Adults Under Age 65 Driving Decline in U.S. Life Expectancy. NewsWire

NEWSWIRE: 12/23/19

• A major new analysis of the past six decades of mortality data paints a bleak picture of declining life expectancy in America. Specifically, age-adjusted mortality rates among nonelderly adults (age 25-65) have been rising ever since 2010; and these rises span every race and ethnicity and nearly every state. (Journal of the American Medical Association)
• NH: I've often commented on the disappointing recent trend in overall U.S. life expectancy: After peaking in 2014, it has been falling for the last three or (possibly) four years. (Equivalently, we could say that the overall age-adjusted mortality rate has been rising since 2014.) See "U.S. Life Expectancy Drops Again," "U.S. Life Expectancy Lags," "U.S. Life Expectancy Declines Again." See first chart below.
• But as Steven Woolf and Heidi Schoomaker make clear in this comprehensive JAMA report, the news is really a lot worse than that. The mortality rate of the elderly is still falling. But the mortality rate of nonelderly adults age 25-65 (the authors confusingly call them all "midlife") has been rising so steeply that it has overwhelmed this improvement. From 2014 to 2017, the age-adjusted mortality rate of all age brackets rose by 1%; but the mortality rate of nonelderly adults rose by 6%--thus accounting for more than all of the increase. What's more, the rising mortality of nonelderly adults started four years earlier, in 2010. Generationally, at the moment, we're talking about first-wave Millennials, Gen-Xers, and last-wave Boomers. See second chart below.
• What exactly is driving these increases? Drug overdose deaths are one obvious culprit. While largely sparing seniors, the opioid epidemic has hit every age bracket of nonelderly adults about equally hard. Among Millennials and late-wave Xers, it is by far the largest cause of higher mortality. But opioids are not the only driver. Rising suicide rates are afflicting all nonelderly adult age brackets. And among those over age 45 (first-wave Xers and last-wave Boomers), many more drivers kick in: rising mortality from heart disease; diabetes; alcoholic liver disease; and chronic respiratory disorders (such as emphysema). See third chart below.
• I've written about most of these trends before. For opioids, see "Fentanyl Takes the Title of Deadliest Drug." For suicide, see "America's Suicide Rate--Up One-Third Since 1999." The rising trend in diabetes and heart disease among younger cohorts is probably driven by more obesity and less physical activity--which may make last-wave Xers and Millennials increasingly prone to these causes of death as they grow older. See "Why U.S. Death Rate from Heart Failure Is Surging" and "By Some Measures, Millennials Are In Even Worse Health Than Xers." According to Elo et al.'s analysis of mortality trends among white Americans: "Changes in obesity prevalence have greater correlation with geographic changes in life expectancy than any other variable that we examine." The generational decline in tobacco use will, over time, undoubtedly lead to future mortality reductions, especially those due to organ cancer and chronic respiratory disease. But the positive impact of less smoking thus far seems to be overwhelmed by the other negative lifestyle trends.
• So which nonelderly adults have been most affected by this mortality increase?
• By race, whites have experienced the largest rise (+32 deaths per 100,000), followed by blacks (+22), Hispanics (+10), and Asians (+4). Unlike many other analysts (for example, Anne Case and Angus Deaton), Woolf and Shoomaker deny that the rise has occurred exclusively among whites. These analysts, they say, may have missed the very recent (2016 and 2017) spike in black and Hispanic opioid deaths. See fourth chart below.
• By gender, men overall have experienced about twice the mortality rise as women. An important exception (correctly highlighted by Case and Deaton) is in the 45-64 age bracket, where women experienced a slightly higher rise due mostly to greater mortality from opioids, alcoholism, and suicide. 
• Geographically, the rise has been widespread. From 2010 to 2017, only four states did not experience higher mortality: New York, Texas, California, and Oregon. In West Virginia, Ohio, Maine, and New Hampshire, the mortality rise was over 20%. Of the total "excess deaths" due to higher mortality since 2010 (33,307), most have occurred in Appalachia, New England, the Ohio Valley states, the mid- and south-Atlantic states, and the deep South. Large cities were least likely to show a large rise. Rural counties were most likely, though opioid mortality alone rose most in the suburbs and exurbs of urban centers.
• Not surprisingly, given the regional mix, high-income and college educated Americans were least affected by the decline; and low-income, high-school educated Americans were most affected. As education and income levels rise in urban centers--and with low-income Americans now unable to migrate into urban centers (see "America's Steep and Troubling Decline in Geographic Mobility")--this socioeconomic gap increasingly overlaps with the urban-rural regional gap. Large metro areas are experiencing the fastest growth in college grads; they have the lowest rates of obesity and smoking; they have the most doctors per capita; and they have the highest employment rates. They also have the highest rates of in-migration (but this no longer includes many of the less educated). Rural counties, by contrast, have the highest rates of out-migration (which now consists disproportionately of the more educated). See fifth chart below.
• In short, the growing regional disparity in life expectancy reflects a growing income-and-education disparity in life expectancy. This gap was not a big deal for the G.I. and Silent Generations. But it is growing with Boomers and becoming quite large for Xers and Millennials. For men born in 1930, there was a 5.1 year gap in life expectancy at age 50 between the highest and lowest income quintiles. For men born in 1960, that gap has grown to 12.7 years. See sixth chart below. Entirely aside from the disappointing decline in average life expectancy, the widening mortality gap between urban and rural, rich and poor, has important implications for the actuarial discount rates used by insurers and pension plans--to say nothing of public policy and national politics.
• To be sure, we don't know how durable these trends are. Could they turn around in the next couple of years? One encouraging note: The CDC quarterly data indicate some resumption in mortality declines in 2018 and Q1 of 2019, triggered partly (though not entirely) by declining opioid deaths. There is some reason to look forward optimistically to the final annual numbers for 2018.
• Still, the trajectory of the last decade has been bleak.
• While most other high-income countries are experiencing a recent deceleration in life expectancy gains, few have experienced--like the United States--a multiyear retrogression in life expectancy. America already lags behind every comparable OECD country in life expectancy, and this lag has been growing over time. (Back in 1980, the United States was roughly on par with the high-income OECD average.) See last chart below. It is possible, therefore, that the lag may grow even faster in future years. And it isn't just opioids: The best estimate is that opioid deaths account for only about 10-15% of the "excess" U.S. mortality relative to other countries.
• Incredibly, this abysmal longevity performance has coincided with a vast acceleration in U.S. healthcare spending, which now spends two to three times more per capita than the systems of the other countries showing superior performance. Indeed, some of our worst recent health scourges (case in point: prescription opioids) have been expressly funded by a health system hellbent on overtreatment. And despite this abundance--or maybe even because of it--a large share of Americans put off getting needed care because they can't afford it. Yes, someone needs to grab this system and press the reset button.

