American Men and Life Expectancy

 A release from the Harvard T.H. Chan School of Public Health

We’ve known for more than a century that women outlive men. But new research led by Harvard T.H. Chan School of Public Health and UC San Francisco shows that, at least in the United States, the gap has been widening for more than a decade. The trend is being driven by the COVID-19 pandemic and the opioid overdose epidemic, among other factors.

In a research paper, to be published online on November 13 in JAMA Internal Medicine, the authors found the difference between how long American men and women live increased to 5.8 years in 2021, the largest it’s been since 1996. This is an increase from 4.8 years in 2010, when the gap was at its smallest in recent history.

The pandemic, which took a disproportionate toll on men, was the biggest contributor to the widening gap from 2019-2021, followed by unintentional injuries and poisonings (mostly drug overdoses), accidents, and suicide.

“There’s been a lot of research into the decline in life expectancy in recent years, but no one has systematically analyzed why the gap between men and women has been widening since 2010,” said first author Brandon Yan, a UCSF internal medicine resident physician and research collaborator at Harvard Chan School.

Life expectancy in the U.S. dropped in 2021 to 76.1 years, falling from 78.8 years in 2019 and 77 years in 2020.

The shortening lifespan of Americans has been attributed in part to so-called “deaths of despair.” The term refers to the increase in deaths from such causes as suicide, drug use disorders, and alcoholic liver disease, which are often connected with economic hardship, depression, and stress.

“While rates of death from drug overdose and homicide have climbed for both men and women, it is clear that men constitute an increasingly disproportionate share of these deaths,” Yan said.

Using data from the National Center for Health Statistics, Yan and fellow researchers from around the country identified the causes of death that were lowering life expectancy the most. Then they estimated the effects on men and women to see how much different causes were contributing to the gap.

Prior to the COVID pandemic, the largest contributors were unintentional injuries, diabetes, suicide, homicide, and heart disease.

But during the pandemic, men were more likely to die of the virus. That was likely due to a number of reasons, including differences in health behaviors, as well as social factors, such as the risk of exposure at work, reluctance to seek medical care, incarceration, and housing instability. Chronic metabolic disorders, mental illness, and gun violence also contributed.

Yan said the results raise questions about whether more specialized care for men, such as in mental health, should be developed to address the growing disparity in life expectancy.

“We have brought insights to a worrisome trend,” Yan said. “Future research ought to help focus public health interventions towards helping reverse this decline in life expectancy.”

Yan and co-authors, including senior author Howard Koh, professor of the practice of public health leadership at Harvard Chan School, also noted that further analysis is needed to see if these trends change after 2021.

“We need to track these trends closely as the pandemic recedes,” Koh said. “And we must make significant investments in prevention and care to ensure that this widening disparity, among many others, do not become entrenched.”

Alan Geller, senior lecturer on social and behavioral sciences at Harvard Chan School, was also a co-author.

“Widening Gender Gap in Life Expectancy in the US, 2010-2021,” Brandon W. Yan, Elizabeth Erias, Alan C. Geller, Donald R. Miller, Kenneth D. Kochanek, Howard K. Koh, JAMA Internal Medicine, online November 13, 2023, doi: 10.1001/jamainternmed.2023.6041

Education and Overdose

Many posts have discussed iinequality and higher education.

October 6, 2023  

David Powell, "Educational Attainment and US Drug Overdose Deaths"

JAMA Health Forum. 2023;4(10):e233274. doi:10.1001/jamahealthforum.2023.3274

Key Points

Question  Was educational attainment associated with overdose death rate growth in the US from 2000 to 2021?

Findings  In this cross-sectional study of 912 057 overdose deaths in the US from 2000 to 2021, overdose deaths increased sharply among individuals without any college education. The overdose death rate increased substantially between 2018 and 2021 for those without a high school diploma, primarily due to increases in deaths with synthetic opioid involvement.

Meaning  In this study, educational attainment, an important component of socioeconomic status, was found to be associated with overdose deaths, especially during the COVID-19 pandemic.

