After decades of robust growth, the rise in US life expectancy stalled after 2010. Explanations for the stall have focused on rising drug-related deaths. Here we show that a stagnating decline in cardiovascular disease (CVD) mortality was the main culprit, outpacing and overshadowing the effects of all other causes of death. The CVD stagnation held back the increase of US life expectancy at age 25 y by 1.14 y in women and men, between 2010 and 2017. Rising drug-related deaths had a much smaller effect: 0.1 y in women and 0.4 y in men. Comparisons with other high-income countries reveal that the US CVD stagnation is unusually strong, contributing to a stark mortality divergence between the US and peer nations. Without the aid of CVD mortality declines, future US life expectancy gains must come from other causes-a monumental task given the enormity of earlier declines in CVD death rates. Reversal of the drug overdose epidemic will be beneficial, but insufficient for achieving pre-2010 pace of life expectancy growth.life expectancy | mortality | cardiovascular disease | drug-related mortality | opioid epidemic L ife expectancy in the United States increased at a phenomenal pace throughout the twentieth century, by nearly 2 y per decade (1). A major driver of the improvement after 1970 was the decline in cardiovascular disease (CVD) mortality. This "CVD revolution" has been attributed to improved pharmacological management, advances in surgical techniques, and healthier lifestyles (2). US death rates from CVD halved between 1970 and 2002 (3).After 2010, however, US life expectancy growth stalled and has most recently been declining. A critical question for American health policy is how to return US life expectancy to its pre-2010 growth rate. While much attention is being directed at drug-related deaths (4-6), we demonstrate that the changing trajectory of CVD deaths has been the most consequential cause-specific trend for the post-2010 US life expectancy stall. This link has not been empirically demonstrated, in part, because past analyses have focused on the very recent period in which CVD mortality had already stalled. For example, Ho and Hendi (5) was concerned with the year-over-year life expectancy decline that occurred during 2014-2015, and concluded that the US decline was mainly attributable to drug-related mortality; and Barbieri (4) focused on drug-related mortality in an analysis of causes of deaths that have contributed to the US shortfall in life expectancy relative to 12 other high-income countries in 2014. Consistent with our findings, Barbieri (4) found that drug-related mortality accounted for only about 10% of the US shortfall in 2014, and concluded, "Overall, the largest [reduction in the US life expectancy shortfall] would be achieved by reducing the US disadvantage in mortality not from drug use, alcohol and chronic liver diseases or suicide, but from other broad cause-of-death categories." In this paper, we show that CVD is the key cause-of-death category for understanding the US life expectanc...

ObjectivesTo determine how three dimensions of genetic literacy (familiarity, skills, and factual knowledge) fit the hierarchy of knowledge outlined in E.M. Rogers’ Diffusion of Innovations to better conceptualize lay understandings of genomics.MethodsA consumer panel representing the US adult population (N = 1016) completed an electronic survey in November 2013. Adjusting for education, we used correlations, principle components analysis, Mokken Scale tests, and linear regressions to assess how scores on the three genetic literacy sub-dimensions fit an ordered scale.ResultsThe three scores significantly loaded onto one factor, even when adjusting for education. Analyses revealed moderate strength in scaling (0.416, p<0.001) and a difficulty ordering that matched Rogers’ hierarchy (knowledge more difficult than skills, followed by familiarity). Skills scores partially mediated the association between familiarity and knowledge with a significant indirect effect (0.241, p<0.001).ConclusionWe established an ordering in genetic literacy sub-dimensions such that familiarity with terminology precedes skills using information, which in turn precedes factual knowledge. This ordering is important to contextualizing previous findings, guiding measurement in future research, and identifying gaps in the understanding of genomics relevant to the demands of differing applications.

Despite concerns about recent trends in the health and functioning of older Americans, little is known about dynamics of depression among recent cohorts of U.S. older adults and how these dynamics differ across sociodemographic groups. This study examined sociodemographic differences in mid- and late-life depressive symptoms over age, as well as changes over time. Using nationally representative data from the Health and Retirement Study (1994–2014), we estimated mixed effects models to generate depressive symptoms over age by gender, race/ethnicity, education, and birth cohort in 33,280 adults ages 51–90 years. Depressive symptoms were measured using the 8-item Center for Epidemiological Studies Depression scale. Women compared to men, low compared to high education groups, and racial/ethnic minorities compared to whites exhibited higher depressive symptoms. The largest disparity resulted from education, with those without high school degrees exhibiting over two more predicted depressive symptoms in midlife compared to those with college degrees. Importantly, war babies and baby boomers (born 1942–1959) exhibited slightly higher depressive symptoms with more decreasing symptoms over age than their predecessors (born 1931–1941) at ages 51–65. We additionally observed an age- as -leveler pattern by gender, whereby females compared to males had higher depressive symptomology from ages 51–85, but not at ages 86–90. Our findings have implication for gauging the aging population's overall well-being, for public health policies aimed at reducing health disparities, and for anticipating demand on an array of health and social services.

Objectives Adults around retirement age are especially vulnerable to the effects of the recent economic downturn associated with COVID-19. This study investigated disturbances to working life and mental health among Americans aged ≥55 during early months of the pandemic. Methods Using data from the nation-wide COVID-19 Coping Study (N=6,264), we examined rates of job loss, furloughs, hour/income reductions, and work-from-home, along with unchanged work status, by age, gender, race/ethnicity, educational attainment, and occupation. We next described sources of worry by job transition group and tested the adjusted associations of COVID-19-related job transitions with life satisfaction, loneliness, depressive symptoms, and anxiety symptoms. Results Most job loss occurred among respondents under age 65 and those without college degrees. Job loss and reduced hours/income were more common among Hispanics compared to other racial/ethnic groups, and work-from-home transitions were most common among respondents with high educational attainment and jobs in government- and education-related occupations. Workers who lost their jobs had the lowest life satisfaction and the highest loneliness and depressive symptoms, followed by workers who were furloughed and workers with reduced hours/income. Work-from-home was associated with more anxiety than unchanged work. Discussion COVID-19-related job transitions are detrimental to mental health, even when they might keep workers safe. These results enhance our understanding of the potentially long-term mental health effects of social and economic aspects of the COVID-19 pandemic and highlight the need for economic and mental health support for aging Americans.