• A recent Harvard study spotlighted growing income inequality among Boomers: The highest earners age 65+ have seen record income gains at the same time the number of households burdened by housing costs has hit an all-time high. Researchers also cited the uptick in homelessness among late-wave Boomers, a troubling trend that is projected to get worse. (Joint Center for Housing Studies of Harvard University)
• NH: For the foreseeable future, you can be sure of one thing: Most growth--indeed nearly all growth--in total U.S. households will be among aging-in-place seniors. Over the next 20 years, households age 75+ will grow from 8 to nearly 18 million, or by an astounding 10 million. See first chart below. The JCHS at Harvard takes an in-depth look at the future of senior housing by examining all households over age 50, that is, everyone who is or will soon become a senior.
• Most of what the authors project can be derived from generational aging. Compared to the Silent Generation, first-wave Boomers have already been widening the minority share of households age 65-75. That will continue as late-wave Boomers and Xers move into that age bracket. The same is true for the rising share of divorced (not widowed) singles living alone; the rising share living with their adult children (mostly in the parents' home--not the child's); the rising share living in low-density (exurban or rural) locations; and the rising share who rent rather than own. See second and third charts below. Inequality in income and net worth among seniors will also continue to grow. See fourth chart below.
• What's more, first-wave Boomers will probably represent the apogee of affluence for every senior age bracket they occupy. After them, average income and net worth will fall--and household debt will rise--in every age bracket as successive waves of last-wave Boomers and Xers move into them. This will be pose challenges for future low-income seniors, who will be much more likely to be homeless, or renters, or living alone, or living in a remote location, or burdened by high levels of mortgage or credit card or student loan debt.
• The authors' tabulations of income and net worth at age 50-64 versus age 65+ are revealing. See last chart below. It shows greater inequality in the younger group than the older group. It shows, surprisingly, that the net worth of every quintile in the younger group (which is still mostly working) is lower than the corresponding quintile in the older group (which includes 80- and 90-somethings who presumably are "spending down"). And it also shows, in both groups, a huge difference in net worth in favor of homeowners at every income level. Among 50-to-64 year-olds, for example, the net worth of a homeowner whose income is $19K is more than double the net worth of a renter whose income is $78K.
• As you move down from Boomers to Xers to Millennials, you see ever lower rates of homeownership--and little prospect, despite very low interest rates, of younger generations catching up to their parents any time soon. What kind of net worth will they eventually have when they retire? The JCHS worries about today's seniors--especially low-income Boomers who rent and have little net worth. Yes, life is tough for them. But I worry a lot more about tomorrow's seniors, since they will be ever-more likely to end up in that spot.
• Once upon a time, the New Deal articulated an ambitious national dream: to offer most Americans debt-free homeownership and retirement security. (The two things were thought to be related.) By the 1990s, the G.I. and Silent Generations had made that dream a reality. Today, for younger generations, that dream is starting to unravel.

