USA's Falling Life Expectancy, and Deaths of Despair

How does the USA have a declining life expectancy while other developed countries are rising? Researchers feel it is from deaths of despair. Learn what the factors are and how we can help reverse the trend for ourselves and our communities. Show Notes and Resources: https://bit.ly/3Cm4SLI

Americans Die Prematurely More than Twice as Often as Countries with Similar Wealth - Why?
In 2015, life expectancy in the United States, the wealthiest country in the world, fell for the first time in decades.  When compared with similarly wealthy countries, Americans die prematurely more than twice as often. “Deaths as despair” is an explanation given the trend of despair-related mortalities, and evaluated how despair contributes to the rising drug-, alcohol-, and suicide-related deaths among different racial groups.

We talk about the research surrounding this phenomena and what we as a society can do to help reverse the trend for ourselves and others.

In This Episode:

• 02:40 - Celebrating Supercentenarians: Sister André dies at 118
• 04:43 - Recipe of the Week: French Chocolate Truffles
• 06:26 - Why is the USA's Life Expectancy Falling and What Can We Do About It?
• 24:23 - Old Age is a Gift, an Essay by Margaret Berry (at 100 Years!)
• 27:52 - Outro

Chapters

• 0:00 Intro
• 2:40 Celebrating Supercentenarians: Sister André dies at 118
• 4:43 Recipe of the Week: French Chocolate Truffles
• 6:26 Why is the USA's Life Expectancy Falling and What Can We Do About It?
• 24:23 Old Age is a Gift, an Essay by Margaret Berry (at 100 Years!)
• 27:52 Outro

Transcript

USA’s-Falling-Life-Expectancy-and-Deaths-of-Despair

This podcast does not provide medical nor legal advice. Please listen to the complete disclosure at the end of the recording. Hello, and welcome to Everyone Dies, the podcast where we talk about serious illness, dying, death, and bereavement.

I'm Marianne Matzo, a nurse practitioner, and I used my experience from working as a nurse for 46 years to help answer your questions about what happens at the end of life. And I'm Charlie Navarette, an actor in New York City, and here to offer an every person viewpoint to our podcast. We are both here because we believe that the more you know, the better prepared you are to make difficult decisions in a crisis.

So welcome to this week's show. Please relax, get yourself a pumpkin spice something and a snack, and thank you for spending the next hour with Charlie and me as we talk about deaths of despair, which are the impact of drug overdose, suicide, and alcohol abuse on people in communities who experience a prolonged sense of despair due to their social or economic circumstances. Like the BBC, we see our show as offering entertainment, enlightenment, and education, and divide that into three halves to address each of these goals.

Our main topic is in the second half, so feel free to fast forward to that next free zone if you want. In the first half, Charlie has our recipe of the week, and I think maybe finishes his series reporting about supercentenarian obituaries. This week, he's talking about Sister Andre, who was born in 1904, survived two pandemics and a COVID infection, and died at age 118 in 2023.

In the second half, I'm gonna talk about deaths of despair, and in the third half, Charlie has a reading about aging by an unknown author. No, I'm stunt 118. Marianne, would you want to live to be 118? Well, like I've always said, if I was living, you know, if I could run around and sass and roll my eyes.

What did my grandmother used to say? Something to the effect of as long as I can wipe myself, I'm okay. Something to that effect. Well, there is something to be said for being able to wipe yourself.

That's very true, yes. Okay. So in our first half, Sister Andre, a Roman Catholic nun dedicated decades of her life to caring for orphans and others when she was assigned to work in a hospital in Vichy, France.

Born Lucille Random on February 11th, 1904. Hey, Marianne, that's when New York City opened its first subway station. Really? Thought I'd throw that in.

Yeah, it was like three subway cars around the city hall. Wow, yeah, there we are. But I digress.

Sister Andre grew up in a Protestant family of six in the southern town of Alais. She worked as a governess in Paris and later converted to Roman Catholicism, baptized at the age of 26. She joined a charitable order about two decades later and took on her ecclesiastical title.

Sister Andre was assigned to a hospital in Vichy where she cared for orphans and others for three decades. She was known for her generosity, often aiding the elderly, mainly older people younger than herself. Sister Andre survived the influenza epidemic of 1918 to 1919, which took the lives of some 50 million people worldwide.

Her surviving COVID-19 in early 2021 was an uplifting story during the coronavirus pandemic when nursing homes were particularly at risk. Nearly all of the 88 residents of her facility became infected and several died. She was known to be a gourmet.

For her 117th birthday, she ate foie gras, roasted capon, cheese, and a dessert similar to baked Alaska. And she said she enjoyed a bit of wine and chocolate daily. Maybe that was the secret of her longevity.