Opioid Abuse and Deaths of Despir

National Institute on Drug Abuse:

In 2021, an estimated 2.5 million people aged 18 years or older in the U.S. had opioid use disorder in the past year, yet only 1 in 5 of them (22%) received medications to treat it, according to a new study Some groups were substantially less likely to receive medication for opioid use disorder, including Black adults, women, those who were unemployed, and those in nonmetropolitan areas.

 Chun-Tung Kuo, and Ichiro Kawachi at JAMA Network: "County-Level Income Inequality, Social Mobility, and Deaths of Despair in the US, 2000-2019."

Question  Is the interaction between income inequality and social mobility associated with an increased risk of deaths of despair (deaths from suicide, drug overdose, and alcoholic liver disease) among the working-age population in the US?

Findings  In this cross-sectional study, higher income inequality and lower social mobility were associated with a higher burden of deaths of despair for Black, Hispanic, and White populations. In addition, the joint exposure of unequal income distribution and lack of social mobility was associated with additional risks of deaths of despair on both the additive and multiplicative scales.

Meaning  The findings of this study suggest that policy responses to the epidemic of deaths of despair must address the underlying social and economic conditions associated with these deaths.

Homelessness in California

A number of posts have dealt with homelessness.  

 A release from UC San Francisco:

The University of California, San Francisco BenioffHomelessness and Housing Initiative (BHHI) today released the largest representative study ofhomelessness in the United States since the mid-1990s, providing a comprehensive look at the causes and consequences of homelessness in California and recommending policy changes to shape programs in response. 

The California Statewide Study of People Experiencing Homelessness (CASPEH) used surveys and in-depth interviews to develop a clear portrait of homelessness in California, where 30% of the nation’s homeless population and half of the unsheltered population live.

The study found that, for most of the participants, the cost of housing had simply become unsustainable. Participants reported a median monthly household income of $960 in the six months prior to their homelessness, and most believed that either rental subsidies or one-time financial help would have prevented their homelessness.

...  

The study found that the state’s homeless popula`on is aging, with 47% of all adults aged 50 or older, and that Black and Native Americans are dramatically overrepresented. Contrary to myths of homeless migration, most were Californians: 90% of participants lost their last housing in California and 75% of participants live in the same county as where they were last housed. Nine out of ten spent time unsheltered since they became homeless. The median length of homelessness was 22 months.

One in five participants entered homelessness from an institution. Of those who hadn’t been in an institution, 60% came from situations where they weren’t leaseholders, such as doubling up with family or friends. Participants were disconnected from the job market and services, but almost half were looking for work.

...

 Participants had experienced multiple forms of trauma throughout their life, increasing their vulnerability to homelessness and contributing to their mental health and substance use challenges. Two-thirds reported current mental health symptoms and more than a third experienced physical or sexual violence during this episode of homelessness. More than a third had visited an Emergency Department in the prior six months. One in five who used substances reported that they wanted substance use treatment—but couldn’t get it. 

Religion and Deaths of Despair

Opiates of the Masses? Deaths of Despair and the Decline of American ReligionTyler Giles, Daniel M. Hungerman, and Tamar OostromNBER Working Paper No. 30840January 2023JEL No. I18,J11,Z12

Abstract:

In recent decades, death rates from poisonings, suicides, and alcoholic liver disease have dramatically increased in the United States. We show that these "deaths of despair" began to increase relative to trend in the early 1990s, that this increase was preceded by a decline in religious participation, and that both trends were driven by middle-aged white Americans. Using repeals of blue laws as a shock to religiosity, we confirm that religious practice has significant effects on these mortality rates. Our findings show that social factors such as organized religion can play an important role in understanding deaths of despair.

Life Expectancy Drops Again

Kate Sheridan at STAT:

Americans born in 2021 can expect to live for just 76.1 years — the lowest life expectancy has been since 1996, according to a new government analysis published Wednesday. This is the biggest two-year decline — 2.7 years in total — in almost 100 years.

The Covid-19 pandemic is the primary cause of the decline. However, increases in the number of people dying from overdoses and accidents is also a significant factor.

American Indian and Alaskan Native people have experienced a particularly precipitous drop in life expectancy since 2019, going from 71.8 to 65.2 years. This kind of loss is similar to the plunge seen for all Americans after the Spanish Flu, said Robert Anderson, the chief of the mortality statistics branch of the National Center for Health Statistics, a division of the Centers for Disease Control and Prevention.

