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Wall Street Journal / News

How Death Strikes Around the U.S.

A grim tally of “years of life lost” shows that substance abuse, suicides and diabetes drove a rise in premature deaths in nearly half the country, according to researchers who mapped variations in death rates among people 20 to 55 years old.

Increase

Decrease

Change in the probability of death for ages 20–55, 1990 to 2016 (pct. pts.)

0

–1.0

1.0

National average

Wash.

N.H.

Maine

Mont.

Vt.

N.D.

Minn.

Ore.

Idaho

Wis.

Mass.

N.Y.

S.D.

Mich.

Wyo.

Pa.

Iowa

Neb.

Nev.

Ohio

Ind.

Ill.

Utah

R.I.

W.Va.

Colo.

Va.

Conn.

Kan.

Mo.

Ky.

Calif.

N.J.

N.C.

Tenn.

Del.

Okla.

Ariz.

N.M.

Ark.

S.C.

Md.

Ga.

Ala.

Miss.

Texas

La.

Alaska

Fla.

Hawaii

Change in the probability of death for ages 20–55, 1990 to 2016 (pct. pts.)

Increase

Decrease

0

–1.0

1.0

National average

Wash.

N.H.

Maine

Vt.

Mont.

N.D.

Minn.

Ore.

Idaho

Wis.

N.Y.

Mass.

S.D.

Mich.

Wyo.

Iowa

Pa.

Neb.

Nev.

Ohio

Ind.

Ill.

Utah

W.Va.

Colo.

Va.

Kan.

R.I.

Mo.

Ky.

Calif.

Conn.

N.C.

Tenn.

N.J.

Ariz.

Okla.

Ark.

N.M.

S.C.

Del.

Ga.

Ala.

Miss.

Md.

Texas

La.

Alaska

Fla.

Hawaii

Change in the probability of death for ages 20–55, 1990 to 2016 (pct. pts.)

Decrease

Increase

–1.0

0

1.0

National average

Wash.

N.H.

Vt.

Maine

Mont.

N.D.

Minn.

Ore.

Idaho

Wis.

N.Y.

Mass.

S.D.

Mich.

Wyo.

Pa.

Iowa

Neb.

Nev.

Ohio

Ind.

Ill.

Utah

W.Va.

Colo.

Va.

Kan.

R.I.

Mo.

Ky.

Calif.

Conn.

N.C.

Tenn.

N.J.

Ariz.

Okla.

Ark.

N.M.

S.C.

Del.

Ga.

Ala.

Miss.

Md.

Texas

La.

Alaska

Fla.

Hawaii

Change in the probability of death for ages 20–55, 1990 to 2016 (pct. pts.)

Decrease

Increase

–1.0

0

1.0

National average

NH

WA

ME

VT

MT

ND

MN

OR

NY

ID

SD

WI

MI

WY

PA

IA

NE

OH

NV

IN

IL

UT

WV

CO

VA

KS

RI

CA

MO

KY

NC

CT

TN

OK

AZ

AR

NM

SC

MA

AL

GA

MS

NJ

TX

LA

DE

AK

FL

MD

HI

Source: Institute for Health Metrics and Evaluation

A grim tally of “years of life lost” shows that substance abuse, suicides and diabetes drove a rise in premature deaths in nearly half the country, according to researchers who mapped variations in death rates among people 20 to 55 years old.

The research offers a detailed look at the trends pulling down life expectancy among young and middle-aged Americans in recent years. So-called “deaths of despair,” including drug overdoses, have been on the rise, especially among white Americans, according to recent studies.

The new analysis, published Tuesday in the Journal of the American Medical Association, shows wide variation in where people ages 20 to 55 are at highest risk, and in what diseases or conditions afflict them. The risk of dying young declined in Minnesota, California and New York between 1990 and 2016, the study found. Yet it rose in 21 states, including West Virginia and New Mexico.

