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5MinuteConsult JOURNAL CLUB 

What is Driving Life Expectancy DOWN?


JAMA 2021; 325(20): 2045-46

Study Summary

Through the 20th century and until 2010, life expectancy in the US and around the world increased.  It continued to increase in most affluent nations, but in 2010, it began to decline in the US.  This increase in mortality surprisingly occurred for those considered working-aged (25-65 years).

Data from the National Academies of Science, Engineering and Medicine evaluated mortality data of those considered working age between 1990-2017 by cause of death, race and socioeconomic status.  As other high-income countries continued to improve their life expectancy, the US experienced a decline.  The three main causes of this was Cardiometabolic disorders (4.8 million deaths), Drug and Alcohol Use (1.3 million) and Suicide (~570,000).

For Drug and Alcohol Use, the largest increase was for white males, and older black males.  This was tied to an increase access of legal (i.e. OxyContin) and illegal drugs (fentanyl and heroin), and the vulnerability of certain populations.

Suicide’s influence was greatest for white males, and in those in more rural areas.  Rationales suggest economic downturns, wage disparity, weak access to healthcare and foreclosures as having a strong influence while community social supports became less available.  With regards to methods, easier access to firearms was tied to the higher suicide rate, as were higher conditions of disability and substance use.

Most concerning is the incredible influence of Cardiometabolic Disorders.  The population with the largest relative increase was those aged 24-44 years in all racial and ethnic groups, for white men and women, for black men, and for those in rural areas.  This is believed to reflect two trends: a relative improvement in controlling hypertension and preventing and treating ischemic heart disease in the years prior to the study, and advent of the obesity epidemic.

Obesity began its increase in the 1980’s and led those born between the 1970’s-90s seeing obesity and it subsequent diseases as normal.  Health disparities were found to play a great role, and have likely widened, with persistently higher mortality rates for black men.  This is tied to less access of higher paying employment, to healthcare, and their related health inequities.  


Cardiometabolic disorders leads as a cause of worsening life expectancy in the US, which is related to racial and ethnic disparities, limited access to financial security, and healthcare.

More from 5MinuteConsult:

Hypertension, Essential; Obesity

Contributed by Frank J. Domino, MD, June 23, 2021