Ominous Reversal of Health Gains in the United States: Time to Rethink Research Priorities?
Authors: K.M. Venkat Narayan, Shivani A. Patel, Solveig A. Cunningham, James Curran
Journal: Annals of Internal Medicine (2019)

Ideas and Opinions5 March 2019Ominous Reversal of Health Gains in the United States: Time to Rethink Research Priorities?K.M. Venkat Narayan, MD, Shivani A. Patel, PhD, Solveig A. Cunningham, PhD, and James Curran, MDK.M. Venkat Narayan, MDRollins School of Public Health of Emory University, Atlanta, Georgia (K.V.N., S.A.P., S.A.C., J.C.)Search for more papers by this author, Shivani A. Patel, PhDRollins School of Public Health of Emory University, Atlanta, Georgia (K.V.N., S.A.P., S.A.C., J.C.)Search for more papers by this author, Solveig A. Cunningham, PhDRollins School of Public Health of Emory University, Atlanta, Georgia (K.V.N., S.A.P., S.A.C., J.C.)Search for more papers by this author, and James Curran, MDRollins School of Public Health of Emory University, Atlanta, Georgia (K.V.N., S.A.P., S.A.C., J.C.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M18-3653 Annals Author Insight Video - K.M. Venkat Narayan, MD, and James Curran, MD In this video, K.M. Venkat Narayan, MD, and James Curran, MD, offer additional insight into the article, "Ominous Reversal of Health Gains in the United States: Time to Rethink Research Priorities?" SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail After decades of gains, the average life expectancy in the United States has been declining since 2015 (1, 2). This phenomenon is driven by increases in midlife mortality rates among whites, Hispanics, Asians, and Pacific Islanders, which are caused by various preventable conditions, including overdose, alcohol-related illness, suicide, homicide, hypertensive disease, metabolic disorders, some types of cancer, and chronic respiratory illness (Figure) (1). The pattern and nature of this trend point to potential underlying systemic fault lines and call for a rethinking of the nation's approach to investigating and addressing health.Figure.Reversal of health gains in the United States.Reprinted with ...References1. Woolf SH, Chapman DA, Buchanich JM, Bobby KJ, Zimmerman EB, Blackburn SM. Changes in midlife death rates across racial and ethnic groups in the United States: systematic analysis of vital statistics. BMJ. 2018;362:k3096. [PMID: 30111554] doi:10.1136/bmj.k3096 CrossrefMedlineGoogle Scholar2. Ho JY, Hendi AS. Recent trends in life expectancy across high income countries: retrospective observational study. BMJ. 2018;362:k2562. [PMID: 30111634] doi:10.1136/bmj.k2562 CrossrefMedlineGoogle Scholar3. Woolf SH, Aron L, eds. U.S. Health in International Perspective: Shorter Lives, Poorer Health. Washington, DC: National Academies Pr; 2013. Google Scholar4. Diez Roux AV. Investigating neighborhood and area effects on health. 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Dwyer-Lindgren L, Bertozzi-Villa A, Stubbs RW, Morozoff C, Mackenbach JP, van Lenthe FJ, et al. Inequalities in life expectancy among US counties, 1980 to 2014: temporal trends and key drivers. JAMA Intern Med. 2017;177:1003-11. [PMID: 28492829] doi:10.1001/jamainternmed.2017.0918 CrossrefMedlineGoogle Scholar10. Goodwin JS, Kuo YF, Brown D, Juurlink D, Raji M. Association of chronic opioid use with presidential voting patterns in US counties in 2016. JAMA Netw Open. 2018;1:e180450. doi:10.1001/jamanetworkopen.2018.0450 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Rollins School of Public Health of Emory University, Atlanta, Georgia (K.V.N., S.A.P., S.A.C., J.C.)Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-3653.Corresponding Author: K.M. Venkat Narayan, MD, Rollins School of Public Health and School of Medicine, Emory University, RSPH, 1518 Clifton Road NE, Atlanta, GA 30322; e-mail, [email protected]edu.Current Author Addresses: Dr. Narayan: Rollins School of Public Health and School of Medicine, Emory University, RSPH, 1518 Clifton Road NE, Atlanta, GA 30322.Drs. Patel, Cunningham, and Curran: Emory University, 1518 Clifton Road NE, Atlanta, GA 30322.Author Contributions: Conception and design: K.M.V. Narayan, J. Curran.Analysis and interpretation of the data: K.M.V. Narayan, S.A. Cunningham, J. Curran.Drafting of the article: K.M.V. Narayan, S.A. Patel, S.A. Cunningham, J. Curran.Critical revision of the article for important intellectual content: K.M.V. Narayan, S.A. Patel, S.A. Cunningham, J. Curran.Final approval of the article: K.M.V. Narayan, S.A. Patel, S.A. Cunningham, J. Curran.Collection and assembly of data: K.M.V. Narayan, J. Curran.This article was published at Annals.org on 12 February 2019. PreviousarticleNextarticle Advertisement Annals Author Insight Video - K.M. Venkat Narayan, MD, and James Curran, MD In this video, K.M. Venkat Narayan, MD, and James Curran, MD, offer additional insight into the article, "Ominous Reversal of Health Gains in the United States: Time to Rethink Research Priorities?" 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