“We get this very divergent pattern in that middle-age area,” said Christopher J.L. Murray, director of the Institute for Health Metrics and Evaluation at the University of Washington, who led the analysis. “We’re seeing how different it is by state.”

The examination of health by U.S. state between 1990 and 2016 is part of IHME’s ongoing Global Burden of Disease epidemiological study, which assesses illnesses and death from major diseases and conditions globally using multiple data sources.

Leading 25 causes of death in the U.S., ranked by years of life lost

1990

rank

2016

rank

Ischemic heart disease

1

1

2

2

Lung cancer

Motor vehicle injuries

3

3

4

4

COPD

5

6

Colon cancer

6

7

7

Alzheimer’s/dementia

8

Lower respiratory infections

8

9

Preterm birth complications

9

10

Breast cancer

10

11

11

Ischemic stroke

12

12

Diabetes

13

13

Hemorrhagic stroke

14

Suicide by firearm

14

15

Firearm violence

15

16

Suicide by other means

16

17

17

Pancreatic cancer

18

Other cardiovascular diseases

18

19

20

21

22

23

Non-Hodgkin lymphoma

23

24

24

Other cancers

25

Hypertensive heart disease

26

Cirrhosis/liver disease (alcohol use)

27

Cirrhosis/liver disease (Hepatitis C)

30

35

Chronic kidney disease

Endocrine/immune disorders

37

Opioid use disorders

52

Leading 25 causes of death in the U.S., ranked by years of life lost

2016

rank

1990

rank

1

Ischemic heart disease

1

2

Lung cancer

2

3

Motor vehicle injuries

3

4

COPD

4

5

Colon cancer

6

6

7

7

Alzheimer’s/dementia

8

Lower respiratory infections

8

9

Preterm birth complications

9

Breast cancer

10

10

11

Ischemic stroke

11

12

12

Diabetes

13

13

Hemorrhagic stroke

14

14

Suicide by firearm

15

15

Firearm violence

Suicide by other means

16

16

17

17

Pancreatic cancer

18

Other cardiovascular diseases

18

19

20

21

22

23

Non-Hodgkin lymphoma

23

24

24

Other cancers

25

Hypertensive heart disease

26

Cirrhosis/liver disease (alcohol use)

27

Cirrhosis/liver disease (Hepatitis C)

30

Chronic kidney disease

35

37

Endocrine/immune disorders

Opioid use disorders

52

Leading 25 causes of death in the U.S., ranked by years of life lost

1990

rank

2016

rank

1

Ischemic heart disease

1

2

Lung cancer

2

Motor vehicle injuries

3

3

4

4

COPD

5

Colon cancer

6

6

7

7

Alzheimer’s/dementia

Lower respiratory infections

8

8

Preterm birth complications

9

9

10

Breast cancer

10

11

11

Ischemic stroke

12

Diabetes

12

13

13

Hemorrhagic stroke

14

Suicide by firearm

14

15

Firearm violence

15

16

Suicide by other means

16

17

Pancreatic cancer

17

18

Other cardiovascular diseases

18

19

20

21

22

23

23

Non-Hodgkin lymphoma

24

Other cancers

24

25

Hypertensive heart disease

26

Cirrhosis/liver disease (alcohol use)

27

30

Cirrhosis/liver disease (Hepatitis C)

Chronic kidney disease

35

37

Endocrine/immune disorders

Opioid use disorders

52

Leading 25 causes of death in the U.S., ranked by years of life lost

2016

rank

1990

rank

1

Ischemic heart disease

1

2

2

Lung cancer

3

Motor vehicle injuries

3

4

4

COPD

5

6

Colon cancer

6

7

7

Alzheimer’s/dementia

Lower respiratory infections

8

8

9

Preterm birth complications

9

10

Breast cancer

10

11

Ischemic stroke

11

12

12

Diabetes

13

13

Hemorrhagic stroke

14

14

Suicide by firearm

15

15

Firearm violence

16

Suicide by other means

16

17

17

Pancreatic cancer

18

18

Other cardiovascular

diseases

19

20

21

22

23

23

Non-Hodgkin lymphoma

24

24

Other cancers

25

26

Hypertensive heart disease

Cirrhosis/liver disease

(alcohol use)