The link to her full obituary is in the show notes. In honor of Sister Andre, and because we think that chocolate is the secret to a great life, our recipe this week is chocolate truffles. Homemade chocolate truffles are as decadent as they are simple to make.

These bite-sized chocolate confections are made with only four ingredients. Yet, they're blissfully elegant and incredibly delicious. They're creamy, melt in your mouth, and will satisfy any chocolate lover's cravings.

They're a luxurious treat to take to your next funeral lunch. Please go to our- Do you need a cigarette after that, or? Oui, yes I do. Falling in love again.

Please go to our webpage for this week's recipe for homemade chocolate truffles and additional resources for this program. Everyone Dies is offered at no cost, but is not free to produce. Please contribute what you can.

Your tax-deductible gift will go directly to supporting our nonprofit journalism so that we can continue to remain accessible to everyone. You can also donate at www.everyonedies.org. That's every, the number one dies.org. Or at our site on Patreon, www.patreon.com and search for Everyone Dies. Marianne.

Thanks, Charlie. In 2015, life expectancy in the United States, the wealthiest country in the world, fell for the first time in decades. The U.S. National Academy of Sciences reported that life expectancy was increasing in a control group of 16 wealthy nations, including countries in Western Europe, Canada, Australia, and Japan, while ours was dropping.

When compared with similarly wealthy countries, Americans die prematurely more than twice as often. That same year, two researchers, Case and Deaton, published a study about rising death rates and the stagnating life expectancy in the United States. These authors proposed a deaths as despair explanation given the trend of despair-related mortalities and evaluated how despair contributes to the rising drug, alcohol, and suicide-related deaths among different racial groups.

Drugs, alcohol, and suicide, called DAS for short, are cited as a major contributor to the declines in the overall life expectancy in the United States. Specifically, deaths from these causes have increased between 56% and 387%, and 87%, depending on the age cohort over the last 20 years, averaging 70,000 deaths per year. The impact of diseases of despair is greater among males than females and affects poor, uneducated, non-Hispanic whites more than any other race or ethnicity.

The ongoing opioid epidemic in the United States has brought attention to the suffering caused by diseases of despair and has provided a glimpse into how widespread and significant these conditions are. Deaths of despair fit into our current series about things that we don't have to die from, as well as our topic related to high school dropouts and early death. The phenomena was first examined more than a century ago.

In 1897, French sociologist Emile Durkheim defined these deaths as anomic suicide, anomic meaning alienated, in his book, Le Suicide. These deaths, he argued, resulted from a breakdown in social equilibrium or social rooms, or when individuals believe there's a lack of communal spirit or conclude the government is indifferent to their needs. The resulting health effects are predictable.

Insecurity, deprivation, the loss of possibilities, the lack of belonging, hopelessness, and social maladjustment lead to negative emotions, including loneliness, unhappiness, worry, and stress that in turn lead individuals to, in part, experience more pain and pain sensitivity, both physical and psychological. Over approximately the last 30 years, survey data document that Americans, particularly middle-aged white people, report more pain than respondents in 30 other wealthy countries. Pain, especially chronic pain, can become a gateway to opioid use and addiction.

Case and Deaton wrote that, quote, jobs are not just the source of money. They're the basis for the rituals, customs, and routines of working class life. Destroy work, and in the end, working class life cannot survive.

It is the loss of meaning, of dignity, of price, and of self-respect that comes with the loss of marriage and the community that brings on despair. End quote. There's little doubt that the ongoing opioid crisis has contributed to surging deaths, particularly among vulnerable Americans, with smaller roles attributable to non-drug suicides and alcohol.

One research study documented that increasing drug use between 1999 and 2016 reduced the life expectancy of American men by 1.4 years and that of women by 0.7 years. In West Virginia, the most affected state, the reductions were 3.6 years for women and 1.9 for men. Economists Novosadrok and Asher make similar points in their paper on the fate of the less educated Americans over time.

As of their data endpoints in 2018, deaths of despair that from drug overdose, suicide, and alcoholism account for a large share of mortality increases in young whites, but a very small share of rising mortality among older whites and very little of the differing mortality rates of blacks, they noted. Further deaths of despair have increased more uniformly across education distribution than deaths from other causes. In other words, while the overall rise in mortality is concentrated among the least educated, the opioid, suicide, and alcohol-related deaths is not.

Researchers have continued to study deaths of despair and a 2024 UCLA Health researchers document that middle-aged black Americans experienced higher mortality rates from despair than their white counterparts. And Native Americans endured the worst, having more than double the rates of these deaths compared to both black and white Americans. Deaths of despair among black Americans tripled from 2013 to 2022, while Native Americans experienced the highest rates of suicide, drug overdose, and alcoholic liver disease.

