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Life Expectancy Study Jolts Assumptions Made About Life In America


A new study in the Journal of the American Medical Association tests the assumptions some people have about life in America. The research finds that working-age Americans are less likely to live to retirement age than at any time in recent history. Dr. Steven Woolf is the report's lead author. He's director emeritus of the Center on Society and Health at Virginia Commonwealth University. Thank you for being here.

STEVEN WOOLF: It's a pleasure. I just wish it was for better reasons.

GREENE: Yeah. I mean, these numbers are pretty alarming. You were looking at life expectancy, mortality across the United States between 1959 and 2017. Tell me what you found.

WOOLF: Well, what we found is that since 2010, all-cause mortality - that means the chances of dying before age 65 - have been increasing in the United States. And for the past three years, life expectancy has been decreasing. It's a quite alarming recent trend. But our study shows that it's been decades in the making, starting back in the 1980s.

GREENE: Is this happening in other wealthy countries, or is this a distinctly U.S. thing?

WOOLF: That's the thing. This does appear to be a distinctly American phenomenon. There is some element of this happening a little bit in the U.K. and Canada but nothing on the scale of the United States. Life expectancy continues to climb in other wealthy nations.

GREENE: So what are the factors here? What do you think is happening?

WOOLF: Well, we did a pretty detailed analysis to peel back the onion and try to understand this. The trend in life expectancy is being caused, as you said, by increased mortality in working-age Americans from age 25 to 64. And the leading contributors to that is the drug addiction problem. Drug overdoses are a major factor in explaining this trend. However, we also found increases in deaths from alcoholism, from suicides and from dozens of organ diseases - all told, 35 causes of death where mortality rates had increased in this age group.

GREENE: So that's the age group, a broad age group. As you start to look into different parts of that age group, I mean, who exactly is this affecting the most?

WOOLF: Well, it's affecting everyone - both young adults and middle-aged adults. But I guess the more alarming piece of this is the large increase in young adults. We saw a 29% increase in mortality among adults 25 to 34. And hence in the data that even younger Americans, late teens, early 20s - those numbers are beginning to creep up.

GREENE: Is there a geographic element to this?

WOOLF: Well there is, exactly. In fact, our analysis intentionally looked at the data for all 50 states to try to locate where in the country this was happening the most. And what we found was that the increase was largest in the industrial Midwest, central Appalachia and northern New England but particularly in the Ohio Valley. That was like ground zero for this phenomenon. We found, for example, that of all the excess deaths that occur in the United States due to this increase in mortality, one-third of them occurred in four states - Ohio, Pennsylvania, Kentucky and Indiana. Those four states accounted for one-third of the excess deaths between 2010 and 2017.

GREENE: Why those four states, do you think?

WOOLF: Well, that's something that researchers like myself continue to need to tease out. But one very attractive explanation is the economy. This is the Rust Belt and the area where - at the time when this decline began, the 1980s and '90s, is when we saw a major transformation in the economy, the loss of manufacturing jobs, coal mines closing, steel mills closing and families and communities exposed to many years of economic stresses. And we think they're taking their toll on folks' health.

GREENE: I mean, I mentioned some of the assumptions that that some make about life in America. And, you know, I mean, I think about the medical advances we've made. Like, when you started looking at these numbers, how surprised were you and your team?

WOOLF: Well, this is not a new subject for us. So we weren't entirely surprised by the trend. We were concerned about the scale of it, the pervasiveness of it and how it's cutting across all racial and ethnic groups, affecting basically all geographic settings - large cities, suburbs and rural America.

GREENE: Can it be reversed?

WOOLF: I think it can. But we need to change our policy priorities in this country and focus more on improving the social and economic conditions for the middle class if we're going to see a reversal to this trend. Otherwise, our children are destined to live younger lives.

GREENE: Dr. Steven Woolf is director emeritus of the Center for Society and Health (ph) at Virginia Commonwealth University, lead author of the report "Life Expectancy And Mortality Rates In The United States, 1959 To 2017." It's in the Journal of the American Medical Association. We appreciate your time.

WOOLF: Pleasure to be with you. Transcript provided by NPR, Copyright NPR.