A Forgettable Year

The final mortality statistics for 2020 were recently released by the National Center for Health Statistics. They document what we already know—2020 was a very bad year...

• Life expectancy fell 1.8 years between 2019 and 2020, to 77.0 years. 
• The overall age-adjusted death rate climbed 16.8 percent, to 835.4 deaths per 100,000 population (up from 715.2 in 2019).
• The age-adjusted death rate increased for both males and females. 
• The age-adjusted death rate increased for Blacks, Hispanics, and non-Hispanic whites. 
• The death rate increased in every age group 15 and older between 2019 and 2020. The biggest increase in the death rate occurred in the 25-to-44 age group (up 24 percent).
• The age-adjusted death rate increased for 6 of the 10 leading causes of death: heart disease, unintentional injuries, stroke, Alzheimer's disease, diabetes, and influenza/pneumonia. 
• Between 2019 and 2020, the death rate increased the most for unintentional injuries. 
• Many unintentional injury deaths are drug overdoses. 
• The age-adjusted death rate from drug overdoses increased 31 percent between 2019 and 2020. 
• The death rate from drug overdoses increased in every age group between 2019 and 2020. 
• The drug overdose death rate is highest for people aged 25 to 44, which is also the age group whose death rate increased the most in 2020. 

It wasn't just Covid creating all the misery in 2020, but Covid may be why so many other things got worse. When all the numbers are in for 2021, it is likely to have been just as bad a year as 2020. Let's hope 2022 is better.

Source: National Center for Health Statistics, Mortality in the United States, 2020 and Drug Overdose Deaths in the United States, 1999–2020

Many Americans Report Drug Problems in Family

Drug use is a common family problem. Nearly one-third of Americans (32 percent) report having had a drug problem in their family, according to a Gallup survey. This figure is up from 23 percent who reported family issues with drugs in the early 2000s. 

The percentage who report having had a drug problem in their family has grown in every demographic segment over the past two decades. One of the biggest increases occurred in small towns and rural areas. In the early 2000s, only 17 percent of residents in small towns/rural areas reported having had a drug problem in their family. By 2018–21, fully 28 percent of rural residents reported a family drug problem—an 11 percentage point increase. Consequently, urban and rural residents are now about equally likely to report a drug problem in their family. 

Percent who say drug abuse has been a cause of trouble in their family 

(and percentage point change, 2000–05 to 2018–21)

City residents: 29% (+5)

Suburban residents: 32% (+8)

Small town/rural residents: 28% (+11)

Source: Gallup, Drugs Have Been a Problem in Family for 32% of Americans

Life Expectancy Is at a Standstill

Life expectancy in the United States was no higher in 2018 than it was in 2010, which makes the 2010s (so far) the first decade in modern history in which the lives of Americans have not increased. During those eight years, life expectancy at birth succeeded in climbing 0.2 years, reaching a high of 78.9 in 2014. Then, to the consternation of many, it fell by 0.2 years between 2014 and 2015—the first decline since 1993. It fell another 0.1 year between 2016 and 2017, but gained 0.1 year between 2017 and 2018. In 2018, as in 2010, life expectancy at birth in the United States was 78.7 years.

Life expectancy at birth in the United States, 2010 to 2018
2018: 78.7 years
2017: 78.6
2016: 78.7
2015: 78.7
2014: 78.9
2013: 78.8
2012: 78.8
2011: 78.7
2010: 78.7

A study by the National Center for Health Statistics takes a look at the reasons for the 0.3 year decline in life expectancy between 2014 and 2017. Most of the decline was caused by the increase in drug overdose deaths. In 2010, there were 38,329 deaths from drug overdoses. The number grew to 47,055 by 2014. Then things really got bad, with deaths surging to 70,237 by 2017—a 49 percent increase between 2014 and 2017. This surge explains the 51 percent majority of the decline in life expectancy during those years, reports the National Center for Health Statistics. Other causes of death contributing to the decline in life expectancy were Alzheimer's disease, suicide, homicide, and diabetes.

Drug deaths fell slightly in 2018, and life expectancy recovered a bit—but it's only back to where it was nearly a decade ago.

Source: National Center for Health Statistics, Mortality Data, Changes in Life Expectancy at Birth, 2010–2018; and Drug Overdose Deaths in the United States, 1999–2018

Struggling to Sleep, Many Take Medications

Millions of Americans frequently take a medication to help them fall or stay asleep, according to the National Health Interview Survey. Overall, 8.2 percent of adults aged 18 or older took a sleep medication four or more times in the past week. Women are more likely than men to use sleep medications frequently—9.7 percent of women versus 6.6 percent of men. Frequent use of sleep medications rises with age...

