scholarly journals US life expectancy stalls due to cardiovascular disease, not drug deaths

2020 ◽  
Vol 117 (13) ◽  
pp. 6998-7000 ◽  
Author(s):  
Neil K. Mehta ◽  
Leah R. Abrams ◽  
Mikko Myrskylä
Keyword(s):  
Cardiovascular Disease ◽  
Life Expectancy ◽  
Drug Overdose ◽  
Causes Of Death ◽  
High Income ◽  
Death Rates ◽  
Drug Deaths ◽  
The Us ◽  
Main Culprit ◽  
Cvd Mortality

After decades of robust growth, the rise in US life expectancy stalled after 2010. Explanations for the stall have focused on rising drug-related deaths. Here we show that a stagnating decline in cardiovascular disease (CVD) mortality was the main culprit, outpacing and overshadowing the effects of all other causes of death. The CVD stagnation held back the increase of US life expectancy at age 25 y by 1.14 y in women and men, between 2010 and 2017. Rising drug-related deaths had a much smaller effect: 0.1 y in women and 0.4 y in men. Comparisons with other high-income countries reveal that the US CVD stagnation is unusually strong, contributing to a stark mortality divergence between the US and peer nations. Without the aid of CVD mortality declines, future US life expectancy gains must come from other causes—a monumental task given the enormity of earlier declines in CVD death rates. Reversal of the drug overdose epidemic will be beneficial, but insufficient for achieving pre-2010 pace of life expectancy growth.

scholarly journals Is the long-term decline in cardiovascular-disease mortality in high-income countries over? Evidence from national vital statistics

2019 ◽  
Vol 48 (6) ◽  
pp. 1815-1823 ◽  
Author(s):  
Alan D Lopez ◽  
Tim Adair
Keyword(s):  
Cardiovascular Disease ◽  
Mortality Rate ◽  
Vital Statistics ◽  
High Income ◽  
World Health ◽  
Death Rates ◽  
Males And Females ◽  
Rate Of Decline ◽  
Cvd Mortality

Abstract Background The substantial decline in cardiovascular-disease (CVD) mortality in high-income countries has underpinned their increasing longevity over the past half-century. However, recent evidence suggests this long-term decline may have stagnated, and even reversed in younger populations. We assess recent CVD-mortality trends in high-income populations and discuss the findings in relation to trends in risk factors. Methods We used vital statistics since 2000 for 23 high-income countries published in the World Health Organization Mortality Database. Age-standardized CVD death rates by sex for all ages, and at ages 35–74 years, were calculated and smoothed using LOWESS regression. Findings were contrasted with the Global Burden of Disease (GBD) Study. Results The rate of decline in CVD mortality has slowed considerably in most countries in recent years for both males and females, particularly at ages 35–74 years. Based on the latest year of data, the decline in the CVD-mortality rate at ages 35–74 years was <2% (about half the annual average since 2000) for at least one sex in more than half the countries. In North America (US males and females, Canada females), the CVD-mortality rate even increased in the most recent year. The GBD Study estimates, after correcting for misdiagnoses, suggest an even more alarming reversal, with CVD death rates rising in seven countries for at least one sex in 2017. The rate of decline and initial level of CVD mortality appear largely unrelated. Conclusions A significant slowdown in CVD-mortality decline is now apparent across high-income countries with diverse epidemiological environments. High and increasing obesity levels, limited potential future gains from further reducing already low smoking prevalence, especially in English-speaking countries, and persistent inequalities in mortality risk pose significant challenges for public policy to promote better cardiovascular health.

scholarly journals The contribution of drug-related deaths to the US disadvantage in mortality

2018 ◽  
Vol 48 (3) ◽  
pp. 945-953 ◽  
Author(s):  
Magali Barbieri
Keyword(s):  
Life Expectancy ◽  
High Income ◽  
World Health ◽  
Drug Deaths ◽  
Wide Range ◽  
The Us ◽  
Working Age ◽  
The Usa ◽  
The Difference ◽  
Health Organization

