A comprehensive report published this week in JAMA finds that the US has overall become a safer place to live over the past 25 years. But the report also reveals that in several states and among certain age groups, it’s only become deadlier.
Researchers used data from the Global Burden of Disease Study, an annual research program that tracks how many people are killed and disabled by various ailments across 127 countries. They specifically looked, on a state by state level, at the mortality rate of Americans from 1990 all the way up to 2016.
Between that time period, deaths dropped significantly. In 1990, the overall annual death rate was estimated to be 745.2 deaths per every 100,000 people; by 2016, the rate had dropped to 578 deaths per every 100,000 people. The average life expectancy increased as well, from 71.9 years in 1990 to 76.5 in 2016. Death and injury rates of major chronic disorders, such as cardiovascular disease and lung cancer, declined as well.
Behind the general rosy picture, though, they also found profound differences—and worse outcomes—depending on where people lived. While someone born in Hawaii in 2016 could be expected to live 81.3 years, for instance, someone else born that same year in Mississippi had a life expectancy of 74.7 years. And though people between the ages of 50 to 99 as well as people under the age of 20 were less likely to die in 2016 in every state than they were in 1990, the same wasn’t entirely true for adults between the ages of 20 to 55.
The probability of someone dying between those ages declined in 31 states and Washington DC. But in five states—Kentucky, Oklahoma, New Mexico, West Virginia, and Wyoming—the probability of death had increased by 10 percent or more from 1990 to 2016.
“The US has witnessed some improvements among youth under 20 and seniors over 55, but overall the nation and some of our states are falling behind other, less developed countries,” said co-author Ali Mokdad, an epidemiologist at the University of Washington’s Institute for Health Metrics and Evaluation in a statement.“The strain on America’s health resources is getting worse, and the need for prevention services and greater access to and quality of medical care is increasing.”
As for what’s killing these adults, Mokdad and his team point to factors like the ongoing opioid crisis and mental health disorders. In 1990, they noted, opioid use disorder was the 11th leading cause of accumulated “Disability-Adjusted Life Years,” or DALYs, a measure that’s used to calculate the loss of one healthy year to disability. By 2016, it became the 7th leading cause. States such as West Virginia have tellingly reported some of the highest rates of opioid overdose deaths in recent years.
DALYs attributed to major depression and anxiety disorders also increased by 17.32 percent and 16.7 percent, respectively.
“These findings point to an urgent need to address mental health and drug use disorders in the United States,” the authors wrote. “There is a need for improved access to quality mental health care and screening to improve outcomes, as well as programs to prevent mental disorders and promote mental health.”
These programs, as well as those that address other chronic risk factors like a poor diet or sedentary behavior, should ideally be focused at reaching out to the public though their local doctors, the authors advocate.
“Primary care is our health system’s front line of defense, detection, and treatment,” Mokdad said. “Local, state, and federal dollars need to be targeted more effectively for primary care, especially for those millions of Americans not on Medicare.”