Percent of women who took a sleep medication 4 or more times in past week
Aged 18 to 44: 5.8%
Aged 45 to 64: 12.7%
Aged 65-plus: 13.2%

Source: CDC, Percentage of Adults Aged ≥ 18 Who Took Medication to Help Them Fall or Stay Asleep Four or More Times in the Past Week, by Sex and Age Group—National Health Interview Survey, United States, 2017–2018

Big Increase in Deaths due to Unintentional Injuries

The third leading cause of death in the United States is what the CDC calls "unintentional injuries"—or accidents. Because a growing number of people are dying from unintentional injuries, this cause of death has been rising among leading causes of death. From 2000 through 2012, it was the fifth leading cause of death. It rose to fourth place in 2013 and climbed into third place in 2015, behind only heart disease and cancer.

Not only were there 74 percent more accidental deaths in 2017 than in 2000, but the age-adjusted death rate per 100,000 population grew from 34.9 to 49.4 during those years. Three types of unintentional injuries account for the great majority of accidental deaths—drug overdoses, motor vehicle accidents, and falls. These three causes accounted for 80 percent of all unintentional injury deaths in 2017...

Unintentional injury deaths in 2017
Total deaths: 169,936 (100.0%)
Drug overdoses: 61,311 (36.1%)
Motor vehicles: 38,659 (22.7%)
Falling: 36,338 (21.4%)
Other: 33,628 (19.8%)

Drug overdoses are the most common type of accidental death, accounting for 36 percent of unintentional injury deaths in 2017. The number of accidental drug overdoses more than quadrupled between 2000 and 2017. The age-adjusted death rate per 100,000 population climbed from 4.1 to 19.1 during those years.

Motor vehicle accidents were once the most common type of accidental death, but drug overdoses surpassed them in 2013. The number of motor vehicle deaths has fallen slightly over the years—from 41,994 in 2000 to 38,659 in 2017. The age-adjusted death rate per 100,000 population fell from 14.9 to 11.5 during those years.

Falls, like drug overdoses, are a growing cause of accidental death. In 2017 there were almost as many deaths from falls as there were from motor vehicle accidents. This was not the case in 2000, when motor vehicle deaths outnumbered deaths from falls by more than three to one. Growth of the 85-plus population is one reason for the greater number of deaths from falls.

Source: National Center for Health Statistics, Unintentional Injury Death Rates in Rural and Urban Areas: United States, 1999–2017

Opioid Prescriptions Are More Common in Rural Areas

Rural areas have been hit hard by the opioid epidemic. The injury is, in part, self-inflicted. Primary care physicians in rural areas are more likely than those in urban areas to prescribe opioids for their patients, reports the CDC in a study of opioid prescribing rates.

CDC researchers examined electronic prescriptions written by 31,422 primary health care providers during the January 2014 to March 2017 time period. Their findings document the big differences in opioid prescription rates by a county's urban-rural status...

Percent of patients receiving opioid prescriptions, January 2014—March 2017 average
9.6% in rural counties
9.4% in micropolitan counties
7.7% in small metro areas
6.7% in medium metro areas
5.6% in large fringe metros
5.2% in large central metros

The CDC undertook the study to determine whether the 2016 release of its Guideline for Prescribing Opioids for Chronic Pain had helped to reduce opioid prescriptions. It did. In every type of county, the opioid prescription rate declined over the time period. In rural counties, the percentage of patients who received opioid prescriptions fell from 10.3 percent in 2014 to 9.0 percent during the March 2016 to March 2017 time period. In large central metropolitan counties, the rate fell from 5.4 to 5.0 percent.

"As less densely populated areas appear to indicate both substantial progress in decreasing opioid prescribing and ongoing need for reduction," the researchers conclude, "community health care practices and intervention programs must continue to be tailored to community characteristics."

Source: CDC, Morbidity and Mortality Weekly Report, Opioid Prescribing Rates in Nonmetropolitan and Metropolitan Counties among Primary Care Providers Using an Electronic Health Record System—United States, 2014–2017

Life Expectancy Gap Grew in 2016

In the United States, women live longer than men. But the female advantage has been shrinking for decades—until now. In 2016 the life expectancy gap between females and males widened for the first time since 1990, according to the National Center for Health Statistics report, Deaths: Final Data for 2016, increasing from 4.8 to 5.0 years between 2015 and 2016. Here is the trend since 1950...

