For non-Hispanic whites in the US, life expectancy outlook worsens

For the better part of a century, life expectancy in industrialized countries like the United States steadily improved. But during the past three decades, and particularly since 2010, the trend has slowed or, in some places, reversed for non-Hispanic white populations in the U.S. It's been especially stark for 25- to 44-year-olds and for women, as well as in rural communities

Those are the key findings of research published in the journal Population and Development Review.

What the researchers say: “The trends vary by region,” said the lead author. “Large central metropolitan areas have done extremely well, particularly compared to the non-metropolitan areas that have done poorly. To varying degrees, that pattern is evident across the country.”

In the past 10 or so years, the mortality trajectory of non-Hispanic whites in the U.S. has worsened, diverging from progress seen for Hispanic and non-Hispanic black populations. This prompted the researchers to take a closer look at what was happening with this population and why. They also broadened their focus to include adults as young as 25 and as old as 64.

To draw their conclusions, they analyzed age, sex, race/ethnicity, and cause-of-death data compiled by the National Center for Vital Health Statistics, then estimated death rates by age, year, and geographic region. Finally, they distilled the data into four locality categories: large central metropolitan areas, large metro suburbs, small/medium metros, and non-metros.

“The biggest contrast we saw was between large metropolitan areas and their suburbs and non-metropolitan areas, which have moved in different directions,” said the lead author. “Between 1990 and 2016, non-metropolitan areas had rising mortality, which is extremely unusual in the context of life expectancy that has gotten better nearly every year for nearly every group for more than a century.”

Women in general and younger adults also didn't fare well, the former perhaps because of educational disparities, the latter largely due to drug overdoses. Though the opioid epidemic initially seemed gravest in Appalachia and other non-metropolitan areas, it has since proven much more widespread.

It's one plausible cause for the bleak mortality trends for non-Hispanic whites as a whole. The researchers also point to increases in mortality from mental and nervous-system disorders and respiratory disease, likely a lingering result of the smoking epidemic.

“Compared to other countries in 1990, the U.S. started out doing very poorly, and we are now in a much worse situation,” said the researchers. “But there are two pieces of good news: The decline in HIV/AIDS mortality has been important in all central metros, but particularly in the mid-Atlantic, south Atlantic, and some of the Pacific region. And there have been declines in cardiovascular diseases pretty much everywhere.”

Plus, they add, deaths from screenable cancers like prostate, breast, cervical, and colon cancer are down in all areas, too.

The lead author said the work this paper highlights is an important step toward grasping and potentially reversing the negative trend. “There's a lot to be done to try to understand what's driving these patterns and, most importantly, what could be done to change them,” she says. “I don't think anyone has the crystal ball yet for how to do it.”

So, what? The mortality rate in other countries is not yet on the increase overall like that of the U.S., but some of the same trends can be seen. In Australia for example, the alarming rise in suicide in young people between 15 and 24 mirrors the situation in America.

Also, the suicide/addiction/mortality rate mirrors the economic picture in the U.S. Rising income in the urban and university areas where the population is generally better educated and thus able to obtain and retain high-paying jobs leads to better overall health and medical care. This is perpetuated because high-tech employers are attracted to that pool of readily usable educated workforce.