...

This year’s life expectancy figure is 0.9 years lower than last year’s. Covid-19 accounted for about half of the decline, and a category encompassing accidents and unintentional injuries is responsible for another 16%. That category includes overdoses; in fact, about half of the unintentional injury deaths in this analysis were due to overdoses.
...

Not every demographic group saw the same changes, the researchers found. Asian-Americans have the highest life expectancy of any group — 83.5 years — and only saw a 0.1 year decline from 2020. Meanwhile, Black Americans lost 0.7 years between 2020 to 2021.

But American Indian and Native Americans saw the largest loss of life expectancy of all — 1.9 years less than 2020’s life expectancy, and 6.6 years less than 2019’s. They also had the lowest life expectancy among the groups studied. (Historically, Native Americans’ life expectancy has been staying level even in years when the life expectancy of the entire population did increase, one recent study found.)

Guns: Leading Cause of Death among Children and Adolescents

Jason E. Goldstick, Ph.D. Rebecca M. Cunningham, M.D.  Patrick M. Carter, M.D at The New England Journal of Medicine:

The Centers for Disease Control and Prevention (CDC) recently released updated official mortality data that showed 45,222 firearm-related deaths in the United States in 2020 — a new peak.1 Although previous analyses have shown increases in firearm-related mortality in recent years (2015 to 2019), as compared with the relatively stable rates from earlier years (1999 to 2014),2,3 these new data show a sharp 13.5% increase in the crude rate of firearm-related death from 2019 to 2020.1 This change was driven largely by firearm homicides, which saw a 33.4% increase in the crude rate from 2019 to 2020, whereas the crude rate of firearm suicides increased by 1.1%.1 Given that firearm homicides disproportionately affect younger people in the United States,3 these data call for an update to the findings of Cunningham et al. regarding the leading causes of death among U.S. children and adolescents.

 The previous analysis, which examined data through 2016, showed that firearm-related injuries were second only to motor vehicle crashes (both traffic-related and nontraffic-related) as the leading cause of death among children and adolescents, defined as persons 1 to 19 years of age.4 Since 2016, that gap has narrowed, and in 2020, firearm-related injuries became the leading cause of death in that age group (Figure 1). From 2019 to 2020, the relative increase in the rate of firearm-related deaths of all types (suicide, homicide, unintentional, and undetermined) among children and adolescents was 29.5% — more than twice as high as the relative increase in the general population. The increase was seen across most demographic characteristics and types of firearm-related death (Fig. S1 in the Supplementary Appendix, available with the full text of this letter at NEJM.org).

In addition, drug overdose and poisoning increased by 83.6% from 2019 to 2020 among children and adolescents, becoming the third leading cause of death in that age group. This change is largely explained by the 110.6% increase in unintentional poisonings from 2019 to 2020. The rates for other leading causes of death have remained relatively stable since the previous analysis, which suggests that changes in mortality trends among children and adolescents during the early Covid-19 pandemic were specific to firearm-related injuries and drug poisoning; Covid-19 itself resulted in 0.2 deaths per 100,000 children and adolescents in 2020.1

Although the new data are consistent with other evidence that firearm violence has increased during the Covid-19 pandemic,5 the reasons for the increase are unclear, and it cannot be assumed that firearm-related mortality will later revert to prepandemic levels. Regardless, the increasing firearm-related mortality reflects a longer-term trend and shows that we continue to fail to protect our youth from a preventable cause of death. Generational investments are being made in the prevention of firearm violence, including new funding opportunities from the CDC and the National Institutes of Health, and funding for the prevention of community violence has been proposed in federal infrastructure legislation. This funding momentum must be maintained.

Leading Causes of Death among Children and Adolescents in the United States, 1999 through 2020.



.

Penetrable

On September 18, 2019, the 45th president said:

Now, the wall still, obviously, has a ways to go, but we're building it at a breakneck speed. I wanted them to show you the interior of parts of the wall and what's inside of each individual slat. And you'll see it's a combination of steel, concrete, and—as one of the folks just said—it really is virtually impenetrable. Any walls that were put up would get knocked down very quickly, very easily. This wall is not something that can be really knocked down. I guess anything can, but this is very tough.

