There's good news and bad news when it comes to American mortality — and the bad is threatening to overwhelm the good.
On the positive side, there are fewer deaths, per 100,000 people, from car accidents. There are fewer deaths from cancer. And there has been significant progress in recent years in driving down the death rate from heart disease.
Add to that the aggressive interventions in medical care in old age, and the picture is one of Americans living significantly longer — gaining exactly two years in life expectancy from 2000 to 2014, according to a report published Friday by the U.S. Centers for Disease Control and Prevention.
And yet simultaneously a variety of self-destructive behaviors are killing many thousands of Americans at an early age. The result is a situation that at a glance seems paradoxical: People on average have greater longevity, but the annual "death rate" — the number of deaths per 100,000 population — hasn't declined much in the past few years, and it actually went up between 2014 and 2015, according to the CDC.
The point seems to be, you might live a very long time if you can avoid dying young. And dodging an early demise is getting harder for a large swath of Americans.
The rise in the death rate between 2014 and 2015 reflects the increasing number of people dying from drug overdoses, homicides, suicides, firearms-related injuries, alcohol-related diseases, Alzheimer's disease, strokes, hypertension and other health problems, according to the CDC.
Because so many factors are driving this mortality, it's hard for policy makers to know what to do, said Dave Kindig, professor emeritus of population health sciences at the University of Wisconsin at Madison.
“The problem is that there’s not a silver bullet anymore – like a flu vaccine," Kindig said. “It makes for policy paralysis. If it’s everything, it’s nothing.”
The overdoses reflect a surge in opioid addiction. The pop star Prince, for example, died from an overdose of the synthetic opioid fentanyl, according to an autopsy report released Thursday.
The one-year rise in the U.S. death rate was not unprecedented: There have been upticks before, typically caused by a contagion such as HIV or influenza. But this was the first increase in 10 years. The recent pattern in the death rate suggests that gains on the mortality front in recent decades have been grinding to a halt.
White Americans are the outliers in the latest numbers — lagging behind blacks and Hispanics when it comes to increases in longevity. Blacks gained 3.6 years in life expectancy between 2000 and 2014, and Hispanics 2.6 years — compared with 1.4 years for whites.
Non-Hispanic whites still have a higher life expectancy than non-Hispanic blacks — 78.8 years to 75.2 years. Hispanics, at 81.8 years, have the highest life expectancy of the three demographic groups.
The CDC did not publish figures for Asian Americans and Native Americans because of insufficient data.
“Some of the data for Asian Americans and Native Americans, the quality of the racial information on the death certificate is not good," said Kenneth Kochanek, a statistician with the CDC's National Center for Health Statistics.
The relatively weak longevity gains for non-Hispanic whites reflects a huge spike in “unintentional poisonings,” as the CDC calls overdoses. The death rates due to "unintentional injuries," which includes poisonings, automobile accidents, drownings, falls, etc., increased a whopping 73.5 percent for non-Hispanic whites ages 45 to 54 between 2000 and 2014.
Death rates from suicides among whites in that same midlife group rose 57.5 percent, and their death rate from chronic liver disease rose 30.9 percent.
The drug overdoses have had a particularly severe effect on the life expectancy of whites ages 25 to 34. According to the CDC, they've seen a decline in life expectancy of 0.125 years between 2000 and 2014. Life expectancy also dropped for whites in the 35-to-44 and 45-to-54 age brackets.
By contrast, whites in older age brackets showed big gains in longevity. Leading the way were whites in the 65-to-74 age bracket, who gained 0.568 years in life expectancy, followed closely by whites 75 to 84, who gained 0.485 years.
The CDC did not break out the figures by gender, education, income or geography. An analysis of gender differences may be forthcoming, Kochanek said.
Research published last fall by economics professors Anne Case and Angus Deaton of Princeton University called attention to the rise in all-cause mortality among U.S. whites in the 45-to-54 age bracket between 1999 and 2013; their analysis showed that the rising death rate was concentrated among whites with a high school education or less. The CDC numbers extend that through 2014 and show three age brackets — 25 to 34, 35 to 44 and 45 to 54 — in which whites had higher mortality.
The Washington Post's own analysis, published in April, showed a similar result and pointed to a gender and geographical divide, with a sharper rise in mortality for white women compared with white men, particularly in small cities and the most-rural areas.