Abstract Background The USA ranks last in life expectancy among high-income countries. Since 2000, excess US mortality has been particularly concentrated in the working ages, which are also the ages hardest hit by the increase in drug deaths. This study measures the effect of drug-related mortality on the gap in life expectancy between the USA and other countries. Methods Data from the Human Mortality Database and the World Health Organization were combined to construct age-standardized mortality rates for 2000–14 in 12 high-income countries and the USA for seven broad causes of death, including drug use. The contribution of each cause to the difference in life expectancy between the USA and the other 12 countries was estimated. Results In 2014, the increase in drug-related deaths accounted for 10–15% of the US disadvantage in mortality, but with marked differences by age group. For working-age men, the increase in drug-related deaths accounted for up to 38% of the difference. Overall, American mortality is higher than the comparison countries across a wide range of causes. Conclusions The severity of the drug epidemic appears to be specific to the USA, but it only partly contributes to the American shortfall in mortality.

scholarly journals No change in life expectancy: the devil is in the detail

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
M Karanikolos ◽  
S Rajan ◽  
A Murphy ◽  
M McKee
Keyword(s):  
Life Expectancy ◽  
Causes Of Death ◽  
Age Groups ◽  
The United States ◽  
High Income ◽  
The Past ◽  
Economic Climate ◽  
Younger Age ◽  
The Us ◽  
External Causes

Abstract Background The rate of improvement in life expectancy in high income countries has slowed down over the past few years, and instances where life expectancy is lower than a year before are increasingly common. This paper aims to analyse changes in life expectancy over the last decade to better understand what causes and age groups contribute to the slowdown. Methods We use WHO mortality data by age and cause to construct life tables, and we use Arriaga decomposition method to analyse the contribution of specific causes and age groups to changes in life expectancy in Australia, Canada, France, Germany, Netherlands, United Kingdom and the United States of America. We look at the change between 2007-2012 and 2012-2017 (or latest available). Results All countries experienced a slowdown in life expectancy in the past 5 years (2012-2017), in comparison to the preceding period. Slowdown in under 65s was particularly pronounced, with younger age groups only contributing minimally (between 0.4 years for males in Germany and -0.4 years for males in the United States) to changes in life expectancy. Among people aged 65 and over, gains ranged between 0.05 years for females in France and 0.6 years for males in the Netherlands. Certain causes of death contributed negatively to change in life expectancy between 2012 and 2017, with notable increases in deaths from accidental poisonings in males (up to -0.09 year in the UK and Canada, and -0.34 in the US) and suicides (up to -0.08 year in Australia and -0.07 in the US). Conclusions While recent slowdown in life expectancy gains in high income countries is often attributed to lack of improvement in people of older ages, we show that, beyond this, there are increases in mortality in younger age groups from external causes, that contribute negatively to change in life expectancy in some countries. This pattern is of a particular concern, as deterioration in preventable mortality points to broader worsening of socio-economic climate. Key messages Improvements in life expectancy in high income countries slowed down markedly over the past few years, but contributing mortality patterns differ for age groups and causes of death across countries. Persistent increases in preventable mortality from certain external causes in younger age groups in Australia, Canada, US and UK point to broader deterioration of socio-economic climate.

scholarly journals Life expectancy and mortality in 363 cities of Latin America

2021 ◽  
Author(s):  
Usama Bilal ◽  
◽  
Philipp Hessel ◽  
Carolina Perez-Ferrer ◽  
Yvonne L. Michael ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Latin America ◽  
Life Expectancy ◽  
Latin American ◽  
Causes Of Death ◽  
Urban Environments ◽  
Noncommunicable Diseases ◽  
Modifiable Factors ◽  
Specific Mortality ◽  
Latin American Countries

