U.S. death rates falling, but health gains bypassing some states

(Reuters Health) - Even as U.S. death rates decline, wide variation in life expectancy persists at the state level, a new study shows.

The state-by-state differences are due in large part to problems people can control, like how much they eat, drink, smoke, and exercise, researchers say.

Overall, death rates in the U.S. declined to 578 fatalities for every 100,000 people in 2016, from 745 per 100,000 in 1990, researchers report in JAMA. Much of this progress is happening because death rates are generally improving for children and teens as well as for Americans over age 55.

But among young and middle age adults - people from 20 to 55 - death rates have been going up for years in many states even as they fall in others.

More than six years now separate the state with the shortest life expectancy - Mississippi - from Hawaii, with the longest life expectancy at 81.3 years, the study found.

“Our analysis of those states confirms that an important part of the difference is related to the levels of the major risk factors: tobacco, overweight and obesity, diet, and alcohol and drug use,” said senior study author Dr. Christopher Murray, director of the Institute for Health Metrics and Evaluation at the University of Washington in Seattle.

Many of these risk factors contribute to death, illness and disability related to common chronic conditions like diabetes, heart disease and certain cancers.

During the study period, mortality rates for adults between the ages of 20 and 55 declined in 31 states and Washington, D.C., but increased more than 10 percent in five states.

Nationwide and in several states, risk factors like obesity, high blood sugar and drug use are getting worse, Murray said by email. While smoking has been on the decline, improvements vary widely from one state to the next, with smoking rates dropping 61 percent in California but only 20 percent in Kentucky.

All of these things are possible to change, Murray noted.

“The leading risk factors - tobacco, overweight and obesity, diet, alcohol and drug use - are highly amenable to individual action supported by effective primary care,” Murray said.

Heart disease and lung cancer were the leading causes of years of life lost in both 1990 and 2016, the study found.

At the start of the study, motor vehicle injuries were the third leading cause of lost years of life. By the end, chronic obstructive pulmonary disease took third place.

Researchers also looked at risk factors for “disability adjusted life years” (DALYs), or the number of years lost to poor health, disability or premature death.

Smoking, obesity, alcohol and drug use were among the leading risk factors for a shortened lifespan or living longer with illness and disability, the study found.

By the end of the study, opioids were the seventh leading cause of years lost to poor health, disability and premature death, up from 11th place in 1990.

The study wasn’t a controlled experiment designed to prove whether or how any individual risk factors contributed to illness, disability or premature death.

Still, it adds to a large and growing body of evidence highlighting a wide chasm between states with the healthiest residents and states with the highest rates of disease and disability.

“The national burden of modifiable risk factors is still unacceptably high,” said Dr. Howard Koh of the Harvard T.H. Chan School of Public Health in Boston.

“In the midst of so much suffering, prevention as a major health strategy remains overlooked and underappreciated,” Koh, author of an accompanying editorial, said by email. “Too many people are not reaching their full potential for health.”

SOURCE: and JAMA, online April 10, 2018.