• In Q3 2019, South Korea’s fertility rate fell to 0.88, the lowest quarterly rate on record. This number is down from the 0.98 yearly figure South Korea reported in 2018, which was already the lowest fertility rate in the world. (Bloomberg)
• NH: Again, South Korea awes demographers. Last September, I wrote extensively on South Korea becoming the first country whose fertility rate fell below 1 (see “South Korea’s Total Fertility Rate Falls Below One”). But now, the country has broken its own record with the fertility rate falling from 0.98 to 0.88 in July 2019. See first chart below.
• True, this is a quarterly estimate, not a final annual number. But the Q3 estimate is much lower than Q3 in 2018 or in any earlier year.
• This rapid drop in fertility is set to create real difficulties for South Korea. Extreme aging will put heavy burdens on younger generations who are taxed to fund pay-as-you-go retirement systems. And, of course, it will pose challenges for an economy accustomed to steady workforce growth.
• Previously, I wrote about the ramifications for the country's military (see “South Korea’s Declining Birthrate Means Fewer Soldiers”). South Korea has a two year male conscription requirement, and the current number of eligible men stands around 720,000 but this could drop to 520,000 by 2024. If fertility continues to fall so will the number of soldiers in the ROK Armed Forces.
• In 2018, the government began offering a subsidy of $88 per month for families with children under 5 years old. In 2019, the government shortened the workday by one hour for parents with a child 8 years old or younger. As of now, these incentives have failed to spur more babies--though similar subsidies in Russia, Poland, and Hungary suggest that the strategy may be helpful over time (see "Bold New Policies to Encourage More Births").

• The NHL is facing a demographic problem: It’s too white. With only 50 nonwhite players in the 2018-19 season, observers say the league has to “diversify or die”; already, nearly half of the 21 metro areas with NHL franchises have minority white youth populations. (The Wall Street Journal)
• NH: Bill Frey at Brookings, the author of the report that triggered the WSJ article, is a friend of mine. I partly disagree with his assessment. And I partly agree.
• Where I disagree is on the quantitative analysis. The NHL currently has 610 active players, 50 of whom are nonwhite or Hispanic. That's 6 more than three years ago. But it's also only 8% of all players, which sounds very low in a country in which 24% of the population is nonwhite and 40% is either nonwhite or Hispanic. (These percentages are even higher in younger age brackets.)
• But the NHL is unlike other major U.S. sports in one critical respect: Most of its players are not born here. Currently, only 24% of active NHL players were born in the United States. 48% were born in Canada, whose total nonwhite population share is only 22%, mostly of recent origin. And the rest are from Sweden, Russia, Finland, and other countries with historically very small nonwhite population shares.
• The broader question, I suppose, is whether racially skewed player and audience participation is necessarily a problem. In the NBA, for example, 76% of the active players are black--along with 45% of TV viewers (per Nielsen). This is wildly out of whack with U.S. demographics, but is not widely regarded as controversial. Procrustean population formulas may be out of place here. Winter sports like hockey have strong roots in Canadian and Nordic European countries. That may just be a fact about who is most likely to participate in them.
• Where I agree with Bill Frey is his advice that the NHL enforce strict policies promoting racial and ethnic tolerance. The NHL has experienced several recent instances of blatant prejudice or threats against nonwhite players. I don't agree with NHL Commissioner Gary Bettman on much, but I do on this: Bettman has taken a zero-tolerance policy on racial intolerance within the league. Some argue that the (immense) popularity of the NHL in Canada is beginning to decline due to such incidents. Perhaps. But maybe a better explanation is Canada's failure to win a Stanley Cup since 1993, as most of the best players migrate to the United States (which boasts bigger TV markets and lower tax rates).

