Life Expectancy Has Declined; Chronic Illness Rates Have Risen

Life expectancy in the U.S. had been rising steadily before a wave of overdoses and the COVID-19 pandemic. Chronic diseases are also making old age tougher for some.

Hollywood icon Betty White was a prime example of how extreme old age can be a time of health, productivity, and even fun. She was energetic, in demand as an actress, winning awards, and going strong until she passed away just weeks before what would have been her 100th birthday.

Although living into our 90s like Betty White isn’t the norm yet for most Americans, we’ve been headed in that direction. Life expectancy at birth in the U.S. had been rising steadily until a wave of overdoses and the arrival of COVID-19.

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The recent dip in life expectancy

It takes many deaths to change an average that includes the fate of more than 330 million people. Life expectancy dipped almost two years in 2020, when  the coronavirus became the third leading cause of death. The National Center for Health Statistics tallied more than 350,000 COVID-19 deaths, accounting for nearly 10.5 percent of all deaths. The number of people who died in 2020 was up in every age group after age 15, compared to the year before.

The toll affected every race or ethnic group, but not equally. Hispanic males were hardest hit, followed by Hispanic females, black males, and black females, in that order.

Early evidence, not yet the official count, suggests that life expectancy will fall again for 2021 (the next report will come in December 2022), with a change: Death rates for whites may pull down the overall numbers this time.

The all-time high in life expectancy came in 2014. A wave of drug overdoses pulled the average down until it rose again in 2018 and 2019, then fell with COVID-19.

How long might a newborn live?

The news is still good for babies, assuming we can do better at avoiding deaths from drugs and new viruses. Life expectancy numbers are always a snapshot of the current conditions. According to the most recent government report, females born in 2020 will likely make it to their 80th birthdays, while males born that year are projected to live to just past 74.

On average, American women who were 65 in 2020 had a projected two additional decades ahead of them; their male counterparts could expect to live about 17 more years.

We can thank better medical care, including prevention, for bringing down the rates of early death from cancer, heart disease, and stroke.

The impact of chronic disease

Not everyone is as lucky as Betty White. Even putting aside infectious diseases, living longer has been difficult for many. Chronic health problems make old age uncomfortable and ultimately shorten lives.

“The medical advances that have allowed sick people to live longer may not be able to keep up with the growing burden of chronic disease. It is becoming very clear that preventing the development of additional chronic conditions in the elderly could be the only way to continue to improve life expectancy,” noted Eva H. DuGoff, PhD, an assistant professor in the Department of Health Services Administration at the University of Maryland.

In an analysis of 1.4 million Medicare enrollees aged 67 and over, researchers at Johns Hopkins University found that nearly four in five of this group lives with multiple conditions. The first chronic condition cuts your life expectancy by about half a year, but that impact becomes more severe as the conditions pile up.

Many younger people have chronic conditions as well. Among all U.S. adults, more than 27 percent have multiple chronic conditions, and more than half have one.

“The balancing act needed to care for all of those conditions is complicated; more organ systems become involved as do more physicians prescribing more medications,” said Gerard F. Anderson, PhD, a professor in the Department of Health Policy and Management at Johns Hopkins. “Our system is not set up to care for people with so many different illnesses. Each one adds up and makes the burden of disease greater than the sum of its parts.”

While simply growing older raises the risk for many ills, the good news is that most chronic diseases that impair the quality of life as we age can be prevented or delayed. Heart disease, stroke, many cancers, type 2 diabetes, and arthritis are not only among the most common and costly of all health problems but also the most preventable.

One way Americans can lower the risk of chronic health problems in old age, while reducing healthcare expenditures throughout their lifetime, is to get weight under control. Obesity raises the risk of all the major killers in the U.S. as well as mental illness and pain.

An international report found that type 2 diabetes, largely exacerbated by people with the condition being overweight and sedentary, costs those Americans about $283,000 each in healthcare costs over their lifetime.

“Our findings underline the fact that diabetes not only has strong adverse effects on people's health but also presents a large — and at least partly avoidable — economic burden,” said Luxembourg-based health economist Till Seuring, who headed the global survey.

Keeping weight under control can also reduce your risk of arthritis. Taking better care of yourself will help make longer lives enjoyable.

Increased longevity is a global challenge. In a series of reports on aging and health, World Health Organization (WHO) researchers outlined both societal and medical strategies to promote flourishing old age. They called for policies that encourage older adults to remain active in the workforce longer and promote exercise, better diets, and quitting smoking.

"Collectively, we need to look beyond the costs commonly associated with aging to think about the benefits that an older, healthier, happier, and more productive older population can bring to society as a whole,” said Somnath Chatterji, MD, of the Department of Health Statistics and Information Systems at WHO.

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