27

Cirrhosis/liver disease

(Hepatitis C)

30

Chronic kidney disease

35

37

Endocrine/immune

disorders

Opioid use disorders

52

Source: Institute for Health Metrics and Evaluation

While the two leading causes of death for Americans of all ages nationwide—heart disease and lung cancer—remained the same for those years, “years of life lost” for several others soared, reflecting the ills of young and middle-aged adults. That calculation involves multiplying the number of deaths at each age by a standard life expectancy at that age, according to IHME.

Substance use, mental-health issues, cirrhosis and diabetes accounted for most of the increases in premature death among people ages 20 to 55, Dr. Murray said. That shows a lack of progress in fighting obesity and addressing mental-health problems, he said. However, medical advances have helped curb premature deaths from certain types of cancer and other causes.

Percentage change in the age-standardized death rate for the leading 25 causes of death in the U.S., 1990 to 2016

Opioid use disorders

343.0%

Endocrine/immune disorders

89.1

Chronic kidney disease

61.1

Suicide by other means

16.9

COPD

13.8

Alzheimer’s/dementia

11.6

Cirrhosis/liver disease (alcohol use)

9.5

8.4

Cirrhosis/liver disease (Hepatitis C)

Other cancers

5.3

2.7

Hypertensive heart disease

0.4

Pancreatic cancer

–10.3

Hemorrhagic stroke

–11.4

Diabetes

Lower respiratory infections

–12.3

Suicide by firearm

–13.2

Other cardiovascular diseases

–19.1

Non-Hodgkin lymphoma

–19.5

Ischemic stroke

–23.8

Lung cancer

–24.0

Firearm violence

–28.5

Colon cancer

–29.6

Breast cancer

–32.6

–35.4

Motor vehicle injuries

–39.9

Preterm birth complications

Ischemic heart disease

–50.7

Percentage change in the age-standardized death rate for the leading 25 causes of death in the U.S., 1990 to 2016

Opioid use disorders

343.0%

Endocrine/immune disorders

89.1

Chronic kidney disease

61.1

Suicide by other means

16.9

COPD

13.8

Alzheimer’s/dementia

11.6

Cirrhosis/liver disease (alcohol use)

9.5

8.4

Cirrhosis/liver disease (Hepatitis C)

Other cancers

5.3

2.7

Hypertensive heart disease

Pancreatic cancer

0.4

–10.3

Hemorrhagic stroke

–11.4

Diabetes

Lower respiratory infections

–12.3

Suicide by firearm

–13.2

Other cardiovascular diseases

–19.1

Non-Hodgkin lymphoma

–19.5

Ischemic stroke

–23.8

Lung cancer

–24.0

Firearm violence

–28.5

Colon cancer

–29.6

Breast cancer

–32.6

–35.4

Motor vehicle injuries

–39.9

Preterm birth complications

Ischemic heart disease

–50.7

Percentage change in the age-standardized death rate for the leading 25 causes of death in the U.S., 1990 to 2016

Opioid use disorders

343.0%

Endocrine/immune disorders

89.1

Chronic kidney disease

61.1

Suicide by other means

16.9

COPD

13.8

Alzheimer’s/dementia

11.6

Cirrhosis/liver disease (alcohol use)

9.5

8.4

Cirrhosis/liver disease (Hepatitis C)

Other cancers

5.3

2.7

Hypertensive heart disease

Pancreatic cancer

0.4

–10.3

Hemorrhagic stroke

–11.4

Diabetes

Lower respiratory infections

–12.3

Suicide by firearm

–13.2

Other cardiovascular diseases

–19.1

Non-Hodgkin lymphoma

–19.5

Ischemic stroke

–23.8

Lung cancer

–24.0

Firearm violence

–28.5

Colon cancer

–29.6

Breast cancer

–32.6

–35.4

Motor vehicle injuries

–39.9

Preterm birth complications

Ischemic heart disease

–50.7

Percentage change in the age-standardized death rate for the leading 25 causes of death in the U.S., 1990 to 2016

