Life expectancy rises as fatal drug overdoses decline in the U.S.

The number of fatal drug overdoses declined for the first time in 28 years, and U.S. life expectancy at birth ticked upward for the first time since 2014, according to long-awaited numbers for 2018 published Thursday by the U.S. Centers for Disease Control and Prevention.

A decline in the death rate from cancer is the single largest driverof the small increase in life expectancy,the CDC reported. Five of the other nine leading causes of death also showed declines in death rates, including the top cause, heart disease, as well as unintentional injuries (which include overdoses), chronic lower respiratory diseases, stroke and Alzheimer's disease. Two more, diabetes and kidney disease, were essentially unchanged. Deaths from suicide and influenza and pneumonia increased.

Despite the encouraging elements of the CDC mortality report, the broader pattern for American health remains sobering. Life expectancy improved by the tiniest of increments, from 78.6 to 78.7 years. That figure remains lower than the peak in U.S.life expectancy, at 78.9 years,in 2014.

It is also identical to life expectancy in 2010, and it appears unlikely that U.S. longevity will show any significant improvement over the entire decade of the 2010s. The United States is continuing to fall behind similarly wealthy countries - a phenomenon that experts refer to as the U.S. "health disadvantage."

"It's good news that there was an increase in life expectancy. That's what we want to see, but it doesn't really alter the long-term picture. We still have a very bleak situation at this point," said Steven Woolf, director emeritus of the Center on Society and Health at Virginia Commonwealth University.

Woolf was the co-author of a report published in November in the JAMA, the American Medical Association's journal, that revealed a long-term increase in death rates in the United States for people in the prime of life - from 25 to 44. That study was based on mortality data from 1959 to 2017, and showed that improvements in life expectancy and a lowering of death rates peaked in the 1970s, with more gradual increases after that. In 1998, the United States for the first time fell behind the average life expectancy in peer nations, Woolf said.

"As a country, we are not doing as well as we should, and other high-income countries are outperforming us and continue to outperform us. There is a lot of American exceptionalism at work here. The U.S. is on a very distinct path when it comes to our health, our well-being and our survival," said Laudan Aron, senior fellow at the Urban Institute, a Washington-based nonpartisan research organization.

She said the long-term health trends are driven by socioeconomic factors "that are really proving to make life very challenging for many Americans."

Another new overview of American health, released early Thursday by the Commonwealth Fund, a health-care research organization based in New York, noted that the United States has a lower life expectancy than 10 peer nations - Germany, Britain, Canada, Australia, France, the Netherlands, New Zealand, Norway, Sweden and Switzerland - despite spending far more per capita on health care than any of them. The suicide rate, at 14 per 100,000 people, is twice that of Britain, the report said.

"We live sicker and die younger than our counterparts around the world - despite spending around twice as much as other nations on health care," said Roosa Tikkanen, a research associate at the Commonwealth Fund and the lead author of the report.

"We can do better," she added.

David Blumenthal, president of the Commonwealth Fund, said Wednesday that the poor health outcomes are due to a "very inadequate primary care system" in which too few people have access to medical care, with costly consequences such as trips to the emergency room and preventable illnesses. The report said the United States, compared with peer countries, has the highest rate of hospitalization from preventable causes and the highest rate of "avoidable deaths."

In recent years, obesity has increased death rates for heart disease, diabetes and other ailments: About 4 out of 10 adults age 20 and older in the United States are considered obese, and another 3 out of 10 are overweight, according to the CDC.

The CDC's annual report on life expectancy had been dismaying the previous three years, with the number dropping or remaining flat each year as the United States dealt with a wave of drug overdoses from illicit fentanyl flooding communities with high levels of opioid addiction. The CDC has linked the addiction epidemic of the past two decades to the widespread marketing and distribution, starting in the late 1990s, of prescription opioids.

As the epidemic blew up into a national crisis, doctors in 2013 began prescribing fewer painkillers, and deaths from pill overdoses gradually declined. But deaths from street drugs soared.

Governments and public health groups have dramatically increased the amount of naloxone, an anti-overdose medication, in communities across the nation. Billions of dollars have been poured by federal, state and local governments into drug treatment and other support services. The new report shows the first drop in the death rate per 100,000 people from overdoses since 2012 and the first decline in the raw number of deaths since 1990 - from 70,237 in 2017 to 67,367 in 2018.

That remains a staggering death toll, higher than the fatalities from motor vehicle accidents. The figure includes deaths from opioids, 46,802, a slight drop from the previous year's total of 47,600. By comparison, a decade earlier, in 2008, fatal opioid overdoses had not yet topped 20,000.

Still rising: fatal fentanyl overdoses, a subset of the opioid number. There were 31,335 in 2018, up from 28,466 in 2017 and a 10-fold increase from the number five years earlier.

Also up are overdose deaths from cocaine and psychostimulants such as methamphetamine - 14,666 and 12,676, respectively. The latter number is about triple the number from just four years earlier.

The American drug abuse crisis continues to evolve, with meth a growing cause of fatalities. There are ominous indications that the downward trend in fatal overdoses will not hold when the 2019 mortality data comes out. (The CDC usually takes about one year to produce final mortality data.) Earlier this month, the CDC released provisional drug overdose data - numbers that include "predicted" deaths, using an algorithm that adjusts for likely undercounts - that showed a slight increase nationally in drug deaths over the first six months of 2019.

Most of that increase has been seen in states west of the Mississippi. Experts on drug use in the West say that fentanyl, which became widespread initially in the eastern United States, has begun to play a bigger role in the western U.S. drug supply.

Drug overdoses play an outsize role in life expectancy because they often claim the lives of young people, cutting off many years of life, whereas a disease such as cancer typically affects people who are much older, noted Otis Brawley, an oncologist at Johns Hopkins University School of Medicine. "The average age of someone who dies from cancer is in their early 70s," he said.

Life expectancy at birth for females in 2018 remained five years greater than that of males: 81.1 and 76.1, respectively. That gap narrows with age because men are more likely than women to die young. At the age of 65, men have a life expectancy of 18 additional years and women 20.6.

The Washington Post’s Lenny Bernstein contributed to this report.