• Fidelity’s Q3 2019 retirement report contained a warning for Boomers: Lay off the stocks. Over the past 10 years, this generation has increasingly exceeded the recommended allocation for stocks for people in their age group; a full 8% have their entire portfolio invested in equities. (Fidelity Investments)
• NH: There is plenty of good news in Fidelity's 2019 audit of its 30 million retirement accounts. Average defined contribution savings rates (employer plus employee) have been rising strongly in recent years. Participation rates are also rising strongly, especially among Millennials, thanks to auto-enrollment. And a rising share of savers are making a reasonable portfolio allocation between stocks and bonds. (Target-date funds are helpful here.)
• The main exception, however, is Boomers, who continue to favor odd portfolio mixes.  Some 5% of Boomers have zero exposure to equities in their 401-k's. And an estimated 38% are over-invested in equities (8% are 100% into equities) relative to what most investment advisers recommend for their current phase of life. Taking more personal risks has been a lifelong peer personality trait for Boomers--just as taking fewer personal risks is coming to be a cardinal trait of Millennials.
• It’s not just adulting: A new wave of “life design” courses has arisen to help stressed-out college students find meaning and better cope with the unknown. For many Millennials, it’s their first time taking a course that isn’t focused on executing a concrete task. (Christian Science Monitor)
• NH: If there’s one thing that makes Millennials nervous, it’s lack of structure. From grade school to college, they’ve been guided up each rung of the ladder backed by a chorus of parents and coaches. Ideally, all of their possible post-college paths would be laid out and tested for them, Game of Life-style. Alas, they’re not, and the uncertainty about the future is turning out to be a major source of stress.
• Enter “life design” courses, which are an increasingly popular way for Millennials to step off the ladder and think about life’s big questions. The title of a course at Smith College—“Getting Unstuck When You Don’t Know What’s Next”—says it all. What’s my purpose? How can I live a good life? What makes me happy?
• This methodological approach hearkens back to their parents' and grandparents' college experience, when higher learning was all about contemplating values and uncovering the meaning of life. The difference is that, back then, this quest often led students to question and challenge the establishment. Today, it's all about identifying priorities, setting goals, and building skills so that students can maximize their life chances within the establishment. You don't take out a six-figure student loan to learn how to criticize the bourgeoisie. You do it to figure out where the bourgeoisie (still) thrives--and then, step by step, to learn how to join it.

• In an essay, pop culture critic Jen Chaney describes the lasting influence that Mister Rogers had on Generation X growing up. Among other things, she writes, his show was more honest than other media or children’s fare about the fact that “life could be scary and it wouldn’t always be easy, but that you could get through it.” (Vulture.com)
• NH: Fred Rogers (aka "Mister Rogers") was an admirable role model for kids, especially compared to the drekkish and commercialized cartoon series that gradually pushed him to the side. But he was by no means a "role model" that Gen-Xers emulated. Jen Chaney is way off base on this one.
• Fred Rogers was, instead, a quintessential representative of his own Silent Generation (he was born in 1928)--and in many ways he reflected the best traits of his generation. He was soft-spoken, kind, tolerant, liberal yet orthodox in his religion (Presbyterian)--if also repressed, cloying, and soporific in demeanor. His "neighborhood" was gingerbread and white picket fences. His clothing never called attention to itself. His sock puppets were never angry. Everything about Mister Rogers said no risk and no edge. He got married at age 24 and remained married (once) until his death 50 years later.
• Does this sound like many Xers you know? Xers came of age with thrash metal and gansta rap, with ripped jeans and tongue rings, with X Games and Just Do It, with post-modern families and post-'60s cynicism, with free agency and a winner-takes-all economy. This was not Mister Roger's world. In Rich Dad, Poor Dad (an Xer bible), Mister Rogers was the nebbishy poor dad. The Silent were a well socialized generation that succeeded by playing by the rules. Xers were a barely socialized generation that learned young that they had to break the rules.
• A basic rule of Generations Theory (read The Fourth Turning to learn more) is that two-apart generations represent archetypal opposites. Xers are on the other side of the cycle from the Silent Generation. Just as Boomers are on the other side of the cycle from the G.I. Generation.
• To say that Fred Rogers served as a role model emulated by Xers is like saying Art Linkletter or John Wayne served as a role model emulated by Boomers. As the Duke would say, not hardly. If it's true at all, then it's only in the archetypal sense that I find myself precisely by pushing hard against this thing.

DID YOU KNOW?

One New Friend, Hold the Judgment. A recent New York Times article called attention to teenage “cancel culture”: the decision to “cancel,” or shun, others when they’ve done something objectionable. Typically, it’s portrayed as left-leaning young people distancing themselves from right-leaning peers. But as the Christian Science Monitor reports, cancel culture doesn’t mean that young people aren’t open to forming friendships with those with differing viewpoints. In fact, according to a new study from the nonprofit Interfaith Youth Core, the vast majority (94%) of first-year college students report having at least one friend of a differing religious or non-religious perspective as they begin school. Close friendships between first-year college students of different races (72%) or sexual orientations (59%) are more common than friendships between people with different religions or political leanings, but not by much. Moreover, majorities of students at both ends of the political spectrum—very liberal (54%) and very conservative (51%)—say they’ve disagreed with a friend about politics and remained friends.