Could the Connection Be ACEs and/or a Pair of ACEs?


The Washington Post online ran an article November 26th, titled "'There's something wrong:' Americans are dying young at alarming rates." The article talked about a recent report published in Journal of the American Medical Association, titled "Life Expectancy and Mortality Rates in the United States, 1959-2017." I've copied the report's findings are below: 

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.

As we know from Jane Steven's review of the CDC-Kaiser ACE Study and ACEs Science shared in her article, "ACEs Science 101," early death, suicides, organ system diseases, obesity, and alcohol or other drug addiction are outcomes of having experienced Adverse Childhood Experiences. And as further explained by Wendie Ellis, in her article, "the soil in which we're rooted, the branches on which we grow,"  Adverse Childhood Experiences are fueled/exacerbated by Adverse Community Environments; referred to as The Pair of ACEs.

Which leads to my title...

Could the Connection Be ACEs and/or a Pair of ACEs?

Likely this is the case. As the report's authors summarized in their "Research and Policy Considerations" section:

Moving from speculation to evidence about root causes will require innovative research methods, including cohort studies, multivariate modeling, investigation of migration effects, and the application of machine learning to historical data sets. Fully understanding the timing of US mortality trends will also require interdisciplinary research involving epidemiology, demography, sociology, political science, history, economics, and the law. Clarifying the role of state policies may be especially important, given the divergent state trajectories reported here.

The implications of increasing midlife mortality are broad, affecting 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. Recent data suggest that all-cause mortality rates are increasing among those aged 15 to 19 years and 20 to 24 years (increasing from 44.8 deaths/100 000 to 51.5 deaths per 100 000 and from 83.4 deaths/100 000 to 95.6 deaths/100 000, respectively, during 2013-2017) (Figure 2). Evidence-based strategies to improve population 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.181-185 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.186


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