AbstractThe concept of a so-called urban advantage in health ignores the possibility of heterogeneity in health outcomes across cities. Using a harmonized dataset from the SALURBAL project, we describe variability and predictors of life expectancy and proportionate mortality in 363 cities across nine Latin American countries. Life expectancy differed substantially across cities within the same country. Cause-specific mortality also varied across cities, with some causes of death (unintentional and violent injuries and deaths) showing large variation within countries, whereas other causes of death (communicable, maternal, neonatal and nutritional, cancer, cardiovascular disease and other noncommunicable diseases) varied substantially between countries. In multivariable mixed models, higher levels of education, water access and sanitation and less overcrowding were associated with longer life expectancy, a relatively lower proportion of communicable, maternal, neonatal and nutritional deaths and a higher proportion of deaths from cancer, cardiovascular disease and other noncommunicable diseases. These results highlight considerable heterogeneity in life expectancy and causes of death across cities of Latin America, revealing modifiable factors that could be amenable to urban policies aimed toward improving urban health in Latin America and more generally in other urban environments.

scholarly journals Contribution of avoidable causes of death to premature mortality in Poland and selected European countries

2020 ◽  
Author(s):  
Bogdan Wojtyniak ◽  
Jakub Stokwiszewski
Keyword(s):  
Life Expectancy ◽  
Central Europe ◽  
Causes Of Death ◽  
Average Rate ◽  
Premature Mortality ◽  
European Countries ◽  
Annual Percent Change ◽  
Death Rates ◽  
Central European ◽  
The Difference

Our study, availing the new, agreed by the OECD and Eurostat, lists of preventable and treatable causes of death, seeks to quantify the contribution of avoidable causes to premature mortality and its dynamics in Poland and Central European countries – Czechia, Hungary, Lithuania and Slovenia, in comparison with Sweden serving as a benchmark country in 1999–2017. We calculated age standardised death rates for the broad groups of avoidable causes and more specific ones, which comprised preventable and treatable cancer and diseases of the circulatory system (DCS), preventable injuries and alcohol-related diseases. Deaths from not avoidable causes were also analysed. The analysis of time trends in the death rates and calculation of the Average Annual Percent Change (AAPC) for the overall trend were performed with joint-point models. The contribution of changes in mortality from avoidable causes to increase life expectancy during 1999–2017 and contribution of the difference in mortality from these causes to the difference in life expectancy between five countries and Sweden were based on the decomposition of temporary life expectancy between birth and age 75 [e(0-75)]. For the calculation of life expectancy, we used the classic Chiang method and the decomposition of life expectancy by the death causes and age was conducted with the Arriaga method. The AAPC of death rates from avoidable causes in 1999–2017 was similar in all the countries but Lithuania, where the decline started later. The decline in the death rates from not avoidable causes is much slower than the rates from avoidable causes. Mortality from treatable causes was decreasing faster than from preventable causes in most populations. In 1999–2017, the average rate of mortality decline for preventable cancer was greater among men than among women, while for treatable cancer the sex-related differences were much smaller and in favour of women. As for preventable and treatable death from DCS, their decrease was faster among women than men in all the countries but Sweden. Improvements in mortality from causes that could be avoided through prevention or treatment made substantial positive contributions to the overall change in life expectancy in all the countries. The differences in temporary life expectancy e(0-75) between the analysed Central European countries and Sweden were much smaller in 2017 than in 1999, due to the reduction of the gap in mortality from avoidable causes. Our results show that among men, and to a lesser extent among women, mortality from preventable causes contributes more than mortality from causes that can be effectively treated to shorter life expectancy in the countries of Central Europe than in Sweden. This indicates that in reducing the health gap between the inhabitants of Central Europe and Western Europe, the healthcare system should consider disease prevention even to a greater extent than just treating them.

Abstract P060: Reduction of Cardiovascular Mortality in the United States Population, 1988-2004: A Larger Contribution of Declining Exposures to Cadmium and Lead Compared to Traditional Cardiovascular Risk Factors

Circulation ◽  
2016 ◽  
Vol 133 (suppl_1) ◽  
Author(s):  
Adrian Ruiz-Hernandez ◽  
Ana Navas-Acien ◽  
Roberto Pastor-Barriuso ◽  
Josep Redon ◽  
Eliseo Guallar ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Cardiovascular Mortality ◽  
Blood Lead ◽  
Mortality Rates ◽  
Lead And Cadmium ◽  
The Us ◽  
Urine Cadmium ◽  
Cadmium And Lead ◽  
Cvd Mortality