And this isn't to say that white Americans are doing just fine. Deaths of despair in this group jumped from 72 per 100,000 people in 2013 to 103 per 100,000 people in 2022. Deaths of despair among Latinos are starting to catch up to those among black and Native Americans.

One of the deaths of despair that we've not covered on our show is death from alcohol. Excessive alcohol use is the leading preventable cause of death in the United States, and about 178 people die from excessive drinking each year. These deaths occur from both drinking alcohol over several years to drinking too much on one occasion.

Excessive alcohol use is a term used to describe four ways that people drink alcohol that can negatively impact health and can be deadly. So excessive alcohol use includes one, binge drinking, which is defined as four or more drinks for women or five or more drinks for men during an occasion. The second type is heavy drinking, and this is eight or more drinks for women or 15 or more drinks for men during a week.

The third is underage drinking. That's any alcohol used by people younger than 21. And the fourth is drinking while pregnant, and that's any alcohol use during pregnancy.

Moderate alcohol use is defined as having one drink or less in a day for women or two drinks or less in a day for men. Drinking excessively on an occasion can lead to these harmful health effects in terms of injuries, which are motor vehicle crashes, falls, drownings, burns, violence, homicide, suicide, sexual violence, intimate partner violence. We become disinhibited when we drink.

And the part of our brain that tells us not to do dangerous things just shuts off and we just kind of do what our primal parts of us feel like doing. The third is alcohol poisoning. And this is high blood alcohol levels that affect body functions like breathing and heart rate.

And I've heard way too many stories of young kids who decide that they're going to, you know, I had my niece's best friend on her 16th birthday told everyone that she was gonna get really drunk on her 16th birthday and it was having a sleepover at her house and my niece was there. And the girl really drank a lot of alcohol. And went to bed.

And in the morning when her mother went to wake her up, she was dead. So, and that happens way more than you know about. Overdose from alcohol use with other drugs like opioids.

Things like sexually transmitted infections or unplanned pregnancy. Alcohol use can lead to sex without protection, which can cause these conditions. And in terms of pregnancy, miscarriage, stillbirth, or fetal alcohol syndrome disorder from any alcohol use during pregnancy.

Drinking any alcoholic beverages, including red or white wine, beer or liquor, is linked with cancer. The risk of some cancers increases with any amount of alcohol use. This includes breast cancer in women.

More than 20,000 people die from alcoholic related cancers each year in the United States. In terms of our general health, alcohol use can lead to high blood pressure, heart disease, liver disease, stroke. What's called alcohol use disorder, which affects both physical and mental health.

Digestive problems. Weaker immune systems, which increases your chances of getting sick. Social and wellness issues.

Mental health conditions, including depression and anxiety. Learning problems and issues at school or work. Memory problems, including dementia.

And relationship problems with family and friends. There's an online tool where you can check your drinking and it'll tell you if you fall into any of these categories. And we have a link in our show notes as well as other resources to help you rethink your drinking and decide if you want to cut down or stop drinking.

We know that this is your choice to make. This conversation about deaths of despair may trigger the thought that the rising rates of death of despair are tied to mental health and substance use disorders. Other factors also contribute to these disparities, including unequal access to healthcare and social service, an increasing toxic illicit drug supply, and dwindling economic insecurity.

David Intracaso wrote an opinion piece where he said, quote, the federal government's public acknowledgment of the existence and impact of death of despair would be good. Better still would be for HHS leadership to recognize the relationship between socioeconomic stratification and health or social medical status. Still better would be to borrow a page from Rudolf Virchow, the founder of Social Medicine, and recognize that disease is an expression of individuals under unfavorable conditions and that epidemics, by which I mean here deaths of despair, must be indicative of mass disturbances of mass life.

So you might have listened to this series and said, well, how does this affect me? What do I do with this information? Well, you take a look at all the things that we've talked about and say, how does this relate to me? Do I do these things and do I think I need to make a change? And it might, in fact, have an effect on your lifespan, how long you live and how many healthy years you have in front of you. You might take a look at the, when you go to vote and say to yourself, which of these candidates are talking about things like our public education system on the social determinants of health and taking a look at where are we really going wrong that we have one of the lowest life expectancies in developed countries? So these are the things that you can think about. And when you see kids in trouble, perhaps reach out to them.

You see peers in trouble, perhaps reach out to them. But the most that you can do, or at least the thing that you have primarily have control over is yourself and the choices that you make. Charlie, anything you wanna add? Well, you're a barrel of fun.

No, I mean, I, oh gosh. No, I'm just sitting here thinking. I mean, how many people I have dealt with just like that.

They're just feeling despair and sometimes just not aware that they're feeling that despair. And it's what you're saying, going, relying on drugs or booze to numb that pain. And sometimes it's physical pain, but a lot of the time it's emotional pain.