Nick Miroff at WP:

Mexican smuggling gangs have sawed through new segments of border wall 3,272 times over the past three years, according to unpublished U.S. Customs and Border Protection maintenance records obtained by The Washington Post under the Freedom of Information Act.

The government spent $2.6 million to repair the breaches during the 2019 to 2021 fiscal years, the CBP records show. While the agency has acknowledged that smugglers are able to hack through the new barriers built by the Trump administration, the maintenance records show damage has been more widespread than previously known, pointing to the structure’s limitations as an impediment to illegal crossings.

Smuggling gangs typically cut the barrier with inexpensive power tools widely available at retail hardware stores, including angle grinders and demolition saws. Once the 18-to-30-foot-tall bollards are severed near the ground, their only remaining point of attachment is at the top of the structure, leaving the steel beam dangling in the air. It easily swings open with a push, creating a gap wide enough for people and narcotics to pass through.

Deaths: COVID and Overdose

The U.S. faces other steep disadvantages, ones that experts worry could cause additional problems. For example, many Americans have health problems like obesity and diabetes that increase the risk of severe Covid. https://t.co/Ie4YT3jLlI

— The New York Times (@nytimes) February 2, 2022

Jon Kamp, Jennifer Levitz, Brianna Abbott and Paul Overberg at WSJ:

Two years into the Covid-19 pandemic, America’s death toll is closing in on one million.

Federal authorities estimate that 987,456 more people have died since early 2020 than would have otherwise been expected, based on long-term trends. People killed by coronavirus infections account for the overwhelming majority of cases. Thousands more died from derivative causes, like disruptions in their healthcare and a spike in overdoses.


Covid-19 has left the same proportion of the population dead—about 0.3%—as did World War II, and in less time.

Unlike the 1918 flu pandemic or major wars, which hit younger people, Covid-19 has been particularly hard on vulnerable seniors. It has also killed thousands of front-line workers and disproportionately affected minority populations.

It robbed society of grandparents, parents, spouses, sons and daughters, best friends, mentors, loyal employees and bosses. Those lost include a 55-year-old Rhode Island correctional officer; a 46-year-old Texas dental-office receptionist who helped care for her granddaughter; a 30-year-old Iowan who fatally overdosed; and an active 72-year-old and grandmother of 15 who was Nashville’s first female city bus driver.

“It’s catastrophic,” said Steven Woolf, director emeritus at the Center on Society and Health at Virginia Commonwealth University. “This is an enormous loss of life.”

O. Trent Hall and colleagues have an article at JAMA Pediatrics titled "Unintentional Drug Overdose Mortality in Years of Life Lost Among Adolescents and Young People in the US From 2015 to 2019."

 Over the 5-year period of this cross-sectional study, adolescents experienced nearly 200 000 YLL, and young people amassed greater than 1.25 million YLL [years of life lost]. Male adolescents and young people accounted for substantially greater unintentional drug overdose mortality (YLL and incident deaths) than female adolescents and young people. Although limited by death records potentially undercounting overdoses and a cross-sectional design insensitive to temporal relations between risk factors and deaths, our findings represent an unacceptable preventable mortality burden for adolescents and young people in the US. Prior research has identified polysubstance use, psychiatric comorbidity, and unstable housing as relevant risk factors for unintentional drug overdose in this age cohort.6 Our findings suggest that further resources are needed to mitigate these factors. The present study should inform future mortality reviews among adolescents and young people, as well as ecologic interventions involving family, school, and community, in unintentional drug overdose prevention and substance use treatment.

COVID and Deaths of Despair

At STAT, David Introcaso writes of deaths of despair:

The term deaths of despair comes from Princeton economists Anne Case and Angus Deaton, who set out to understand what accounted for falling U.S. life expectancies. They learned that the fastest rising death rates among Americans were from drug overdoses, suicide, and alcoholic liver disease. Deaths from these causes have increased between 56% and 387%, depending on the age cohort, over the past two decades, averaging 70,000 per year.

...