Introduction: Lead and cadmium exposures have markedly declined in the US following the banning of lead in gasoline and the implementation of tobacco control, air pollution reduction, and hazardous waste remediation policies since the mid 1970s. While lead and cadmium have been proposed as cardiovascular disease risk factors, little is known about their potential contribution to the decline in cardiovascular mortality in US adults. Hypothesis: We assessed the hypothesis that lead and cadmium exposure reductions partly explain the decreasing trend in cardiovascular mortality that occurred in the US from 1988-1994 to 1999-2004, after controlling for traditional cardiovascular risk factors including smoking, obesity, physical inactivity, hypertension, diabetes, chronic kidney disease, and dyslipidemia. Methods: Cohort study of 15,421 men and women ≥40 years old participating in the National Health and Nutrition Examination Survey (NHANES) 1988-1994 and 1999-2004. We implemented a mediation approach with additive hazard models to estimate the reductions in cardiovascular disease (CVD) mortality rates over time explained through changes in urine cadmium and blood lead concentrations. Results: After adjusting for age, sex, race and smoking, urine cadmium and blood lead concentrations decreased by 20.4 and 38.2%, respectively, between 1988-1934 and 1999-2004. Age-adjusted CVD mortality rates in the US decreased from 712.0 to 356.8 /100.000 person-years comparing 1988-1994 to 1999-2004. Changes in traditional CVD risk factors explained 16% of this decline. The observed reductions in urine cadmium and blood lead levels explained an additional 27.6% of this decline. Conclusions: The net impact of declining cadmium and lead exposures on mortality changes in the US was larger compared to traditional risk factors. These findings support that reducing cadmium and lead exposures resulted in a major public health achievement. The general population, however, remains exposed to cadmium and lead at concentrations that have been associated to CVD in the US population. Preventive strategies to enable additional reductions in exposure to cadmium and lead are needed.

scholarly journals Effect of the covid-19 pandemic in 2020 on life expectancy across populations in the USA and other high income countries: simulations of provisional mortality data

BMJ ◽  
2021 ◽  
pp. n1343 ◽  
Author(s):  
Steven H Woolf ◽  
Ryan K Masters ◽  
Laudan Y Aron
Keyword(s):  
Life Expectancy ◽  
Ethnic Minority ◽  
Race And Ethnicity ◽  
Minority Groups ◽  
High Income ◽  
Mortality Data ◽  
Ethnic Minority Groups ◽  
The Us ◽  
Black Populations ◽  
Racial And Ethnic Minority

Abstract Objective To estimate changes in life expectancy in 2010-18 and during the covid-19 pandemic in 2020 across population groups in the United States and to compare outcomes with peer nations. Design Simulations of provisional mortality data. Setting US and 16 other high income countries in 2010-18 and 2020, by sex, including an analysis of US outcomes by race and ethnicity. Population Data for the US and for 16 other high income countries from the National Center for Health Statistics and the Human Mortality Database, respectively. Main outcome measures Life expectancy at birth, and at ages 25 and 65, by sex, and, in the US only, by race and ethnicity. Analysis excluded 2019 because life table data were not available for many peer countries. Life expectancy in 2020 was estimated by simulating life tables from estimated age specific mortality rates in 2020 and allowing for 10% random error. Estimates for 2020 are reported as medians with fifth and 95th centiles. Results Between 2010 and 2018, the gap in life expectancy between the US and the peer country average increased from 1.88 years (78.66 v 80.54 years, respectively) to 3.05 years (78.74 v 81.78 years). Between 2018 and 2020, life expectancy in the US decreased by 1.87 years (to 76.87 years), 8.5 times the average decrease in peer countries (0.22 years), widening the gap to 4.69 years. Life expectancy in the US decreased disproportionately among racial and ethnic minority groups between 2018 and 2020, declining by 3.88, 3.25, and 1.36 years in Hispanic, non-Hispanic Black, and non-Hispanic White populations, respectively. In Hispanic and non-Hispanic Black populations, reductions in life expectancy were 18 and 15 times the average in peer countries, respectively. Progress since 2010 in reducing the gap in life expectancy in the US between Black and White people was erased in 2018-20; life expectancy in Black men reached its lowest level since 1998 (67.73 years), and the longstanding Hispanic life expectancy advantage almost disappeared. Conclusions The US had a much larger decrease in life expectancy between 2018 and 2020 than other high income nations, with pronounced losses among the Hispanic and non-Hispanic Black populations. A longstanding and widening US health disadvantage, high death rates in 2020, and continued inequitable effects on racial and ethnic minority groups are likely the products of longstanding policy choices and systemic racism.

