In a recent study published within the Proceedings of the National Academy of Sciences (PNAS), researchers analyzed the mortality trends amongst adults of working age in addition to retirement age (above 65 years) in the US (US) and their relative impact on life expectancy stagnation observed post-2010. They found that increased mortality within the retirement age group, in addition to the years of life lost (YLL) and excess deaths in 2019, had a more significant impact on life expectancy stagnation than the increased mortality within the working-age population.
The life expectancy growth within the US has stalled since 2010 despite the advances made in science and healthcare. Previous studies attributed this stagnation to the increased mortality in middle-aged and younger adults, caused mainly by drug overdose, cardiometabolic diseases, and suicide. The current study aimed to investigate, for the primary time, the relative contributions to mortality amongst adults of working age and retirement age within the US.
Temporary Report: The “double jeopardy” of midlife and old age mortality trends in the US. Image Credit: Hyejin Kang / Shutterstock
In regards to the study
This study used statistical analyses to research the impact of mortality trends amongst working-age and older-age adults on life expectancy stagnation within the US. The term “double jeopardy” is coined to depict the mortality trends in these two age groups.
Annual mortality rates were obtained from the Human Mortality Database. The researchers calculated counterfactual death rates between 2000 and 2019 by extrapolating the common change in all-cause mortality specific to sex and single-year-age-group from 2000–2009 to 2010–2019. They applied these rates to 4 age groups: above 25 years, 25–49 years, 50–64 years, and above 65 years. Moreover, the surplus deaths and YLL were calculated and summed at every year of age between 5-year age groups.
To comprehensively assess age-specific contributions in situations that in a different way weight the age groups, the study used three population indicators of mortality: life expectancy, YLL, and excess deaths. The independent effects of mortality rates in working-age and retirement-age adults were mapped to those indicators between 2010 and 2019 and in comparison with the period 2000 to 2009, when the life expectancy at 25 years of age (e25) increased for men and women by 1.36 years and 1.72 years, respectively.
Results and discussion
As per the findings, e25 increased by 0.41 and 0.17 years for men and women, respectively. Had the trend for mortality in age above 25 years between 2000 and 2009 continued until 2019, e25 would have increased for each men (by 2.1 years) and ladies (by 1.2 years).
Real and counterfactual life expectancies at age 25, 2000 to 2019. Note: y axis is life expectancy at birth calculated from adding 25 y to e25 (life expectancy at age 25, conditional on surviving to age 25 y).
To isolate the effect of old age, only the mortality rate of age above 65 years was allowed to proceed at its 2000–2009 pace until 2019, while the working-age trends remained at their actual levels. Nevertheless, as an alternative of retirement age mortality, if the working-age mortality (ages 25–49 years and 50–64 years) were allowed to proceed on the 2000–2009 pace until 2019, the e25 would only have increased barely. These findings thus suggest that although the e25 stagnation is affected by mortality trends on the working age in addition to the retirement age, the latter trends have a more significant impact. Moreover, it was observed that the effect for ages above 65 years was contributed to more by hostile trends within the age group 65–84 than by the age group above 85.
In the surplus death evaluation, the impact of real and counterfactual death rates was compared on the 2019 population. As per the study, 76% of the 230,000 excess deaths in men and 81% of the 157,000 excess deaths in women occurred at ages above 65 years. Additional evaluation shows that the mortality in ages above 65 years accounts for YLL in each women (61%) and men (55%). As per the study, the coronavirus disease 2019 (COVID-19) pandemic further compounded the effect on preexisting life expectancy stagnation post-2019.
The authors discussed various interconnected aspects contributing to those mortality trends, corresponding to economic inequality, social isolation, and inadequate healthcare access. The counterfactual death rates presented on this study were comparable to those present in Japan, Switzerland, the UK, and Italy. Further research is required to raised understand the causes of mortality and the contribution of upstream aspects to this “double jeopardy.”
Conclusion
In conclusion, the findings suggest a greater impact of mortality trends of retirement-age individuals on life expectancy stagnation within the US. The study highlights the urgent need to handle the “double jeopardy” of midlife and old age mortality within the US, which could have significant implications for population health and well-being. Comprehensive and coordinated policy interventions geared toward addressing the underlying causes and determinants of those mortality trends may very well be helpful for improving health outcomes within the US population.