After bottoming out at a 25-year low during the COVID pandemic, American life expectancy is climbing again but has not fully rebounded. The increase of about a year was mostly attributed to falling COVID death rates.
That's good news. Yet, the partial recovery — and plateaus in US life expectancy that predate the pandemic — suggest much more work remains to be done, according to public health experts. And physicians can be the tip of that spear.
"This is no time for complacency," says Brandon Yan, MD, MPH, a resident physician and public health researcher at the University of California San Francisco. "This is the time to re-double our efforts in COVID vaccine outreach and continue [the] full-court press on combatting a drug overdose epidemic that will kill about 100,000 Americans this year."
In 2022, life expectancy at birth was 77.5 years, up from 76.4 in 2021, according to data released last week by the Centers for Disease Control and Prevention. But this remains below the pre-pandemic baseline of 78.8 years.
For American men, life expectancy at birth also rose (to 74.8), though it's still 5 years lower than that of their female counterparts. "Men die on average 5.4 years earlier than women, which is above what it was in 2010 (4.8 years) and higher than what we see globally, which is closer to 4 years," says Yan, author of a recent study on the lifespan gender gap.
Before the pandemic, gains in US life expectancy had been slowing for decades, putting us behind other wealthy countries with life expectancies into the 80s. Public health experts have pointed to a range of factors, including drug overdose deaths, alcohol-related disease, suicides, and cardiometabolic disease.
Medscape spoke with experts about these and other reasons, and what you can do to help keep life expectancy trending in the right direction.
Preventing COVID and Other Disease
Let's start with the elephant in the room: To date, COVID has killed more than a million Americans, hitting men harder than women.
Growing gender gaps in rates of cardiovascular disease and diabetes may help explain the disparity, Yan says, as these comorbidities increase the risk of dying from COVID.
That the gap has started to narrow "speaks to the effectiveness of COVID-19 vaccines in bringing down COVID death rates," Yan says.
What you can do:
Keep encouraging COVID vaccines. If declining vaccination rates have you discouraged, just know that your voice matters: In a study from UMass Chan Medical School, 13% of participants who had said they would not get vaccinated, and one third who were on the fence, changed their minds following a physician's recommendation. The line that worked especially well: "The vaccine is the best way to protect the people you are close to from this virus and keep them healthy."
Preach prevention for risk factors. Obesity, diabetes, and cardiovascular disease can all increase the risk for severe COVID. While not all your patients will take your lifestyle advice, some might — and that makes the effort worthwhile. "There's an urgent need for our healthcare system to transform toward one that focuses on preventive care," says Yan. "Focusing on underlying risk factors that can be intervened upon can lead to productive action over time."
Addressing Loneliness and Mental Health
Even before the pandemic, and since then, there has been a rise in so-called deaths of despair, such as drug overdoses, suicides, and alcohol-related liver disease. During COVID, homicides and deaths from traffic accidents spiked, too. Loneliness, declining mental health, and easy access to firearms compound these problems.
What you can do:
Take a little extra time with patients who live alone. Start with an open prompt like "talk about loneliness," suggests the University of Washington's Stephen Bezruchka, MD, MPH, who led a panel on America's declining health at this year's American Public Health Association annual meeting. If the patient lacks social connections, consider referring them to a social worker or a service like Meals on Wheels that provides opportunities for social interaction.
Ask patients about their childhood. "Something that has become remarkably powerful is that adverse childhood experiences, or abuse in childhood, has lifelong effects," says Bezruchka. Childhood trauma is linked to an increased risk of drug use, suicide, and poor cardiometabolic health. If the patient reports a history of abuse, listen empathetically, let them know that their past could affect their health today, and refer them to a counselor or other resources for support. "Just allowing the patient to realize that these early life factors have profoundly affected them in therapy — it's a big, important step," Bezruchka says.
Ask patients if they have firearms at home. Make it a routine screening question, even if it can be a difficult one. Some patients may consider the subject off limits in the doctor–patient relationship. But research suggests that gun ownership increases suicide risk, and that unsafe gun storage is linked to unintentional firearm deaths. Avoid a defensive reaction by using neutral language. A 2021 article in the American Journal of Public Health suggests using the term "firearm," not "gun." For patients who own firearms: Instead of "Are your firearms locked up?" consider saying, "Do you prevent access of your firearms by unauthorized individuals?"
Ask open-ended questions and let patients speak. A study from Mayo Clinic showed that physicians tend to interrupt patients after just 11 seconds. "Active listening helps build the patient–physician relationship and bring out topics that otherwise might have gone unnoticed," says Yan.
Raising Awareness for Health Equity
Social and racial inequality hampers access to everything, from healthcare to healthy foods and physical activity. "It's very much an individualistic country," says Ryan Masters, PhD, associate professor of sociology at the University of Colorado Boulder. This means we try to educate the population at large, "but then put the onus of responsibility on individuals to utilize that knowledge to act in the best way possible." The result: highly unequal outcomes along lines of class, race, and other marginalized populations.
What you can do:
Join an advocacy group. This may seem like a big ask, but physicians are in a unique position to advocate for health equity. In fact, many medical organizations consider it a professional responsibility. The American Medical Association has stated that physicians must "advocate for the social, economic, educational, and political changes that ameliorate suffering and contribute to human well-being."
"There's a whole host of groups that doctors could ally with," says Bezruchka, author of Inequality Kills Us All: COVID-19's Health Lessons for the World. He's active in Washington Physicians for Social Responsibility, which has a task force dedicated to inequity.
Talk to patients and their families about the social determinants (or nonmedical factors) of health. "The best evidence suggests that perhaps 10% of mortality aversion can be produced by medical care," says Bezruchka. The other 90% primarily comes down to social determinants. Consider using a social risk screening tool to help clarify the patient's true risk; visit the Agency for Healthcare Research and Quality website for validated options. For each domain on the screening tool, be ready with a list of institutional resources, community organizations, and public health agencies that patients can turn to in areas where they need help.
Recognize that you can make a difference. Simply talking about these issues may not feel like a lot, but awareness is the first step toward change, says Bezruchka. Try this tip he teaches to medical students: Prepare a 20-second elevator pitch about social issues that affect health. Consider this: When Bezruchka was an emergency department physician, he found ways to discuss these issues with patients and their friends and families. Often, people would later tell him they remembered his points — a sign that he was making an impact, one person at a time. "If we can't talk about something, then it is almost impossible to expect something good to happen," Bezruchka says.
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