Gap in female-male life expectancy
2016: 5.0 years (first increase since 1989-90)
2015: 4.8 years
2010: 4.8 years
2000: 5.2 years
1990: 7.0 years
1980: 7.4 years
1979: 7.8 years (biggest gap)
1970: 7.6 years
1960: 6.5 years
1950: 5.5 years

Since 1950, the life expectancy of both males and females has increased substantially—rising from 65.6 to 76.1 years (+10.5 years) for males, and from 71.1 to 81.1 years (+10.0 years) for females. During those years, the female-male life expectancy gap grew from 5.5 years in 1950 to a peak of 7.8 years in 1979. The gap then began to shrink, falling to 4.8 years from 2010 through 2015.

Behind the 1950-to-1979 increase in the female-male life expectancy gap were higher rates of smoking and heart disease among men. As smoking rates fell and heart disease was better controlled, the life expectancy gap began to decline. The decline has come to a halt, at least temporarily, as male mortality rates rise faster than female for some causes of death. One of those causes is drug-induced deaths. Between 2015 and 2016, the drug-induced mortality rate of males climbed 26.0 percent. The female rate increased by a smaller 13.6 percent.

Source: National Center for Health Statistics, Mortality Data

Life Expectancy Declines, Again

Big, big news: Life expectancy at birth fell for the second year in a row in 2016, according to the National Center for Health Statistics. This is the first two-year life expectancy decline since flu outbreaks in 1962 and 1963 drove life expectancy down, according to NCHS. Life expectancy at birth in 2016 was 78.6 years, 0.1 year less than in 2015. Life expectancy at birth peaked at 78.9 years in 2014.

Drug overdose deaths are behind the life expectancy decline. There were 63,632 overdose deaths in 2016—21 percent (!) more than in 2015. The increase in drug overdose deaths has managed to rearrange the list of leading causes of death. "Unintentional injuries," which includes most drug overdose deaths, is now the 3rd leading cause of death. It was 4th in 2015.

Drug overdose deaths are highest among 25-to-54-year-olds and uncommon among people aged 65 or older. In fact, life expectancy at age 65 increased by 0.1 years in 2016 to 19.4 years as death rates from heart disease and cancer declined.

Source: National Center for Health Statistics, Mortality in the United States, 2016 and Drug Overdose Deaths in the United States, 1999–2016

Nearly 1/3 of Accidental Deaths are Poisonings

More than 146,000 Americans died from "accidents (unintentional injuries)" in 2015, according to the National Center for Health Statistics, making it the 4th leading cause of death in the United States. Nearly one-third of accidental deaths are due to unintentional poisoning—mostly drug overdoses. Unintentional poisoning has been the leading mechanism of accidental death since 2011, reports NCHS.

Number (and percent distribution) of accidental deaths by mechanism in 2015
Total accidental deaths: 146,571
Deaths from poisoning: 47,478 (32%)
Deaths from motor vehicles: 36,161 (25%)
Deaths from falls: 33,381 (23%)
Deaths due to other mechanisms: 29,551 (20%)

If unintentional poisoning were a separate cause of death, it would rank 10th among the leading causes of death in the United States.

Source: National Center for Health Statistics, Deaths: Final Data for 2015

More than 1 in 8 Americans Use Antidepressants

Millions of Americans are taking antidepressants, according to data collected by the National Health and Nutrition Examination Survey. Among the population aged 12 or older, more than one in eight (12.7 percent) took an antidepressant medication in the past month in the 2011–2014 time period. Women are far more likely to take antidepressants than men (16.5 versus 8.6 percent), and older women are most likely to take them—nearly one in four women aged 60 or older took an antidepressant in the past month.

Percent of women (and men) taking an antidepressant in past month
Aged 12 to 19: 5.0% (1.9%)
Aged 20 to 39: 9.8% (5.9%)
Aged 40 to 59: 21.2% (11.6%)
Aged 60-plus: 24.4% (12.6%)

Antidepressant use has increased since 1999–2002, when 7.7 percent of Americans aged 12 or older had taken the medication in the past month. One reason for the growing use of antidepressants is their long-term use. Among those taking an antidepressant in the past month, one in four had been taking the medication for 10 or more years.

Source: National Center for Health Statistics, Antidepressant Use among Persons Age 12 and Over: United States, 2011–2014

47% Took Prescription Drug in Past 30 Days

Nearly half of Americans (47%) took at least one prescription drug in the past 30 days, according to the 2011–14 National Health and Nutrition Examination Survey. The use of prescription drugs rises with age to more than 90 percent of people aged 65 or older...

