Life expectancy increased for the first time in four years in 2018, the federal government said Thursday, raising hopes that a key measure of the nation’s health may finally be stabilising after a rare and troubling decline that was driven by a surge in drug overdoses.
Life expectancy is the most basic measure of the health of a society, and declines in developed countries are extremely unusual. But the United States experienced one from 2015 to 2017 as the opioid epidemic took its toll, worrying demographers who had not seen an outright decline since 1993, during the AIDS epidemic. An uptick in what have become known as “deaths of despair” — younger people dying from overdoses, suicide and alcoholism — has drawn considerable attention from politicians and policymakers.
The 2018 data, released in a report on Thursday, confirmed the first decline in drug deaths in 28 years, an important improvement after decades of rises.
The increase in life expectancy it helped produce was small — just over a month — and demographers cautioned that it was too early to tell if the country had turned the corner with opioid overdoses, which have claimed nearly 500,000 lives since the late 1990s.
“It’s good news, but we don’t know yet if it’s the beginning of a new trend,” said Elizabeth Arias, a demographer at the National Center for Health Statistics, which released the report.
Still, the rise was welcome news in states like Ohio, which in 2018 had the biggest decline in overdose deaths in the country.
“It’s literally like coming out of a fog,” said Andrew Wright, 34, who has been drug-free since August 2018, when he entered treatment at the Counseling Center in Portsmouth, Ohio. Medicaid, the government insurance program, covered his care. “It’s like I’m 22 and I’ve finally made it out of my parents’ house, embracing life for the first time. I’m learning how to live.”
The last time life expectancy in the United States flatlined for several years was in the 1960s, when the mass habit of smoking, particularly among men, began showing up in the mortality statistics, said Dr. Samuel Preston, a demographer at the University of Pennsylvania. But from 1968 to 2010, life expectancy went up by an average of about two years a decade, he said, a substantially slower rate than in European countries, but twice as fast as the increase in 2018.
Life expectancy at birth rose to 78.7 years in 2018 from 78.6 the previous year. It peaked at 78.9 in 2014, but has fallen or been flat since then.
Preston pointed out that the small rise in 2018 merely put the country back where it was in 2010, amounting to nearly a decade of stagnation, rare for a wealthy country.
Improvements in cancer mortality rates represented the single largest share of the life expectancy gain in 2018, about 30%. Next came the decline in so-called unintentional injuries, which include deaths from car accidents and drug overdoses. That category accounted for about 25% of the gain, a change that was driven almost entirely by a decline in drug deaths, Arias said.
Recent widespread efforts to expand access to opioid addiction medications, clean needles and naloxone — the drug used to revive people overdosing on opioids — may be having an effect.
“Good things are happening that hadn’t before, like sheriffs, hospitals and others who now use naloxone telling me, ‘We saved a life,’” said Shane Hudson, president and chief executive of CKF Addiction Treatment in Salina, Kansas. His clinic is treating 117 people with medication for opioid addiction, up from 35 two years ago.
Deaths from overdoses dropped by 4.1% in 2018, to 67,367 from 70,237 in 2017. The decrease was largely driven by a dip in deaths from prescription opioid painkillers, which set off the opioid epidemic in the late 1990s before heroin and, later, fentanyl moved in. Provisional data suggests those deaths continued to fall in 2019, likely in part because of restrictions on prescribing.
But the death rate from fentanyl rose by 10% in 2018, and early data suggests it kept rising last year, though not as sharply as before. There were more overdose deaths in 2018 than in any year on record except 2017, and nearly 70% involved opioids.
A separate federal report, also released Thursday, found that the rate of drug overdose deaths dropped in 14 states in 2018, climbed in five and stayed about the same in the rest. The five states whose rates climbed were California, Delaware, Missouri, New Jersey and South Carolina. Ohio saw the biggest drop, to 3,980 overdose deaths in 2018 from 5,111 in 2017.
With the fentanyl death rate still climbing, along with deaths involving cocaine and psychostimulants like methamphetamine, it is not clear whether the overall drop will be sustained.
Wright, of Delaware, Ohio, developed an opioid addiction when he was 23, starting with prescription pills and moving to heroin. He said he spent years, on and off, sleeping in his car, under bridges and on his parents’ screened porch in the winter under a table so his father wouldn’t see him.
But he has now stayed off drugs for the longest period in his adult life, he said, a fact he attributes to his treatment program together with a change in the attitudes of the people in his town. A small grooming products company, Doc Spartan, hired him to make beard oil and grenade-shaped soap. Someone sold him a cheap car. Others helped him start sorting out his life — getting driver’s license, dealing with his unpaid bills and getting treatment for hepatitis C.
“I literally feel like I’m a soldier in this war, and I really like it,” said Wright, who now works as a trainer at PSKC, a CrossFit gym, and at a halfway house.
Another bright spot in Thursday’s data was cancer mortality. The overall cancer death rate dropped by 2.2% in 2018, a substantial decline.
Rebecca Siegel, the scientific director of surveillance research at the American Cancer Society in Atlanta, said the new data appeared to extend gains from 2017, when the overall cancer mortality rate drop was the largest since record-keeping began around 1930.
These improvements were driven largely by a decline in the mortality rate for lung cancer, the leading cause of cancer death. Continued drops in the country’s smoking rate and advances in treatment, such as more precise tumor classification, better surgical techniques, and improved drug therapies, contributed to the progress, Siegel said.
Despite this good news, the United States lags far behind most European countries in life expectancy. John Haaga, a demographer who retired from the National Institute on Aging in December, said that when he first started his job in 2004, life expectancy in the United States was about equal to that of Portugal, a much poorer country. Over his career, Portugal gained four years while the United States gained only one. He pointed out that life expectancy was longer in Costa Rica, Cuba and Slovenia.
The increase in life expectancy might have been greater if not for rising mortality due to influenza and pneumonia — the death rate grew by 4.2% — as well as suicide and nutritional deficiencies. But while there has been increased concern about suicide as a public health crisis, the growth in reported cases — to 48,344 in 2018 from 47,173 in 2017 — was relatively small. The suicide rate grew by 1.4% overall, with a larger rise for men than women.
Jill Harkavy-Friedman, a vice president at the American Foundation for Suicide Prevention, said the nation needed to invest far more in research to understand emerging patterns.
“I’ve been a researcher in this area for 30 years and I can tell you the conversation and the funding has definitely changed,” she said, “but it’s still nowhere near the level of funding for any other public health problem of this scope.”
A federal report last fall found that the suicide rate among adolescents was at its highest level in 20 years, although the total number of teenagers who died by suicide in 2017 was fewer than 2,500. Jane Pearson, chairwoman of the Suicide Research Consortium at the National Institute of Mental Health, said there was no definitive explanation as of yet for the climbing suicide rate.
“We are worried about adolescents in particular showing increases in depression and anxiety, and trying to understand what’s driving all of this,” she said. “We can’t measure a lot of things that we would like to.”
Sabrina Tavernise and Abby Goodnough c.2020 The New York Times Company