Life expectancy at birth in the U.S. decreased by 0.3 years from 2014 to 2017—the largest decline since 1993. Although originally attributed to rising midlife deaths among white non-Hispanic residents, decreases in life expectancy have been observed in other ethnic groups. The rise in mortality has been attributed to unhealthy alcohol and drug use and suicide, but this was not evenly shared across socioeconomic strata. By 2010, the gap in life expectancy at age 25 between high school non-completers and college graduates ranged from 4.6 to 11.9 years. Between 60 to 80 percent of this gap was attributed to heart disease, smoking-related disease, and external causes of death (i.e. accidents, drugs, alcohol abuse, and suicide). A subsequent study in 2011 found that drug use deaths accounted for 15 to 20 percent of this difference.
Recently, a study was published that looked at differences in life expectancy in relation to educational achievement. It used publicly available data from the U.S. National Vital Statistics System and population estimates from the American Community Survey. They looked at two outcome variables—life expectancy at age 25 and years of life lost (YLL) between ages 25 and 84 from 2010 to 2017. They picked age 25 because by then most people have completed their education (except medical students, that is). They documented an overall decline in life expectance at age 25 between the study years. Although life expectancy increased among college graduates, this was offset by a decline in life expectancy in persons without a four-year college degree. An analysis of causes of death showed that educational differences were responsible for much of the increasing YLLs and were attributable to drug use, especially among less educated white men and women. This is consistent with other studies that have shown that drug use is responsible for increasing educational differences and early death from the 1990s to 2011. In black men, firearm deaths contributed to decreased life expectancies and increased educational differences. In white people between 25 and 84, rising mortality rates were especially increased in those with only a high school degree or less, while those with a college degree experienced an increased life expectancy. Nevertheless, drug use mortality increased over the seven-year period even in those with college degrees.
The nature of the recent declines in adult life expectancy and the differences in educational achievement across all race-sex groups remains unclear. Prior studies had linked the rise in mortality to “deaths of despair,” which consists of drug use, alcohol use, and suicide. It has been argued that these deaths collectively reflect self-destructive behavior linked to growing social isolation, economic distress, and downward social mobility that have characterized large segments of the U.S. middle class. In addition, this study confirmed what other studies have found—years of life lost due to drug use were substantially higher than increases associated with alcohol use and suicide. How prescient our mothers were when they repeatedly told us to stay in school, don’t use drugs, and don’t drink to excess. It’s still good advice today.