Intended for healthcare professionals


US life expectancy falls for third year in a row

BMJ 2018; 363 doi: (Published 04 December 2018) Cite this as: BMJ 2018;363:k5118
  1. Owen Dyer
  1. Montreal, Canada

Life expectancy at birth in the United States fell again in 2017 for the third year running, the longest sustained decline since 1915-18, when the first world war and the 1918 Spanish influenza pandemic were among the causes of death.

A continued increase in deaths by overdose in 2017 was the biggest factor driving rates upward, but seven of the top 10 causes of mortality saw a statistically significant increase while only one, cancer, saw a significant decrease.

Life expectancy at birth for women in 2017 was unchanged at 81.1 years, while for men it fell from 76.2 to 76.1 years, and for both sexes from 78.7 to 78.6 years.

The age adjusted death rate for the total population increased 0.4% from 728.8 per 100 000 standard population in 2016 to 731.9 in 2017, reflecting 69 225 more reported deaths in the US in 2017 than in 2016, according to figures released by the Centers for Disease Control and Prevention (CDC).1

The extra deaths were concentrated among those aged between 25 and 44. The remaining life expectancy for an American aged 65 in 2017 actually rose from 19.4 to 19.5 years.

The extra deaths were also concentrated among white Americans of both sexes. The death rate fell in African-American women, though death rates still remain higher among black than white Americans. Death rates remained stable for African-American men and Hispanic Americans of both sexes.

“Life expectancy gives us a snapshot of the nation’s overall health and these sobering statistics are a wake up call that we are losing too many Americans, too early and too often, to conditions that are preventable,” said CDC director Robert Redfield. “Tragically, this trend is largely driven by deaths from drug overdose and suicide.”

An exceptionally bad influenza season also played a role. Deaths from influenza and pneumonia rose by 5.9%, while deaths from unintentional injury—including overdoses—rose by 4.2%, and from suicides by 3.7%.

But statistically significant increases were also seen in deaths from diabetes (up 2.4%), Alzheimer disease (2.3%), stroke (0.8%), and chronic lower respiratory diseases (0.7%). Deaths from cancer fell by 2.3%, continuing a long term downward trend.

The US trails every western European country in life expectancy, despite its much higher health expenditure. In neighbouring Canada, where opioid addiction has also taken a toll, life expectancy at birth has continued to climb and stood at 82.8 years in 2016, according to WHO statistics—more than four years longer than south of the border.

The 2017 data also showed only a nonsignificant improvement in the US infant mortality rate, which stands at 579.3 per 100 000 live births, nearly twice the rate in the European Union.

The latest CDC statistics on drug overdoses, released earlier this month, offer a first glimpse of hope that the US opioid epidemic may finally be peaking. After 20 years of uninterrupted monthly rises, the number of deaths reported from overdose fell in each of the past six reported months, up to May 2018.2

The data do not show whether the fall reflects fewer overdoses or better access to life saving treatments such as naloxone. A study published in The BMJ in August found that US opioid prescribing has hardly declined from its peak, despite years of warnings and increased awareness of the dangers.3


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