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

Abstract

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.

Keywords: cardiovascular disease; drug-related mortality; life expectancy; mortality; opioid epidemic.

Fig. 1.

Age-standardized death rates (per 100,000 person-years) from drug-related causes and CVD. Gray shaded lines are trends for individual US states and Washington, DC. US data are from the CDC Wonder Database. Longevity leaders is the average of countries that had the highest life expectancy at birth in year 2010 (Japan, Switzerland, Singapore, Australia, Spain, Iceland, Italy, Israel, Sweden, and France). Non-US data are from WHO Cause of Death Database. Sexes are combined. CVD deaths include deaths from heart attacks and strokes (ICD 10: I00 to I78). Drug-related causes include ICD 10: X40 to X44, X60 to X64, X85, and Y10 to Y14.

Fig. 2.

Actual and simulated life expectancy at age 25 y during 2010–2017 in men and women. Drug-related counterfactual is estimated by holding age-specific drug-related mortality fixed at its 2010 level through 2017. CVD counterfactual is estimated by extrapolating average age-specific changes in CVD mortality from 2000 to 2009 forward to 2017. Data are from the CDC Wonder database.