ife expectancy at birth, a common measure of a population's health, 1 has decreased in the United States for 3 consecutive years. 2 This has attracted recent public attention, 3 but the core problem is not new-it has been building since the 1980s. 4,5 Although life expectancy in developed countries has increased for much of the past century, US life expectancy began to lose pace with other countries in the 1980s 6,7 and, by 1998, had declined to a level below the average life expectancy among Organisation for Economic Cooperation and Development countries. 8 While life expectancy in these countries has continued to increase, 9,10 US life expectancy stopped increasing in 2010 and has been decreasing since 2014. 2,11 Despite excessive spending on health care, vastly exceeding that of other countries, 12 the United States has a long-standing health disadvantage relative to other high-income countries that extends beyond life expectancy to include higher rates of disease and cause-specific mortality rates. 6,7,10,13 This Special Communication has 2 aims: 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 from a new analysis of state-level trends. Methods Data Analysis MeasuresThis report examines longitudinal trends in life expectancy at birth and mortality rates (deaths per 100 000) in the US population, 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, 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

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For the past century, life expectancy in industrialized countries has increased, and the U.S. has shared in that progress. However, beginning in the 1980s, advances in U.S. life expectancy began to lose pace with peer countries. By 1998, U.S. life expectancy had fallen below the average for Organisation for Economic Cooperation and Development nations. U.S. life expectancy peaked in 2014 and has been decreasing for three consecutive years, a trend not been seen since the influenza pandemic a century ago. Put simply, U.S. health is in decline.