Opioid use disorders

343.0%

Endocrine/immune disorders

89.1

Chronic kidney disease

61.1

Suicide by other means

16.9

COPD

13.8

Alzheimer’s/dementia

11.6

Cirrhosis/liver disease (alcohol use)

9.5

Cirrhosis/liver disease (Hepatitis C)

8.4

Other cancers

5.3

Hypertensive heart disease

2.7

Pancreatic cancer

0.4

Hemorrhagic stroke

10.3

Diabetes

11.4

Lower respiratory infections

12.3

Suicide by firearm

13.2

Other cardiovascular diseases

19.1

Non-Hodgkin lymphoma

19.5

Ischemic stroke

23.8

Lung cancer

24.0

Firearm violence

28.5

Colon cancer

29.6

Breast cancer

32.6

Motor vehicle injuries

35.4

Preterm birth complications

39.9

Ischemic heart disease

50.7

Source: Institute for Health Metrics and Evaluation

Death rates went down for several cancers—including breast, colon and lung cancers—as prevention and treatment have improved, as well as for motor-vehicle crashes, the result of more safety features in cars and certain changes in traffic laws, health experts said.

Hawaii had the highest life expectancy at birth in 2016, at 81.3 years, while Mississippi had the lowest, at 74.7 years, the study found.

For Americans between ages 20 and 55, the risk or probability of death over the years studied rose more than 10% in five states: West Virginia, Oklahoma, New Mexico, Kentucky and Wyoming.

Mental and substance-use disorders were the biggest driver of an increase in probability of death for young and middle-aged adults in West Virginia, one of the states hardest hit by the opioid epidemic. Suicide also played a big role. The increases in mortality were so large they didn’t offset declines in deaths from cardiovascular disease, accidents such as car crashes, HIV and tuberculosis. In Oklahoma, those same factors, along with cirrhosis, were significant contributors to an increase in risk of death.

In Minnesota, on the other hand—the state with the lowest probability of death for this age group in 2016—a decrease in deaths from cardiovascular diseases, cancer, injuries, and HIV far offset an increase in deaths from mental and substance-use disorders. New York and California also benefited from declines in deaths from suicide, cardiovascular disease, cancer, HIV and tuberculosis, offsetting increases in drug deaths.

Federal drug-overdose death data also show how much the opioid epidemic alone has caused death rates in states to diverge.

Estimated age-adjusted death rates for drug poisoning by county, 2016

Per 100,000 population

4

8

24

26

28

30

20

18

2

16

6

22

10

14

12

Estimated age-adjusted death rates for drug poisoning by county, 2016

Per 100,000 population

8

4

14

12

10

18

6

16

2

22

24

26

28

30

20

Estimated age-adjusted death rates for drug poisoning by county, 2016

Per 100,000 population

8

4

6

10

2

22

12

24

18

14

30

16

20

26

28

Estimated age-adjusted death rates for

drug poisoning by county, 2016

Per 100,000 population

6

10

14

18

22

26

30

2

Source: Centers for Disease Control and Prevention

The latest study by IHME shows how health disparities “leave the United States far from being united,” according to an accompanying editorial by Howard Koh of the Harvard T.H. Chan School of Public Health and Anand Parekh of the Bipartisan Policy Center, both former officials in the U.S. Department of Health and Human Services. They called for more prevention efforts to combat these conditions.

Why ‘Deaths of Despair’ May Be a Warning Sign

Does a decades-long rise in suicide among white Americans signal an emerging crisis for U.S. capitalism and democracy? Nobel Prize-winning economist Angus Deaton and his wife, fellow Princeton Prof. Anne Case, share their provocative theory with WSJ’s Jason Bellini in this episode of Moving Upstream. Photo: Getty

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