-reaching report published Tuesday in JAMA.
- The findings shows disparities in mortality trends across races and geographic locations. The largest increase in midlife mortality rates from 1959 to 2016 was in New England and the Ohio Valley.
- The Virginia Commonwealth University School of Medicine researchers noted the slowdown and eventual decline in life expectancy comes despite the U.S. spending far more than other high-income countries that show better health outcomes. "Deficiencies in the health care system could potentially explain increased mortality from some conditions," they wrote.
The factors affecting mortality rates are numerous and complex — and they go far beyond the healthcare industry itself. Still, issues like poor access to healthcare providers, increasingly unaffordable out-of-pocket costs and lack of parity in behavioral health treatment certainly play a role.
Physician prescribing practices are also key: misuse of drugs like opioids has been a major force behind early deaths in the U.S. Health systems and payers have recently put more of a focus on monitoring prescription patterns, promoting alternative pain management therapies and increasing access to addiction treatment.
In an editorial accompanying the report, public health experts say the research should prompt a "call to action," as the downward trend threatens to "become a troubling new norm."
They point to the movement toward value-based payment reform as potential relief. "Alternative payment models, such as accountable care organizations and accountable health communities, can facilitate" integration of social needs and healthcare, they wrote.
That desire has been fueling the push among payers and providers to focus more of their efforts on social determinants of health like access to transportation, stable housing and safe neighborhoods. CMS has recently allowed for more flexible benefit options addressing such needs in the Medicare Advantage program, and insurers have gone forward with initiatives that cover pest control services or provide air conditioners.
Despite that push, many providers still don't ask patients about social factors. A separate JAMA study from September found that only a quarter of hospitals and 16% of physician practices screened patients for social determinants of health.
The new report outlines that mortality rates in the U.S. grew fastest in the 1970s before slowing somewhat in the 1980s and stalling in early 2010s. The recent decline has been most prevalent among middle-aged adults and is fueled by so-called "deaths of despair." Between 1999 and 2017, mid-life mortality from drug overdoses rose more than 385%. Liver disease deaths and suicides also increased for that age group over the time period.