Losing Ground: Life Expectancy Trends in New York State

[Pages:24]September 2018

Losing Ground: Life Expectancy Trends in New York State

Contents

1 Executive Summary 3 Background 4 A Period of Rapid Growth, then Decline 5 Changes in Death Rates 7 Changes in Years of Life Lost Rates 9 Future Outlook

10 Obesity and Life Expectancy 12 "Deaths of Despair" and Life Expectancy 15 Conclusion 16 Limitations 17 Appendix

Number of Deahts per 100,000 Population

Executive Summary

Life expectancy in New York State had been growing steadily for decades; from 1990 to 2010, it increased from 74.7 years to 80.4 years. After years of being below average, life expectancy in New York has been higher than national levels since 1996; by 2010, New Yorkers could expect to live 1.6 years longer than the average American.

In a troubling reversal, the gains in life expectancy have begun stagnating in recent years, with New York State actually losing ground on life expectancy between 2014 and 2016. While New York still outpaces the nation (life expectancy peaked for the U.S. in 2013, at 78.9 years, and in New York State in 2014, at 80.7 years), the downward trend is cause for concern. Exhibit A, below, shows the dramatic shift in death rates in New York State since 2010, which coincides with the stagnated trend in life expectancy.

E X H I B I T A . Trends in the Number of Deaths per 100,000 Population in New York State: 1990?2016

950

925

900

875

850

825

800

775

750 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Source: Institute for Health Metrics and Evaluation, Global Health Data Exchange: .

To shed light on the drivers of the recent decline in life expectancy, this report explores trends in the rates of death and years of life lost in New York State by various causes. Data used for this analysis was retrieved from the University of Washington's Institute for Health Metrics and Evaluation (IHME) Global Burden of Disease (GBD) study.

1 Losing Ground: Life Expectancy Trends in New York State

Executive Summary (continued)

As Exhibit B illustrates, New Yorkers saw a decrease among most major causes of death in the years 1990?2010 and an increase in most causes for the years 2010?2016. Cardiovascular disease (particularly ischemic heart disease), certain cancers, and some neurological diseases saw particularly stark turnarounds for the worse between the two time periods.

E X H I B I T B . Increases and Decreases in the Number of Deaths per 100,000 Population for Major* Causes of Death: 1990?2010 and 2010?2016

CARDIOVASCULAR DISEASES

NEUROLOGICAL DISEASES

CANCER

OTHER NON-COMMUNICABLE DISEASES

Ischemic heart disease

1990? 2010

Other cardiovascular diseases

Alzheimer's disease and other dementias

Tracheal, bronchus, and lung cancer

Other cancers

Chronic respiratory diseases

2010? 2016

* "Major causes of death" are those that cause at least 5% of all deaths in New York State. See Supplemental Chart E for Causes of Death included in "Other" Categories. Source: Institute for Health Metrics and Evaluation, Global Health Data Exchange: .

The increasing trajectory of death rates for most major causes of death, rising obesity rates, and growing rates of so-called "deaths of despair" (including suicide and drug- and alcoholrelated deaths) are especially concerning for future trends for life expectancy in New York State. Obesity rates have increased dramatically since 1990, and drug use and self-harm have seen increases in recent years as well. The deaths associated with these conditions have contributed to the overall rise in death rate since 2010.

2 Losing Ground: Life Expectancy Trends in New York State

Background

Within the developed world, high and steadily increasing life expectancies have been the norm for generations. Prior analysis by the New York State Health Foundation revealed that life expectancy had increased, both in New York State and nationally, every year between 1990 and 2014 (with the exception of a decrease in New York State in 2001, following the events of 9/11).1

KEY FINDINGS

zz There was a declining trend in rates of death and years of life lost (YLLs) across most causes from 1990 through 2010 in New York State. During these years, life expectancy grew from 74.7 to 80.4 years.

After decades of advances, gains in life expectancy have stalled.

To better understand the reasons for the recent declines in life expectancy, we examined the trends in the rates of death and years of life lost from 1990?2016, by cause, within New York State. We use data from the Global Burden of Disease (GBD) study, conducted by the Institute for Health Metrics and Evaluation (IHME) for the analysis.2 The data allows us to explore trends from various causes of death, including those related to obesity and "deaths of despair" (suicide and drug- and alcohol-related deaths).

zz In a reversal of trends, death rates and YLLs worsened for most major causes of death after 2010. The growth in life expectancy flattened during this time and declined in 2015 and 2016.

zz Several trends raise concerns: the increasing trajectory of death rates for most major causes of death, rising obesity rates, and relatively high rates of drug overdose and other deaths of despair (including suicide and alcoholrelated deaths).

MORE INFORMATION ON DATA AND METHODS

IHME uses data from various sources including mortality data from the Centers for Disease Control and Prevention (CDC)'s National Center for Health Statistics (NCHS), but applies corrections to eliminate codes associated with ill-defined causes of death as well as other adjustments. Because of these differences, numbers are slightly different than government mortality data from the CDC. More information is presented within the IHME codebook, available for download at .

More details on the methods used to develop the Global Burden of Disease life expectancy and mortality related data, along with an analysis of trends across all U.S. states from 1990?2016, is available at:

? The US Burden of Disease Collaborators. The State of US Health, 1990-2016 Burden of Diseases, Injuries, and Risk Factors Among US States. JAMA. 2018;319(14):1444?1472. doi:10.1001/jama.2018.0158

1 New York State Health Foundation, "Trends in Life Expectancy for New Yorkers," resource/trends-life-expectancy-new-yorkers/, accessed July 2018.

2 The US Burden of Disease Collaborators. The State of US Health, 1990-2016. Burden of Diseases, Injuries, and Risk Factors Among US States. JAMA. 2018;319(14):1444?1472. doi:10.1001/jama.2018.0158.

