WASHINGTON – After decades of steady increases, life expectancy in the U.S. ticked down slightly over three recent years, a drop attributed to a rise in “cause-specific” deaths like suicides and drug overdoses among those aged 25 to 64.
The same was true in Arizona where, even though life expectancy was still higher than the national average, it was dropping at a similar rate.
The report in the Journal of the American Medical Association said that after rising to 79.1 years in 2014, U.S. life expectancy fell to 78.9 years in 2016, the latest year for which numbers were available. In Arizona, the number fell from 79.6 to 79.3 years.
The drops were a reflection of increased deaths among 25- to 64-year-old Americans, who saw their mortality rate shoot from 328.5 deaths per 100,000 people in 2010 to 348.2 deaths per 100,000 people in 2017, a nearly 6% increase.
In Arizona, the mortality rate for that age group grew 6.2% in the same period.
“This is a uniquely American phenomenon,” said report co-author Steven Woolf, who said no other developed country is seeing such declines.
Woolf, the director emeritus of the Center on Society and Health at Virginia Commonwealth University, said the decline has been decades in the making. He said high unemployment rates, stagnant wages and the rising cost of living have been building since the 1980s and reached a tipping point after the 2008 economic recession.
“The economy is stronger now, but the benefits of the economy are going to corporations and a small subset of affluent Americans,” Woolf said. “This can lead to health complications and deaths of despair.”
The report says “deaths of despair” include suicides, and drug and alcohol-related deaths. Fatal drug overdoses, specifically from opioids, were a major cause of what the report terms “excess deaths.” A third of those deaths occurred in Ohio, Pennsylvania, Kentucky and Indiana – states hit hard by the recession and the opioid epidemic.
The JAMA report said mortality from drug overdoses in 25- to 64-year-olds increased by 386.5% between 1999 and 2017.
Will Humble, executive director of the Arizona Public Health Association, said the rise in deaths of despair should force a shift for public health officials.
“Throughout most of my career we were dealing with kind of the classic public health issues, things like increasing the number of vaccinations to decrease infant mortality, motor vehicle accidents and injuries, interventions like those,” Humble said.
“Now we’re seeing this new, pretty striking trend on suicide and the opioid epidemic,” he said.
That epidemic has also hit Arizona, where more than 31,000 people have overdosed since June 2017, and more than 3,800 people have died of opioid overdoses in the same span.
Humble pointed to the Arizona Opioid Epidemic Act as an example of the state’s forward thinking on the growing crisis. The 2018 law limits first-fill opioid prescriptions to five days and expands access to the overdose-reversal drug Naloxone, among other initiatives.
Arizona State University professor Dr. David Clarke said the epidemic started in the 1990s before taking hold in recent years. He said chronic pain is directly linked to rising mortality rates.
“A lot of those opioid users got started with prescriptions for chronic pain and a lot of those prescriptions were done because of a lack of understanding of the impact of various kinds of stress in causing chronic pain,” Clarke said.
Clarke thinks that medical professionals who prescribe opioids are ignoring a larger problem: Adverse childhood experiences, such as abuse or a parent in prison, that are carried into adulthood. The more of those experiences a person has, Clarke said, the more likely they are to abuse drugs or alcohol, or commit suicide, among other long-term effects.
“There’s strong efforts now to limit the prescribing of opioids because it’s clear now they lead to excessive deaths,” he said. “So trying to stop people from going down that pathway in the first place has been a strong effort from the medical community.”
Humble said he would also like to see syringe services decriminalized to better connect people to addiction services that could help them. The same goes for suicide.
“Suicide is just a lot more challenging, but it’s really about connecting people to services before they make a decision to end their life,” Humble said.
Woolf noted that opioid use and suicide are not the only causes of death that saw increases in the report, though he said they are major issues. He encouraged elected officials to fix the social and economic drivers that contribute to stress and can lead to excessive deaths.
“The middle class is struggling and people are clamoring for better education for their children, more affordable housing,” he said. “We need investment in programs that would make that happen, and they do not tend to be priority for elected officials.”
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