This psychological state is largely the result of economic hardship or the loss of work or wages, something that today is disproportionately experienced by approximately 66 million white workers without college degrees between the ages of 25 and 64 years, or 38% of working-age people. As Case and Deaton showed, this population has seen the purchasing power of their wages decline by 13% since 1979 while per capita income increased 85% over the same period.

The resulting health effects are altogether predictable. Insecurity, deprivation, the loss of possibilities, the lack of belonging, hopelessness, and social maladjustment lead to negative emotions including loneliness, unhappiness, worry, and stress that in turn lead individuals to, in part, experience more pain and pain sensitivity both physical and psychological. Over approximately the past three decades, survey data show that Americans, particularly middle-aged white people, report more pain than respondents in 30 other wealthy countries. Pain, especially chronic pain, can become a gateway to opioid use and addiction.

Factor in the Covid-19 pandemic, and it’s no wonder that 911 calls for opioid-related use increased 250% between 2019 and early 2020.

Echoing Durkheim, Case and Deaton concluded, “Jobs are not just the source of money; they are the basis for the rituals, customs, and routines of working-class life. Destroy work and, in the end, working-class life cannot survive. It is the loss of meaning, of dignity, of price, and of self-respect that comes with the loss of marriage and of community that brings on despair.”

Overdose

Kaitlin Sullivan and Reynolds Lewis at NBC:

Drug overdose deaths in the United States surpassed 100,000 in a 12-month period for the first time, the Centers for Disease Control and Prevention said Wednesday, a troubling milestone amid an already devastating period for the country.

The number of overdose deaths rose 29 percent, from 78,056 from April 2019 to April 2020, to 100,306 in the following 12 months. The data, from the CDC’s National Center for Health Statistics, is considered provisional but is a good indication of what the final numbers will show next month.

“It’s a staggering increase for one year,” said Bob Anderson, chief of the mortality statistics branch at the NCHS.

“As we continue to make strides to defeat the Covid-19 pandemic, we cannot overlook this epidemic of loss, which has touched families and communities across the country,” President Joe Biden said in a statement Wednesday.

Vermont saw the biggest rise, with a nearly 70 percent increase. Large increases were also observed in West Virginia (62 percent), Kentucky (55 percent), Louisiana (52 percent) and Tennessee (50 percent). Drug overdose deaths went down in just four states: Delaware, New Hampshire, New Jersey and South Dakota. South Dakota had a nearly 20 percent decrease in overdose deaths, the greatest by far.

Washington Post:

Justice Thomas on Federalism and the Inconsistencies of Marijuana Law

 Cite as: 594 U. S. ____ (2021) 1 Statement of THOMAS, J. SUPREME COURT OF THE UNITED STATES STANDING AKIMBO, LLC, ET AL., v. UNITED STATES ON PETITION FOR WRIT OF CERTIORARI TO THE UNITED STATES COURT OF APPEALS FOR THE TENTH CIRCUIT No. 20–645. Decided June 28, 2021

Sixteen years ago, this Court held that Congress’ power to regulate interstate commerce authorized it “to prohibit the local cultivation and use of marijuana.” Gonzales v. Raich, 545 U. S. 1, 5 (2005). The reason, the Court explained, was that Congress had “enacted comprehensive legislation to regulate the interstate market in a fungible commodity” and that “exemption[s]” for local use could undermine this “comprehensive” regime. Id., at 22–29. The Court stressed that Congress had decided “to prohibit entirely the possession or use of [marijuana]” and had “designate[d] marijuana as contraband for any purpose.” Id., at 24–27 (first emphasis added). Prohibiting any intrastate use was thus, according to the Court, “‘necessary and proper’” to avoid a “gaping hole” in Congress’ “closed regulatory system.” Id., at 13, 22 (citing U. S. Const., Art. I, §8).

Whatever the merits of Raich when it was decided, federal policies of the past 16 years have greatly undermined its reasoning. Once comprehensive, the Federal Government’s current approach is a half-in, half-out regime that simultaneously tolerates and forbids local use of marijuana. This contradictory and unstable state of affairs strains basic principles of federalism and conceals traps for the unwary

Thomas notes that the federal government outlaws marijuana even though 36 states have legalized it for medical use and 18 allow recreational use.