Percent who took at least one prescription drug in past 30 days
Under age 18: 21.5%
Aged 18 to 44: 37.1%
Aged 45 to 64: 69.0%
Aged 65-plus: 90.6%

The use of multiple prescription drugs is becoming more common, especially among people aged 65 or older. Overall, 21.5 percent of Americans took three or more prescription drugs in the past 30 days in 2011–14, up from 11.8 percent who did so two decades earlier in 1988–94. Among people aged 65 or older, 67 percent took three or more prescription drugs in the past month, up from 31 percent in 1988–94.

Source: National Center for Health Statistics, Health, United States, 2016

Drug Overdose Deaths by State, 2015

Drug overdose deaths are surging. The age-adjusted death rate nearly tripled between 1999 and 2015, rising from 6.1 to 16.3 deaths per 100,000 population. By race and Hispanic origin, non-Hispanic Whites have by far the highest drug overdose death rate—21.1 deaths per 100,000 population for non-Hispanic Whites versus 12.2 for Blacks and 7.7 for Hispanics. By age, the biggest increase in drug overdose deaths occurred among people aged 55 to 64, the rate rising five-fold from 4.2 to 21.8 deaths per 100,000 population between 1999 and 2015.

The age-adjusted drug overdose death rate is much higher in some states than in others. Here are the states with the highest and lowest death rates in 2015...

States with the highest rate of drug overdose deaths per 100,000 population
West Virginia: 41.5
New Hampshire: 34.3
Kentucky: 29.9
Ohio: 29.9
Rhode Island: 28.2

States with the lowest rate of drug overdose deaths per 100,000 population
Iowa: 10.3
Texas: 9.4
North Dakota: 8.6
South Dakota: 8.4
Nebraska: 6.9

Source: National Center for Health Statistics, Drug Overdose Deaths in the United States, 1999–2015

American Health Care May Be "Uniquely Inefficient"

The U.S. health care system may be uniquely inefficient compared to other countries, according to a National Bureau of Economic Research study. NBER researchers compared the diffusion of drugs of high and low quality (defined by relative therapeutic benefit) in the U.S. versus their diffusion in Australia, Canada, Switzerland, and the United Kingdom.

Low quality drugs, they find, are adopted more quickly in the United States. This finding supports the theory that health care in the U.S. is inefficient relative to health care in other countries. "The U.S. health care system may be 'uniquely inefficient' in the sense of fueling the rapid adoption and diffusion of medical technologies with small or unknown benefits," the researchers conclude.

Source: National Bureau of Economic Research, Is American Health Care Uniquely Inefficient? Evidence from Prescription Drugs, NBER Working Paper #23068

Death Certificates Reveal Drugs Involved in Overdoses

The experts are alarmed. The rapid rise in drug overdose deaths has revealed a shortcoming in the International Classification of Diseases, Tenth Revision. The ICD–10, as it is dubbed, is the system used to classify causes of death. But for overdose deaths, the ICD-10 lumps a variety of drugs into just a few categories, making it nearly impossible to single out the troublemakers.

To solve this problem, the National Center for Health Statistics and the Food and Drug administration developed a method to analyze the "literal text" (literally, the text) on death certificates to tease out specific drug mentions. It worked, and here are some of the findings...

• Between 2010 and 2014, drug deaths grew 23 percent—from 38,329 to 47,055. 
• The percentage of overdose deaths that specified at least one drug on the death certificate climbed from 67 to 78 percent between 2010 and 2014.
• Heroin was the top drug mentioned in overdose deaths in 2014, accounting for 23 percent of the total. Cocaine was second and oxycodone third. 
• The number of heroin overdose deaths more than tripled between 2010 and 2014, rising from 3,020 to 10,863.
• Among overdose deaths with a drug mention, 52 percent mentioned only one drug and 48 percent mentioned two or more. The average was 1.9.

Source: National Center for Health Statistics, National Vital Statistics System, Drugs Most Frequently Involved in Drug Overdose Deaths: United States, 2010–2014

Prescription Painkiller Abuse: The Personal Connection

Most Americans have a personal connection to prescription painkiller abuse, according to a Kaiser Family Foundation survey. The 56 percent majority of Americans say they 1) personally know someone who has taken a prescription painkiller not prescribed to them; and/or 2) personally know someone who has been addicted to prescription painkillers, and/or 3) personally know someone who died from a prescription painkiller overdose.

The demographic segments most likely to have a personal connection to prescription painkillers are Whites, those with a household income of $90,000 or more, adults under age 50, those with some college, college graduates, suburban residents, and men.

The demographic segments least likely to have a personal connection to prescription painkillers are Hispanics, people aged 65 or older, Blacks, those with a high school diploma or less education, urban residents, and women.

Source: Kaiser Family Foundation Health Tracking Poll