U.S. obesity rates over time/National Academy of Science

Some of the roots of the ongoing pandemic deadliness in the U.S. were planted long before the SARS-CoV-2 virus arrived in North America if an exhaustive, 475-page report released Wednesday by the National Academy of Science is to be believed.

The report titled “High and Rising Mortality Rates Among Working-Age Adults” documents an uptick in death rates from “cardiometabolic conditions” starting in the past decade and highlights the obesity epidemic that predated and worsened the ongoing viral pandemic.

Obesity and cardiometabolic conditions appear to have in the past year contributed to the deaths of hundreds of thousands of Americans infected by the COVID-19-causing pandemic virus.

A peer-reviewed study in the Journal of the America Heart Association last week tied almost two-thirds of U.S. COVID-19 deaths to Americans already weakened by cardiometabolic conditions before they were infected by SARS-CoV-2.

The trend toward cardiometabolic illnesses “was prevalent before the pandemic arrived, but working-age Americans have been deeply affected by the pandemic,” the Academy concluded in a news release announcing the report, which fingers SARS-CoV-2 as an accelerant poured on a previously smoldering medical concern.

Self-medicating death

Cardiometabolic conditions sadly aren’t the only problem. Drug, alcohol and suicide rates have also been rising “against the backdrop of major changes in American life, including disruptions in the U.S. economy that devastated families and communities, especially in areas like the Rust Belt and Appalachia where working-age death rates increased the most,” the media statement from the Academy said.

The pandemic only pushed the number of drug deaths higher. The Centers for Disease Control and Prevention (CDC) in December reported the nation witnessed a record number of drug overdoses in the 12 months from May 2019 to May 2020.

“The disruption to daily life due to the COVID-19 pandemic has hit those with substance use disorder hard,” CDC then-director Dr. Robert Redfield said at the time. “As we continue the fight to end this pandemic, it’s important to not lose sight of different groups being affected in other ways.”

Alcohol-related deaths during the pandemic have not been cataloged as of this time, but they are likely to have risen as well. RAND Corporation, a research firm, in September reported a marked increase in alcohol consumption during the pandemic.

The study found consumption by those over age 30 was up 14 percent over 2019 with the shifting drinking behavior of women particularly troubling.

“American adults have sharply increased their consumption of alcohol during the shutdown triggered by the coronavirus pandemic with women increasing their heavy drinking episodes (four or more drinks within a couple of hours) by 41 percent,” a company statement said.

Cardiometabolic diseases, however, are the nation’s number one killer.

Sick America

“The year 2017 marked the third year in a row that life expectancy in the United States
had fallen, the longest sustained decline in life expectancy in a century since the influenza pandemic of 1918–1919,” the Academy report said. “Already ranked relatively low in life expectancy (26th) in 2015 among the 35 countries that make up the Organisation for Economic Co-operation and Development (OECD), the United States would lose even more ground in its global position in national health and well-being.”

The pandemic accelerated this downward trend. The CDC estimates U.S. life expectancy dropped from 78.8 in 2020 to 77.8 in just the first six months of the pandemic as the disease devastated an already ailing population.

More than 530,000 Americans have now died, according to the Worldometer counter. And if the Heart Association study holds true, it would indicate more than 336,000 were weakened by cardiometabolic conditions before their deaths.

The Academy report says the warnings of the potential for this sort of a disaster have been obvious for years.

“Research had already uncovered some troubling mortality trends and disparities
before 2015…,” it said. “Early findings pointed to rising mortality rates among middle-aged white adults, although the trends soon revealed that younger adults were also at risk, as were other racial and ethnic groups, such that premature mortality in
the working ages of 25–64 was becoming more common in the United States than in prior years and in comparison with its international peers.”

Cardiometabolic conditions – primarily diabetes, heart diseases and high blood pressure – have unfortunately become norms in parts of the country. The study links these changes to the obesity epidemic, which it describes as a basic problem of people eating too much and exercising too little.

Obe-so-gen-ic

But the report makes it clear that in the bigger picture the situation is nowhere near that simple and fingers what the researchers call “obesogenic (obe-so-gen-ic) environments.”

“Substantial evidence documents how physical environments have become increasingly obesogenic – from urban landscapes more conducive to automobiles than pedestrians to the proliferation of fast-food restaurants that encourage the consumption of inexpensive, calorie-dense foods,” the reports says. “However, further research is needed to disentangle the complex pathways by which changing environments have led to the rise in the prevalence of obesity that, in turn, has fueled the changing trends in cardiometabolic mortality.”