Abstract P370: Cardiovascular Health Metrics, Lifetime Risks of Cardiovascular Disease and Chronic Disease Mortality, and Life Expectancy in Men and Women

Circulation ◽  
2015 ◽  
Vol 131 (suppl_1) ◽  
Author(s):  
Chong Lee
Keyword(s):  
Cardiovascular Disease ◽  
Chronic Disease ◽  
Life Expectancy ◽  
Lower Risk ◽  
Cardiovascular Health ◽  
Heart Association ◽  
Men And Women ◽  
Ideal Cardiovascular Health ◽  
Disease Mortality ◽  
Cvd Mortality

Whether cardiovascular health metrics relates to lifetime risks of cardiovascular disease (CVD) and chronic disease mortality and life expectancy in U.S. population remains less explored. PURPOSE: We investigated the combined impact of 7 ideal cardiovascular health metrics on lifetime risks of CVD and chronic disease mortality and life expectancy in US men and women at 30 years of age. METHODS: Lifetime risks of CVD and chronic disease mortality to 80 years of age were estimated for men and women, with death free of chronic diseases as a competing event. We followed 11,341 men and women, aged 30 to 80 years, who participated in the Third National Health and Nutrition Examination Survey. All participants completed baseline lifestyle factors and lifestyle behavior questionnaires. The 7 ideal cardiovascular health metrics was defined as physically active, never smoking, a healthy diet, waist girth (<102/88 cm), untreated blood pressure (<120/80 mmHg), untreated total cholesterol (<200 mg/dL), and untreated fasting glucose (<100 mg/dL) defined by the American Heart Association Strategic Committee. They were further categorized as having 0, 1, 2, 3, 4, 5, 6 or 7 combined cardiovascular health metrics. RESULTS: During an average of 13.7 years of follow-up (155,726 person-years), there were a total of 1834 chronic disease deaths (945 CVD, 579 cancer, 217 respiratory disease, 93 diabetes mellitus). The lifetime risks of chronic disease mortality (at 30 years of age) across 0, 1, 2, 3, 4, 5, and 6 or 7 ideal health metrics were (95% CI) 46.2% (41.6, 50.7), 40.3% (36.9, 43.8), 33.1% (30, 36.1), 27.2% (23.9, 30.5), 25.8% (21, 30.5), 24.8% (16.8, 32.9), and 12.7% (1.2, 24.1), respectively. Men and women who had adopted increasing number ideal health metrics had a substantially lower lifetime risk of chronic disease mortality. The lifetime risks of CVD mortality across 7 ideal health metrics showed trends similar to chronic disease mortality. After adjustment for multiple risk factors, men and women with all 6 or 7 combined ideal health metrics had a 75% (95% CI: 51% to 88%) lower risk of chronic disease mortality and 93% (95% CI: 53% to 99%) lower risk of CVD mortality, respectively, when compared with men and women with zero ideal health metrics. Men and women with 0 compared with 6 or 7 combined ideal health metrics had a shorter life expectancy by 16 years (95% CI: 13 to 19.1 years). Approximately 63% (95% CI: 26% to 82%) of chronic disease deaths might have been avoided if men and women had maintained all 6 or 7 combined health factors and healthy lifestyle behaviors. CONCLUSION: Maintaining an ideal cardiovascular health metrics is associated with lower lifetime risks of CVD and chronic disease mortality in men and women.

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