Yet, as petitioners recently discovered, legality understate law and the absence of federal criminal enforcement do not ensure equal treatment. At issue here is a provision of the Tax Code that allows most businesses to calculate their taxable income by subtracting from their gross revenue the cost of goods sold and other ordinary and necessary business expenses, such as rent and employee salaries. See 26 U. S. C. §162(a); 26 CFR. 1.61–3(a) (2020). But because of a public-policy provision in the Tax Code, companies that deal in controlled substances prohibited by federal law may subtract only the cost of goods sold, not the other ordinary and necessary business expenses. See 26 U. S. C. §280E. Under this rule, a business that is still in the red after it pays its workers and keeps the lights on might nonetheless owe substantial federal income tax. 

...

This disjuncture between the Government’s recent laissez-faire policies on marijuana and the actual operation of specific laws is not limited to the tax context. Many marijuana-related businesses operate entirely in cash because federal law prohibits certain financial institutions from knowingly accepting deposits from or providing other bank services to businesses that violate federal law. Black & Galeazzi, Cannabis Banking: Proceed With Caution, American Bar Assn., Feb. 6, 2020. Cash-based operations are understandably enticing to burglars and robbers. But, if marijuana-related businesses, in recognition of this, hire armed guards for protection, the owners and the guards might run afoul of a federal law that imposes harsh penalties for using a firearm in furtherance of a “drug trafficking crime.” 18 U. S. C. §924(c)(1)(A). A marijuana user similarly can find himself a federal felon if he just possesses a firearm. §922(g)(3). Or petitioners and similar businesses may find themselves on the wrong side of a civil suit under the Racketeer Influenced and Corrupt Organizations Act. See, e.g., Safe Streets Alliance v. Hickenlooper, 859 F. 3d 865, 876– 877 (CA10 2017) (permitting such a suit to proceed).

 

Drug Money and State Legislators

 Lev Facher at STAT:

In the last two years, at least 2,467 state legislators — over one-third of all state lawmakers nationwide — used pharmaceutical industry cash to fund their campaigns, according to a new STAT analysis of campaign finance records that spans the full 2020 election cycle. The industry wrote over 10,000 individual checks totaling more than $9 million.

STAT’s findings provide an unprecedented look at drug industry influence in state capitols across the 2020 election cycle. The dataset includes the largest 23 U.S. drug manufacturers by revenue plus the trade groups PhRMA and BIO. It builds upon a previous analysis that STAT published prior to the election, and now includes complete data from nearly every state, including all contributions made through Dec. 31, 2020.

Homicides Up in 34 Cities

 The Council on Criminal Justice has a report titled "Pandemic, Social. Unrest, and Crime in U.S. Cities."

This report examines changes in crime rates in 34 American cities during calendar year 2020, with a special emphasis on homicide and other violent crimes. The current study updates previous studies by the authors with additional data through December 2020. The study was conducted by criminologist and Professor Emeritus Richard Rosenfeld and Ernesto Lopez of the University of Missouri – St. Louis and Thomas Abt, Commission Director and Council on Criminal Justice Senior Fellow.
Methodology

This study examines monthly crime rates for ten violent, property, and drug offenses in 34 U.S. cities. Not all cities reported monthly data for each crime. The largest city in the sample is New York, with 8.42 million residents. The smallest is Norfolk, Virginia, with 245,000 residents. The crime data were obtained from the online portals of city police departments. The data are subject to revision, and offense classifications varied somewhat across the cities.

Findings

• Homicides rose sharply in 2020, and rates of aggravated assaults and gun assaults increased as well. Homicide rates were 30% higher than in 2019, an historic increase representing 1,268 more deaths in the sample of 34 cities than the year before.
• The magnitude of this increase is deeply troubling, but absolute rates of homicide remain well below historical highs. In 2020, the homicide rate was 11.4 deaths per 100,000 residents in sample cities; 25 years earlier, in 1995, the rate was 19.4 per 100,000 residents.
• Aggravated assault and gun assault rates in 2020 were 6% and 8% higher, respectively, than in 2019. Robbery rates declined by 9%.
• Dometic violence increased significantly during the early months of the pandemic, but these results should be viewed with caution as year-end rates were comparable to year-end rates in 2019, and findings were based on data from just 12 cities.
• Property and drug crime rates, with the exception of motor vehicle theft, fell significantly in 2020. Residential burglary decreased by 24%, nonresidential burglary by 7%, larceny by 16%, and drug offenses by 30%. Motor vehicle theft rose by 13%.
• Homicides increased in nearly all of the 34 cities in the sample. In the authors’ view, urgent action is necessary to address these rapidly rising rates. Subduing the pandemic, increasing confidence in the police and the justice system, and implementing proven anti-violence strategies will be necessary to achieve a durable peace in the nation’s cities.