3 Losing Ground: Life Expectancy Trends in New York State

A Period of Rapid Growth, then Decline

Life expectancy increased significantly throughout the United States--but especially in New York State--between 1990 and 2010. Life expectancy in New York State was lower than national life expectancy in 1990, but had eclipsed the national number by 1996. In 2010, life expectancy in New York reached 80.4 years, compared with 78.8 nationally (Exhibit C).

After 2010, progress stalled. Life expectancy peaked for the U.S. in 2013, at 78.9 years, and in New York State in 2014, at 80.7 years. In New York State, life expectancy was largely stagnant during this period, increasing from 80.4 in 2010 to 80.7 in 2014, before decreasing in consecutive years down to 80.5 in 2016. These decreases represent an alarming reversal of decades of growth.

E X H I B I T C . Life Expectancy Estimates for New York State and the United States, 1990?2016

81

Life Expectancy at Birth

80 In New York, life expectancy peaked in 2014 at 80.7 years

79

78

Nationally, life expectancy peaked at 78.9 years in 2013

77

76

75 New York State United States

74

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Source: Institute for Health Metrics and Evaluation, Global Health Data Exchange: .

4 Losing Ground: Life Expectancy Trends in New York State

Changes in Death Rates

The rapid increase in life expectancy between 1990 and 2010 coincided with a 20% decline in the all-cause death rate, from 938 to 751 deaths per 100,000 population. As shown in Exhibit D below, death rates for most causes of death declined between 1990 and 2010 (illustrated by the bars on the left side of the chart). The largest declines were for HIV/AIDS and ischemic heart disease (IHD), which refers to cardiac problems caused by narrowed heart arteries that often lead to heart attacks. The IHD death rate declined by more than onethird (from 319 to 197 per 100,000) and the HIV/AIDS death rate fell by 81% (from 32 to 6 per 100,000). In 1990, one in three deaths in New York was caused by ischemic heart disease. By 2016, only one death in four was caused by IHD (see Supplemental Chart A in the Appendix).

E X H I B I T D . Change in Deaths per 100,000 Population by Cause of Death in New York State, 1990?2010

Ischemic heart disease

-125

Stroke Other cardiovascular diseases

Breast cancer Colon and rectum cancer Tracheal, bronchus, and lung cancer

Other cancers

Alzheimer's disease and other dementias

Other neurological disorders

Cirrhosis and other chronic liver diseases Digestive diseases

Other non-communicable diseases HIV/AIDS and tuberculosis Diarrhea, lower respiratory, and other common infectious diseases

Neonatal disorders Maternal disorders

Chronic respiratory diseases

Nutritional deficiencies Neglected tropical diseases and malaria Other communicable, maternal, neonatal, and nutritional diseases

Unintentional injuries Road injuries

Interpersonal violence Self-harm

Diabetes mellitus

Other urogenital, blood, and endocrine diseases

Forces of nature, conflict and terrorism, and executions and police conflict Other transport injuries Alcohol use disorders Mental disorders

Opioid use disorders Other drug use disorders

-100

-75

-50

-25

0

25

50

Change in Death Rate

See Supplemental Chart A for full detail on levels of death rates over time and Supplemental Chart B, which shows the percent change in death rates for select periods. See Supplemental Chart E for Causes of Death included in "Other" Categories. Note: Change in death rate is calculated by subtracting the number of deaths per 100,000 in 1990 from the rate in 2010. Source: Institute for Health Metrics and Evaluation, Global Health Data Exchange: .

5 Losing Ground: Life Expectancy Trends in New York State

Changes in Death Rates (continued)

However, in the following years, the number of deaths per 100,000 population increased by 6.4% (from 751 in 2010 to 799 in 2016). This increase was spread across the majority of causes of death (illustrated by the bars on the right side of Exhibit E), including many of the causes that saw the largest decreases in the preceding decades. IHD, which had previously seen the most dramatic decline, increased by 4.1%. Alzheimer's disease increased by 14%. The only causes that saw declines in death rate during this period were HIV/AIDS, neonatal disorders, road injuries, interpersonal violence, and forces of nature, conflict, terrorism, and execution; notably, these causes were all already declining from 1990?2010.

E X H I B I T E . Change in Deaths per 100,000 Population by Cause of Death in New York State, 2010?2016

HIV/AIDS and tuberculosis Neonatal disorders

Road injuries

Ischemic heart disease

Stroke

Breast cancer

Other cardiovascular diseases

Colon and rectum cancer

Tracheal, bronchus, and lung cancer Other cancers

Other neurological disorders

Alzheimer's disease and other dementias

Chronic respiratory diseases

Cirrhosis and other chronic liver diseases

Digestive diseases

Other non-communicable diseases

Diarrhea, lower respiratory, and other common infectious diseases

Maternal disorders

Nutritional deficiencies Neglected tropical diseases and malaria

Other communicable, maternal, neonatal, and nutritional diseases Diabetes mellitus

Other urogenital, blood, and endocrine diseases Unintentional injuries

Interpersonal violence

Forces of nature, conflict and terrorism, and executions and police conflict

Self-harm

Other transport injuries Alcohol use disorders

Mental disorders Opioid use disorders Other drug use disorders

-6

-4

-2

0

2

4

6

8

10

Change in Death Rate

See Supplemental Chart A for full detail on levels of death rates over time and Supplemental Chart B which shows the percent change in death rates for select periods See Supplemental Chart E for Causes of Death included in "Other" Categories. Note: Change in death rate is calculated by subtracting the number of deaths per 100,000 in 2010 from the rate in 2016. Source: Institute for Health Metrics and Evaluation, Global Health Data Exchange: .

6 Losing Ground: Life Expectancy Trends in New York State

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