The report credits anti-smoking efforts and medications for significantly reducing cardiometabolic deaths from 1970 to 2010, but says, “progress may have stalled after
2010 because medical advances reached a point of diminishing returns. Medical advances also may be having less impact because their benefits are being offset by the lagged cardiometabolic consequences of rising obesity that are now affecting rates of diabetes, hypertension, and cardiovascular disease and because many people who would benefit from cardiovascular treatments, especially those at greatest risk, face barriers to accessing services and adhering to treatment.”

The obesity trend is national, according to the report, but there are some notable regional and age differences.

“Some of the most notable increases have been in the South and outside of large metropolitan areas,” the Academy reported. “Young adults ages 25-44 have been especially affected because most were born after 1980 when the obesity epidemic began. Younger adults have been more exposed to ‘obesogenic’ environments – unhealthy diets and lack of safe, open space for exercise – for their entire lives. Compared to older adults, they became overweight at a younger age and are more likely to remain overweight or obese today.”

This could help to partially explain the large numbers of COVID-19 fatalities in Mississippi, Louisiana and Alabama – all of which now have death rates over 200 per 100,000 residents, according to the Worldometer database.

Mississippi heads the list of the country’s fattest states. Alabama is number five, Louisiana number seven. They are among 10 states with more than 200 deaths per 100,000 at this time. Most of the others are in the Northeast where the poor and the poorly educated have suffered.

An analysis conducted by the Gothamist found death rates in apartment buildings run by the New York City Housing Authority (NYCHA) were more than twice as high as for the city at large.

Housing density, poor building ventilation and lower social-economic status (SES) have been blamed. Low SES, or social-economic deprivation, has long been linked to a list of health problems.

Deprivation

United Kingdom researchers who in 2018 published a study with a massive database of 328,594 participants aged 40 to 69 years old reported “unhealthy lifestyle factors” – lack of sleep, too much television viewing, physical inactivity, smoking, alcohol abuse and diet –  increased heart disease and death in all people, but “we found that the association between an unhealthy lifestyle and all-cause and cardiovascular disease mortality becomes stronger with increasing levels of deprivation.”

Their peer-reviewed study was published in The Lancet. As with other researchers, they couldn’t clearly define the mechanism connecting social-economic deprivation and early death, It is a link that has long baffled alcohol researchers as the UK authors noted:

“Interactions between alcohol intake and socioeconomic status have been investigated more frequently than other lifestyle factors as researchers attempt to explain the well-described alcohol paradox, in which similar or lower levels of alcohol consumption in more deprived groups are associated with disproportionate alcohol-related harm.”

Scientists have struggled for decades to determine, in particular, why the number of babies born with fetal alcohol syndrome (FAS) among heavy-drinking poor mothers is about 10 times the number of FAS babies born among middle- and upper-middle-class mothers with similar drinking problems.

In Alaska – where some poor, rural areas have for decades battled with alcohol-related problems – the alcohol paradox has been largely ignored in favor of a media-fueled narrative suggesting the problems there are somehow linked to the largely Native American population.

The Academy report dives deep into the economic issues – notably the loss of working-class jobs in fading American industries – that appear to be compounding the nation’s heath problems. And it points out some stark disparaties between the health of rich Americans and poor Americans, white Americans and black Americans, rural Americans and urban Americans.

Race has entered the COVID-19 discussion in areas of the U.S. where disproportionate numbers of people of color are dying from the disease. Some studies have blamed the deaths on racially biased medical treatment; others have suggested race may be a marker of greater or lesser natural resistance to the virus; and still others have cited lower SES.

The exhaustive Academy study of the recent decline in life expectancy implicates all these and more.

“Death rates among black, working-age adults have been disproportionately high for many years due to inequalities in socio-economic status, health care, housing, education, and other factors, reflecting the legacy of structural racism,” the news release summarizing the work said. “Although progress occurred at the turn of the century in reducing the mortality gap between black and white Americans, death rates in working-age black people are now increasing, effectively erasing that progress.”

Though the report clearly outlines the past successes of the nation’s medical and public health communities in helping Americans live healthier and longer lives, it does not exactly offer a glowing forecast for the future. Instead it suggests the successes of yesterday might only have made more difficult the problems of tomorrow.