Read the Report

Drug Money

  Lev Facher at STAT:

Well over one-quarter of all state lawmakers nationwide have accepted money from the pharmaceutical industry since the beginning of 2019, according to a new STAT examination.

In several states, taking drug industry cash was more the norm than the exception: In Illinois, more than 79% of the state’s 177 elected lawmakers have cashed such a check. In California, over 85% of lawmakers have taken pharma money. The data reveals the drug industry has poured over $5 million into state legislators’ campaigns in the past two years alone.

STAT’s analysis, conducted in partnership with the National Institute on Money in Politics, provides a first-of-its-kind study of the drug industry’s influence in state capitols. It follows a companion analysis of drug industry spending at the federal level, which revealed $11 million in industry giving as of July.

Drug Company Contributions 2020

Lev Facher at STAT:

The world’s biggest drug makers and their trade groups have cut checks to 356 lawmakers ahead of this year’s election — more than two-thirds of the sitting members of Congress, according to a new STAT analysis.

It’s a barrage of contributions that accounts for roughly $11 million in campaign giving, distributed via roughly 4,500 checks from the political action committees affiliated with the companies.

The spending follows a long tradition of generous political giving. Major manufacturers typically make hundreds of modest donations to incumbent members of Congress but avoid donating to presidential candidates, seeing little utility in placing presidential bets.

As the Covid-19 pandemic has sparked a race among drug makers eager to develop a vaccine and improve the industry’s standing in Washington — pharma’s giving underscores the breadth of its influence and its efforts to curry favor through lobbying and donations to the lawmakers who regulate health care.

...
“It’s less about a particular deliverable and more about creating a relationship,” said Sheila Krumholz, the executive director of the Center for Responsive Politics, a money-in-politics group that STAT contracted with to supply contribution records. “And, maybe, greasing the skids on a particular issue for which a company has great concern or sees great opportunity. On Covid, it’s certainly both — these corporations are being called to the aid of a country in crisis.”

Marijuana Use

From Gallup:

The July 2019 Gallup survey found that the likelihood to smoke marijuana varies significantly by gender, age, and political ideology.

• Men (15%) are more likely to smoke marijuana than women (9%).
• At 22%, 18- to 29-year-olds are the most likely age group to smoke marijuana -- about twice as likely as those between the ages of 30 and 64, and seven times as likely as adults older than 65.
• Liberals (24%) are six times more likely to smoke marijuana than conservatives (4%), and twice as likely as moderates (12%).

The Marijuana Opportunity Reinvestment and Expungement Act that would federally decriminalize marijuana passed the House Judiciary Committee in November 2019, but, with that bill yet to make it to the House floor and facing an uncertain future in the Senate, the use of marijuana remains illegal under federal law. Meanwhile, 33 states have legalized marijuana in some way for adults -- whether for medicinal or recreational use; however, only one of those states, Florida, is in the South, which is reflected in that region's lower rate of marijuana users.

America's Health Rankings

America's Health Rankings analysis of America's Health Rankings composite measure, United Health Foundation, AmericasHealthRankings.org, Accessed 2019.

• Healthiest State: Vermont: 0.850
• Least-healthy State: Mississippi: -1.005
• Definition: Weighted sum of the number of standard deviations each core measure is from the national average.

