More and more Mainers are dying in the prime of their lives, the result of rising suicide rates, drug overdoses, alcoholism and medical problems such as heart disease, a new study found this week.

The Virginia Commonwealth University study published in the Journal of the American Medical Association found that deaths among Americans ages 25-64 are surging in the Ohio Valley and northern New England in particular.

“There’s been a dramatic increase in the death rate for working age adults,” one of the study’s co-authors, VCU’s Dr. Steven Woolf, said Friday. The trend, he said, is going in “completely the wrong direction.”

Virginia Commonwealth University

The surge in the death rate cut across boundaries of sex, race and culture, but the worst-hit areas are mostly white and rural. It appears that economic factors played a role and that a lack of health care access may have as well.

Woolf said the problem is worst in places with “an economy that lags behind” the middle class, and that dealing with it effectively is going to require policies that address the economic issues that have made it so difficult for many Americans.

“It’s something that’s pretty urgent,” Woolf said.

Between 2010 and 2017, the study published Tuesday determined, the midlife mortality rate increased by nearly 21 percent in Maine, a much faster rate than the nation as a whole. It trailed only three states: New Hampshire, West Virginia and Ohio.

Woolf said that in Maine and the Northeast the opioid epidemic was “probably a major force behind this trend,” but it’s far from the only reason that so many younger adults died.

Compared to the 1990s, the study found, working-age adults in the United States are more likely to die before they reach age 65 from causes often cited as “deaths of despair,” but also from an array of diseases related to hypertension and obesity.

The study estimated that more than 33,000 died between 2010 and 2017 than would have been anticipated had the trend line not turned negative, with the bulk of those deaths occurring in the Ohio Valley, where the population is higher than it is in sparsely populated northern New England.

Mortality rates are up for 35 different causes of death, including strokes and pulmonary disease.

Since 1999, the study found, drug overdose deaths among working age Americans are up 386 percent and suicides 38 percent. Obesity-related deaths are up 114 percent, it found, while deaths from diseases related to hypertension are up 79 percent. Chronic liver disease, usually a sign of alcoholism, increased by 41 percent.

All of it helps explain why life expectancy in the U.S. has slipped for three years in a row, bucking a long-term trend toward longer lives that began at least 120 years ago.

Woolf said the trend toward increasing mortality reaches back several decades when life expectancy increases in the U.S. started to fall behind the gains in other wealthy countries.

Life expectancy stalled in the U.S. in 2011 and began falling five years ago. Maine’s peak life expectancy came in 2012, when it hit 79.2 years. Five years later, it was down to 78.7, according to federal government statistics cited in the study’s supplemental data.

“The notion that U.S. death rates are increasing for working-age adults is particularly disturbing because it is not happening like this in other countries,” Woolf said in the prepared release. “This is a distinctly American phenomenon.”

It has hit especially hard in the three northern New England states, as well as Ohio, West Virginia, Indiana, Kentucky and Pennsylvania, the study found.

“As a group, rural U.S. counties experienced larger increases in all-cause midlife mortality,” the study said.

Woolf said that Americans tend to think they have the best health care system in the world and that they are the most healthy people. Neither is true, he said.

The study found that working-age mortality since 2010 occurred most sharply among women and adults without a high school diploma and hit hardest in places slammed by economic changes in recent decades. Women, who had generally been healthier in the past, are seeing their advantage narrow in part because of cigarettes and obesity.

“Deaths from mental and nervous system disorders were second only to deaths from drug overdoses in influencing changes in life expectancy and were the leading contributors to decreased life expectancy among white females,”  the study said. “Among white females, respiratory disease mortality was a larger contributor to changes in life expectancy than either suicides or alcohol-related causes and accounted for more deaths in rural areas than drug overdoses.”

The difficulty of finding good jobs and other socioeconomic factors played a role in the rising mortality, the study found.

The study said the implications of its findings are broad.

They affect “working-age adults and thus employers, the economy, health care, and national security. The trends also affect children, whose parents are more likely to die in midlife and whose own health could be at risk when they reach that age, or sooner,” it said.

The authors also pointed out that “recent data suggest that all-cause mortality rates are increasing among those aged 15 to 19 years and 20 to 24 years” as well, suggesting the problem isn’t likely to go away soon.

The authors, Woolf and Heidi Schoomaker, a medical student who used to work for Woolf, said that efforts to improve health “seem warranted, such as policies to promote education, increase household income, invest in communities, and expand access to health care, affordable housing, and transportation.”

“The increase in mortality from substance abuse, suicides and organ system diseases argues for strengthening of behavioral health services and the capacity of health systems to manage chronic diseases,” they said.

Woolf said that Medicaid expansion and other policies that directly impact health care coverage will likely help, but it has to go further than that. The problems affecting working age adults go beyond access to medical care, he said, and relate directly to finding ways to create stronger communities and jobs.

Woolf said he would like to delve more deeply into the question of why some states experienced a sharp increase while others did not. What they did differently in terms of policy may help clarify what could be done better, he said.

Death rates in Maine vary widely from place to place.

In 2014, Washington County experienced 931 deaths per 100,000 people. In Cumberland County, the rate was 726 per 100,000, more than 20 percent lower. Androscoggin County had 853 deaths per 100,000.

In general, the healthiest parts of the country for working age Americans are the West Coast, New York and the Southeast.

Woolf said he wondered about JAMA’s decision to publish his findings just before Thanksgiving.

“That’s really a buzzkill,” he said.

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