Life Expectancy and Mortality Rates in the United States, 1959-2017

Abstract

Importance: US life expectancy has not kept pace with that of other wealthy countries and is now decreasing.

Objective: To examine vital statistics and review the history of changes in US life expectancy and increasing mortality rates; and to identify potential contributing factors, drawing insights from current literature and an analysis of state-level trends.

Evidence: Life expectancy data for 1959-2016 and cause-specific mortality rates for 1999-2017 were obtained from the US Mortality Database and CDC WONDER, respectively. The analysis focused on midlife deaths (ages 25-64 years), stratified by sex, race/ethnicity, socioeconomic status, and geography (including the 50 states). Published research from January 1990 through August 2019 that examined relevant mortality trends and potential contributory factors was examined.

Findings: Between 1959 and 2016, US life expectancy increased from 69.9 years to 78.9 years but declined for 3 consecutive years after 2014. The recent decrease in US life expectancy culminated a period of increasing cause-specific mortality among adults aged 25 to 64 years that began in the 1990s, ultimately producing an increase in all-cause mortality that began in 2010. During 2010-2017, midlife all-cause mortality rates increased from 328.5 deaths/100 000 to 348.2 deaths/100 000. By 2014, midlife mortality was increasing across all racial groups, caused by drug overdoses, alcohol abuse, suicides, and a diverse list of organ system diseases. The largest relative increases in midlife mortality rates occurred in New England (New Hampshire, 23.3%; Maine, 20.7%; Vermont, 19.9%) and the Ohio Valley (West Virginia, 23.0%; Ohio, 21.6%; Indiana, 14.8%; Kentucky, 14.7%). The increase in midlife mortality during 2010-2017 was associated with an estimated 33 307 excess US deaths, 32.8% of which occurred in 4 Ohio Valley states.

Conclusions and relevance: US life expectancy increased for most of the past 60 years, but the rate of increase slowed over time and life expectancy decreased after 2014. A major contributor has been an increase in mortality from specific causes (eg, drug overdoses, suicides, organ system diseases) among young and middle-aged adults of all racial groups, with an onset as early as the 1990s and with the largest relative increases occurring in the Ohio Valley and New England. The implications for public health and the economy are substantial, making it vital to understand the underlying causes.

Figure 1.. US life expectancy, 1959–2016.

Black line depicts U.S. life expectancy; boldened data points () denote joinpoint years, when the linear trend (slope) changed significantly based on joinpoint analysis. APC = average annual percent change for the five time periods identified on joinpoint analysis (1959–1969, 1969–1979, 1979–2003, 2003–2011, and 2011–2016). Grey lines depict life expectancy for the 50 states. Life expectancy data obtained from the US Mortality Database.

Figure 2.. Age-specific, all-cause mortality rates among US youth, ages 1–24 years, 1999–2017.

Source: CDC WONDER.

Figure 3.. Age-adjusted, all-cause mortality rates, US adults ages 25–64 years, 25–44 years, and 45–64 years, 1999–2017.

The lowest mortality rates per 100,000 (and corresponding years) are listed in parentheses; 2017 mortality rates are listed in brackets. Source: CDC WONDER.

Figure 4.. Age-specific mortality rates for selected causes, by age decile, 1999–2017.

* Other transport accidents include land, water, air, space, and other transport accidents (V80-V99). ** Other heart disease (I30-I51) includes arrhythmias and heart failure. Other causes of death (and corresponding ICD-10 codes) include diabetes mellitus (E10-E14), mental and behavioral disorders due to psychoactive substance use (F10-F19), hypertensive diseases (I10-I15), accidental drug poisoning (X40-X44), intentional self-harm (suicide) (X60-X84), and assault (homicide) (X85-Y09). Source: CDC WONDER.

Figure 5.. Age-adjusted mortality rates, US adults ages 25–64 years, by race-ethnicity, 1999–2017.

Boldened data points () denote joinpoint years, when the linear trend (slope) changed significantly based on joinpoint analysis. AIAN = American Indians and Alaskan Natives, API = Asians and Pacific Islanders (API), NH = non-Hispanic. The lowest mortality rates per 100,000 (and corresponding years) are listed in parentheses; 2017 mortality rates are listed in brackets. Source: CDC WONDER.

Figure 6.. Age-adjusted mortality from accidental drug overdoses, by race-ethnicity, 1999–2017.

Source: CDC WONDER. Values in parentheses denote relative increases in age-adjusted mortality rates by race-ethnicity between 2010 and 2017. AIAN = American Indians and Alaskan Natives, API = Asians and Pacific Islanders (API), NH = non-Hispanic.

Figure 7.. Life expectancy, selected states, 1990–2016.

Source: US Mortality Database. Graph highlights divergences in state-level life expectancy that began in the 1990s, featuring neighboring states (Alabama/Georgia and Colorado/Kansas). Values in parentheses refer to state life expectancy rankings (among the 50 states) in 1959, 1990, and 2016, respectively. As the 1990s began, life expectancy in Oklahoma exceeded that of New York.

Figure 8.. Estimated excess deaths from increasing midlife mortality, 2010–2017.

Estimated number of deaths caused by year-to-year increases in age-adjusted mortality rates among adults ages 25–64 years during 2010–2017. The map displays the number of estimated excess deaths (numerator) and not the population size (denominator) to clarify which states contributed the largest absolute number of deaths and exerted the largest influence on national trends. For example, although New Hampshire experienced a large (23.3%) relative increase in midlife mortality rates between 2010 and 2017, that state had a relatively small population (0.4% of US population) and therefore accounted for only 1.2% of excess deaths in the US. See text for more details about methods used to calculate excess deaths.