Life Expectancy and Healthy Longevity

Life expectancy declines

Were you surprised by recent headlines that for the second consecutive year, U.S. life expectancy decreased? For hundreds of years, and especially in the 20th century, improvements in life expectancy were the norm. Mortality rates between 1970 and 2013 decreased by 44%. However, ominous trends began to appear as we marched into the new millennium when the number of premature deaths in mid-life non-Hispanic whites unexpectedly began to rise.

Princeton economists Anne Case and Angus Deaton point to increased “deaths from despair” (suicides, drug and alcohol overdoses, and alcoholic liver disease), which occur in communities with limited economic opportunities. The economists cited rising inequities in counties without countervailing social support programs. And premature deaths in mid-life are now twice the rate in those without post-high school education.

The lifespan declines in 2020 and 2021—during the pandemic—are different. First is the direct effect from millions of COVID infections causing disproportionate deaths among the frail and most elderly. Sweden had headline-grabbing news from high death rates in long-term care facilities and in persons with Alzheimer’s—related to Sweden’s decision to avoid lockdowns and social isolation. The 2021 decrease in life expectancy will prove to be less a direct effect of COVID infections, as vaccines became available early that year. Rather, it likely reflects effects of isolation and lower life expectancy in under-resourced, impoverished groups. Native Americans comprise the group with the greatest decline.

Participants in our long running Adult Changes in Thought (ACT) study—with high vaccination rates and adherence to testing and isolation—experienced very few COVID deaths. However, they experienced more depression, loneliness, and overall loss of well-being during the pandemic.

Declining life expectancy and its causes are clearly important issues for public health and public policies. But what do they mean for us as individuals who aim to age well?

Most people (older and younger) do want to live a long life. Increased longevity is both a triumph and blessing of our times. But what most people want is a longer active life—avoiding long periods of dependency and dysfunction.

For individuals at any age, but especially older persons, the goal to pursue is healthy longevity through regular exercise, control of cardiovascular risk (especially maintaining a healthy blood pressure), avoiding excessive alcohol, not smoking, staying engaged in challenging mental undertakings, and maintaining an active life that includes social, spiritual, and other contemplative activities. It’s the usual list, but unfortunately not all that usual in many people’s lives.

The consequences of the pandemic and declines in life expectancy are not surprising. My hope is this will trigger greater awareness of social determinants of health and the absolute necessity that we address them, especially the need for universal high-quality education, and correcting widening economic disparities.

As individuals, we can still expect long lives, enjoying the historical gains in life expectancy. Remember what Eubie Blake, Mickey Mantle, and others have said, “If I’d known I would live this long I would have taken better care of myself.”

Eric B. Larson, MD, MPH, is the author, with Joan DeClaire, of Enlightened Aging. He is the founding principal investigator of the Adult Changes in Thought (ACT) study, ongoing for about 30 years. ACT recently was awarded a $55.6 million expansion grant from the National Institutes of Health.

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