But then as you know, I mean, you take drugs and booze and eventually that numbness wears off. And as you say, an increasing number of people, yeah, instead of dealing with that, okay, time to get that bottle again or more drugs, more pills. Yeah, geez, welcome to the early 21st century.

Hi. Yeah, yeah, and it's tough for people to look in the mirror and to just realize or at least try to start to understand what they're doing to themselves. And I understand there's a lot of outside factors, like as you said.

I don't know, it's tough, Marianne. It is, it is. And we have our vote and we have the choices we make.

And I've always been an advocate of, we're at that age where we've retired and what are we doing? Like I have a friend who, she says, I can't believe all the stuff that you do. I just play on my phone all day and I wanna hit her. It's like, she's a skilled clinician.

She could volunteer, there's lots of things that she could choose to do. And why do we make the choice in our retirement to stop making a contribution to our society? Exactly, yes. I understand it's the path of least resistance.

You pick up the little toy and again, I enjoy having one of these iPhone things very much, but just because then I can find a new Italian restaurant. But yeah, that's me. I don't sit there hours on end, flipping through the thing.

Even when we were kids, sometimes we, parents would, mothers would say, get out of the house. And you just had to do stuff, go play ball or just hang out with friends or just sometimes, I remember just sitting on the porch sometimes, just reading. Yeah, you create a world for yourself instead of having to be entertained all the time, which from 19 to 90, I just see more and more people doing that, just do that.

Well, it's a choice and think about it when you pick up the phone or you pick up the remote, say to yourself, perhaps, is there somebody who needs me? Can you go read to children in a school? Can you go help the babies in the hospital? Can you, we've amassed so many years of experience in our work lives. Is there a way to use that for good? No, not to get paid. Right, exactly.

In our third half, old age, I decided, is a gift. I am now, probably for the first time in my life, the person I have always wanted to be. I mean, not my body.

I sometimes despair over my body, the wrinkles, the baggy eyes and the sagging butt. And often I am taken aback by that old person that lives in my mirror, but I don't agonize over those things for long. I would never trade my amazing friends, my wonderful life, my loving family for less gray hair or a flatter belly.

As I've aged, I've become more kind to myself and less critical of myself. I've become my own friend. I don't chide myself for eating that extra cookie or for not making my bed or buying that silly cement gecko that I didn't need, but really looks so avant-garde in my patio.

I'm entitled to overeat, to be messy, to be extravagant. I've seen too many dear friends leave this world too soon before they understood the great freedom that comes with aging. Whose business is it if I choose to read until 4 a.m. and sleep until noon? I will dance with myself to those wonderful tunes of the 50s, 60s and 70s.

And if I, at the same time, wish to weep over a lost love, I will. I will walk the beach in a swimsuit that is stretched over a bulging body and will dive into the waves with abandon if I choose to. I mean, despite the pity and glances from the bikini set, they too will get old.

I know I am sometimes forgetful, but then again, some of life is just as well forgotten. And I eventually remember the important things. Sure, over the years, my heart has been broken.

How can your heart not break when you lose a loved one or when a child suffers or when a beloved pet gets hit by a car? But broken hearts are what gives us strength and understanding and compassion. A heart never broken is pristine and sterile and will never know the joy of being imperfect. I am so blessed to have lived long enough to have my hair turned gray and to have my youthful laughs be forever etched into the deep grooves on my face.

So many have never laughed and so many have died before their hair could turn silver. You know, I could say no and mean it. I can say yes and mean it.

As you get older, it is easier to be positive. You care less about what other people think. I don't question myself anymore.

I've even earned the right to be wrong. So to answer your question, I like being old. It has set me free.

I like the person I have become. I'm not going to live forever, but while I am still here, I will not waste time lamenting what could have been or worrying about what will be. And I shall eat dessert every single day.

And that's it for this week's episode. Stay tuned for the continuing saga of Everyone Dies and thank you for listening. This is Charlie Navarette.

This is Charlie Navarette. And from Patti Smith, the Poet Laureate of Punk, it's part of the privilege of being human that we have our moment and we have to say goodbye. And I'm Marianne Matzo and we'll see you next week.

Remember, every day is a gift. This podcast does not provide medical advice. All discussion on this podcast, such as treatments, dosages, outcomes, charts, patient profiles, advice, messages, and any other discussion are for informational purposes only and are not a substitute for professional medical advice or treatment.

Always seek the advice of your primary care practitioner or other qualified health providers with any questions that you may have regarding your health. Never disregard professional medical advice or delay in seeking it because of something you have heard from this podcast. If you think you may have a medical emergency, call your doctor or 911 immediately.

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