National Highlights:

• Since 2012, smoking decreased 24% from 21.2% to 16.1% of adults
• Since 2012, obesity increased 11% from 27.8% to 30.9% of adults
• Since 2003, air pollution decreased 36% from 13.2 to 8.4 micrograms of fine particles per cubic meter
• Since peaking in 1993, violent crime decreased 50% from 758 to 381 offenses per 100,000 population
• Low birthweight increased 4% from 8.0% to 8.3% of live births in the past three years, and 19% since 1993
• Since 2012, diabetes increased 15% from 9.5% to 10.9% of adults
• In the past four years, frequent mental distress increased 13% from 11.0% to 12.4% of adults
• Since 1990, infant mortality decreased 43% from 10.2 to 5.8 deaths per 1,000 live births
• In the past two years, mental health providers increased 13% from 218.0 to 247.4 per 100,000 population
• Drug deaths increased 37% from 14.0 to 19.2 deaths per 100,000 population in the past three years, and 104% since 2007

Mortality

Steven H. Woolf and  Heidi Schoomaker have a JAMA report titled "Life Expectancy and Mortality Rates in the United States, 1959-2017."  The abstract:

Importance US life expectancy has not kept pace with that of other wealthy countries and is now decreasing.

Objective To examine vital statistics and review the history of changes in US life expectancy and increasing mortality rates; and to identify potential contributing factors, drawing insights from current literature and an analysis of state-level trends.
Evidence Life expectancy data for 1959-2016 and cause-specific mortality rates for 1999-2017 were obtained from the US Mortality Database and CDC WONDER, respectively. The analysis focused on midlife deaths (ages 25-64 years), stratified by sex, race/ethnicity, socioeconomic status, and geography (including the 50 states). Published research from January 1990 through August 2019 that examined relevant mortality trends and potential contributory factors was examined.

Findings Between 1959 and 2016, US life expectancy increased from 69.9 years to 78.9 years but declined for 3 consecutive years after 2014. The recent decrease in US life expectancy culminated a period of increasing cause-specific mortality among adults aged 25 to 64 years that began in the 1990s, ultimately producing an increase in all-cause mortality that began in 2010. During 2010-2017, midlife all-cause mortality rates increased from 328.5 deaths/100 000 to 348.2 deaths/100 000. By 2014, midlife mortality was increasing across all racial groups, caused by drug overdoses, alcohol abuse, suicides, and a diverse list of organ system diseases. The largest relative increases in midlife mortality rates occurred in New England (New Hampshire, 23.3%; Maine, 20.7%; Vermont, 19.9%) and the Ohio Valley (West Virginia, 23.0%; Ohio, 21.6%; Indiana, 14.8%; Kentucky, 14.7%). The increase in midlife mortality during 2010-2017 was associated with an estimated 33 307 excess US deaths, 32.8% of which occurred in 4 Ohio Valley states.

Conclusions and Relevance US life expectancy increased for most of the past 60 years, but the rate of increase slowed over time and life expectancy decreased after 2014. A major contributor has been an increase in mortality from specific causes (eg, drug overdoses, suicides, organ system diseases) among young and middle-aged adults of all racial groups, with an onset as early as the 1990s and with the largest relative increases occurring in the Ohio Valley and New England. The implications for public health and the economy are substantial, making it vital to understand the underlying causes.

AARP v. PhRMA

Nicholas Florko at STAT:

AARP’s white-haired “strike force,” as the organization calls them, is on the offensive like never before — bashing big business with a righteous indignation that could surprise activists decades younger and positioning AARP as the drug industry’s primary opponent.

“I can’t really think of another time when there’s been this strong a message in opposition to an entire industry,” said John Rother, the group’s former head of policy and the current CEO of the National Coalition on Health Care.

As Max Richtman, head of the National Committee to Preserve Social Security and Medicare, put it, “PhRMA is an 800-pound gorilla. And I think they’re meeting another 800-pound gorilla in AARP.”

Positioning itself as pharma’s main antagonist, however, has opened up the group to a new line of attack from PhRMA, the drug industry’s lobbying arm, which has launched something of a counter-offensive campaign. Its ads zoom in on the roughly $600 million AARP rakes in each year from selling private Medicare Advantage and Medicare supplement insurance plans to its members. That hefty sum, PhRMA says, raises serious questions about the motivation behind AARP’s push.

“In many respects, AARP is an insurance company that is masquerading as a seniors advocacy organization,” said Robert Zirkelbach, executive vice president of public affairs at PhRMA. “AARP has significantly increased their involvement in the drug pricing debate, and we think it’s important to point out what might be motivating their perspective.”