What’s Driving the Longevity Gap

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The decline in U.S. life expectancy is unlike anything we’ve seen  

Bombshell headlines like this popped up in major news outlets last November after the government reported that life expectancy in 2017 fell for the third year in a row.

This is a troubling break from the steady improvements in lifespans since 1900, which were powered by a combination of medical breakthroughs and healthcare policy. Early in the 20th century, antibiotics dramatically increased infant lifespans. Later, new treatments like statins and stents, as well as expanded access to healthcare through Medicare and Medicaid, increased life expectancy across the age range.

But there’s another story behind this story: life expectancy very much depends on where one falls on the economic ladder.

Between 1979 and 2011 – prior to the very recent fall in longevity – the increase in lifespans was much larger for more educated, higher-earning Americans than the gains for people with less education and lower incomes, according to a study by the Center for Retirement Research (CRR).

Smoking is an important factor in this socioeconomic divide. The decline in smoking and cardiovascular disease greatly contributed to rising longevity in the latter half of the 20th century. But while all Americans are smoking less today, those in lower socioeconomic groups still smoke much more. Today, one in four of them is a smoker, compared with just one smoker for every 10 people who attended college, the CRR found.

Looking ahead, education will remain a clear dividing line, and life expectancy will continue to depend crucially on the future prevalence and impact of smoking, as well as obesity, CRR predicted.

A near tripling in the obesity rate, to 40 percent of adults, since the 1970s points to trouble on the horizon. And like smoking, obesity is more pervasive among less-educated people. There are two primary culprits: less exercise and diets high in salt and fats. The risks linked to inactivity and poor diet – heart disease, stroke, Type 2 diabetes, high blood pressure, and some cancers – are estimated to be responsible for one in five adult deaths.

Further, the past expansion of government health insurance, which particularly benefited people with lower socioeconomic status, can’t continue at its historical pace, because so many people today are already covered by these programs. It’s more difficult to foresee how recent medical breakthroughs, such as targeted cancer therapies and a cure for Hepatitis C, will play out in the future.

What does seem clear is that we can expect some people to continue to fare better than others.

To read the brief, authored by Anqi Chen, Alicia Munnell, and Geoffrey Sanzenbacher, see “What’s Happening to U.S. Mortality Rates?”

The research reported herein was performed pursuant to a grant from the U.S. Social Security Administration (SSA) funded as part of the Retirement Research Consortium. The opinions and conclusions expressed are solely those of the author(s) and do not represent the opinions or policy of SSA or any agency of the federal government. Neither the United States Government nor any agency thereof, nor any of their employees, makes any warranty, express or implied, or assumes any legal liability or responsibility for the accuracy, completeness, or usefulness of the contents of this report. Reference herein to any specific commercial product, process or service by trade name, trademark, manufacturer, or otherwise does not necessarily constitute or imply endorsement, recommendation or favoring by the United States Government or any agency thereof.

Edward Hoffer MD

It is little-appreciated, but only some 15-20% of a nation’s health statistics reflect its health care system; the rest are due to socioeconomic factors. See my blog post or read my book Prescription for Bankruptcy. A major reason that European countries have better health outcomes despite spending about half what we do per capita on health care is that they spend more on social services and their cultures promote better habits.

Ken Pidcock

Three questions. (1) If all Americans are smoking less today, why would longevity be declining for some rather than improving more slowly? (2) What does salt have to do with obesity? (3) Why is the best way to address our problems always better education and never doing something about wealth concentration?

Jeff Steele

Ken Pidcock, if you’re asking question number one, you must not have caught this news story published in various periodicals all over the world this past April.

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