We expect life expectancy to rise. We’ve got better medications, better surgical techniques, better diagnostic tests. We can do incredible things in medicine. But life expectancy is down, for the second year in a row.

In the U.S., life expectancy fell 1.8 years in 2020. Almost two years. And it fell another 0.6 years in 2021. People actually live 2.4 years less than they did back in 2019. 78.8 years has been shaved down to 76.4 years. Lives are 876 days shorter, contain 21,000 fewer hours, 1.26 million fewer minutes. Data are not yet available for 2022.

Covid is to blame for about half of the drop. That was the third-leading cause of death in both 2020 and 2021. A large portion (a bit over 15%) is due to more deaths from unintentional injuries. Heart disease is still the leading cause of death, and is actually bringing life expectancy down. Even with all the incredible (and expensive) treatments we have for heart disease, life expectancy has fallen in the last two years from it.

Overdose deaths are a big portion as well. Overdose deaths continue to rise, primarily from synthetic opioids such as fentanyl, not from prescription opioids. Deaths from illegal drugs increased 20-33% depending on which category you look at.

As a physician, this saddens me, and concerns me. We were caught with our pants down when Covid hit; as a hospitalist, I had to wear the same N95 mask for over 4 months, and it wasn’t even the size I was fitted for. We didn’t have those.

No one can argue that we were well-prepared for a pandemic. Maybe you can never really be prepared, but there are things we should have anticipated. Back in medical school I was appalled that the CDC put out reports on bicycle helmet safety. Yes, we want bicycle helmets to be safe, but we also need an organization focused on predicting and responding to infectious disease issues. Strategy is taught in business school, and the bottom line is that strategy is as much about what you choose not to do as it is about what you choose to do. If you want to be great at something, you have to prevent distractions, you have to focus on what you want to achieve. The federal government should separate the CDC to focus on infectious disease. Or hand that to a different organization, and get them focused.

We were not ready, and our lives are now 2.4 years shorter. Will we be ready for the next pandemic, or will we see life expectancy fall further?

Reference: Arias et al. Vital Statistics Rapid Release 2022;23. https://stacks.cdc.gov/view/cdc/118999

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