问题究竟出在哪？美国人正以惊人的速度英年早逝_风闻

【来源龙腾网】

正文原创翻译：

‘There’s something terribly wrong’: Americans are dying young at alarming rates

“问题严重”，美国人正以惊人的速度英年早逝

By Joel Achenbach November 27, 2019 at 12:00 a.m. GMT+8

Brian Benson unloads the body of a 44-year-old woman at the Kern County coroner’s office in Bakersfield, Calif. Prescxtion narcotics were among the medications found in the woman’s apartment. (Bonnie Jo Mount/The Washington Post)

布莱恩·本森在加州贝克斯菲尔德克恩县验尸官办公室中搬运一名44岁妇女的尸体。在这名女子的公寓里发现的药物中包括处方麻醉剂。

Death rates from suicide, drug overdoses, liver disease and dozens of other causes have been rising over the past decade for young and middle-aged adults, driving down overall life expectancy in the United States for three consecutive years, according to a strikingly bleak study published Tuesday that looked at the past six decades of mortality data.

美国的年轻人和中年人，在过去的十年里因自杀、服药过量、肝脏疾病和许多其他原因导致死亡率一直在上升,导致美国整体预期寿命连续三年下降。根据周二（注：11月26日）发表的一项研究，《过去60年的死亡率数据令人触目惊心》。

The report, published in the Journal of the American Medical Association, was immediately hailed by outside researchers for its comprehensive treatment of a still-enigmatic trend: the reversal of historical patterns in longevity.

这篇发表在《美国医学会杂志》(Journal of The American Medical Association)上的报告立即受到了外界研究人员的关注，因为它完全解释了一个仍是个谜的趋势:美国人的长寿历史出现倒退

Despite spending more on health care than any other country, the United States has seen increasing mortality and falling life expectancy for people ages 25 to 64, who should be in the prime of their lives, while other wealthy nations have generally experienced continued progress in extending longevity. Although earlier research emphasized rising mortality among non-Hispanic whites, the broad trend detailed in this study cuts across gender, racial and ethnic lines. By age group, the highest relative jump in death rates from 2010 to 2017 — 29 percent — has been among people ages 25 to 34.

尽管美国在医疗保健方面的投入远超其他任何国家，但美国25岁至64岁年龄段的人口死亡率却不降反升，预期寿命持续下降，而其他富裕国家在延长寿命方面普遍取得了进展。虽然在研究初期强调了非西班牙裔白人死亡率的上升，但目前研究结果涵盖了不同性别、种族和民族。从年龄组来看，从2010年到2017年，25岁到34岁的人群中死亡率上升幅度最大，达到29%。

The findings are sure to fuel political debate about causes and potential solutions, because the geography of rising death rates overlaps to a significant extent with states and regions that are hotly contested in the run-up to the 2020 presidential election.

这项研究的公布定会在政坛上引起轩然大波，因为死亡率上升的地区在很大程度上与2020年总统大选竞争激烈的州和地区重叠

About a third of the estimated 33,000 “excess deaths” that the study says occurred since 2010 were in just four states: Ohio, Pennsylvania, Kentucky and Indiana — the first two of which are critical swing states in presidential elections. The state with the biggest percentage rise in death rates among working-age people in this decade — 23.3 percent — is New Hampshire, the first primary state.

该研究称，自2010年以来，估计共有3.3万例“意外死亡”，其中约三分之一发生在俄亥俄州、宾夕法尼亚、肯塔基和印第安纳四个州中，其中前两个州是总统选举关键摇摆州。在这十年中，工作年龄人口死亡率上升百分比最大的州是新罕布什尔州，为23.3%，这里还是一个初选州。

“It’s supposed to be going down, as it is in other countries,” said the lead author of the report, Steven H. Woolf, director emeritus of the Center on Society and Health at Virginia Commonwealth University. “The fact that that number is climbing, there’s something terribly wrong.”

He said many factors are at play. The opioid epidemic is a major driver of the worrisome numbers, but far from the sole cause. The study found that improvements in life expectancy, largely because of lower rates of infant mortality, began to slow in the 1980s, long before the opioid epidemic became a national tragedy.

该报告主要作者、弗吉尼亚联邦大学社会与健康中心名誉主任史蒂文·h·伍尔夫(Steven H. Woolf)说，“死亡率应该会像其他国家一样下降。”“事实上，这个数字还在继续攀升，这说明问题相当严重。”

他说，问题涉及很多因素。阿片类药物的流行是这些忧心数字的主要原因，但远非唯一原因。研究发现，在阿片类药物泛滥成为全国性悲剧之前，距今久远的上世纪80年代，预期寿命的增加(主要是婴儿死亡率降低)即开始减缓。

“Some of it may be due to obesity, some of it may be due to drug addiction, some of it may be due to distracted driving from cellphones,” Woolf said. Given the breadth and pervasiveness of the trend, “it suggests that the cause has to be systemic, that there’s some root cause that’s causing adverse health across many different dimensions for working-age adults.”

 伍尔夫说道"部分原因可能是肥胖，吸毒成瘾，或因开车分心。“鉴于这一趋势的广度和普遍性，“这说明，造成健康问题的原因一定是系统性的，在许多不同层面上，适龄工作的成年人都存在一些导致健康问题的根本原因。”

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The all-cause death rate — meaning deaths per 100,000 people — rose 6 percent from 2010 to 2017 among working-age people in the United States.

Men, overall, have higher all-cause mortality than women, but the report pulls out some disturbing trends. Women are succumbing to diseases once far more common among men, even as men continue to die in greater absolute numbers.

从2010年到2017年，美国适龄劳动人口的全因死亡率——即每10万人死亡——上升了6%。（注：全因死亡率，既“所有死因的死亡率”,是指一定时期内各种原因导致的总死亡人数与该人群同期平均人口数之比。

总体而言，男性的全因死亡率高于女性，但该报告揭示了一些令人不安的趋势。妇女的死因正一度向在男人中流行的疾病倾斜，尽管男子的死亡人数仍在增加。

The risk of death from drug overdoses increased 486 percent for midlife women between 1999 and 2017; the risk increased 351 percent for men in that same period. Women also experienced a bigger relative increase in risk of suicide and alcohol-related liver disease.

Increasing midlife mortality began among whites in 2010, Hispanics in 2011 and African Americans in 2014, the study states.

从1999年至2017年，中年女性死于药物过量的风险增加了486%;同一时期，男性的患病风险增加了351%。女性自杀以及与酗酒相关的肝病风险也相对增加。

研究表明，白人、西班牙裔和非洲裔美国人的中年死亡率分别于2010年、2011年和2014年开始上升。

Outside researchers praised the study for knitting together so much research into a sweeping look at U.S. mortality trends.

“This report has universal relevance. It has broad implications for all of society,” said Howard Koh, a professor of public health at Harvard University who was not part of the research team.

这项将多方调查结果整合在一起的研究得到外界的研究人员赞赏，它对美国的死亡率趋势全面进行了审视。

“这份报告具有普遍相关性。它对整个社会都有广泛的影响，”非研究小组的成员，哈佛大学公共卫生教授Howard Koh说道。

The report reveals a broad erosion in health, with no single “smoking gun,” said Ellen Meara, a professor at the Dartmouth Institute for Health Policy and Clinical Practice.

“There’s something more fundamental about how people are feeling at some level — whether it’s economic, whether it’s stress, whether it’s deterioration of family,” she said. “People are feeling worse about themselves and their futures, and that’s leading them to do things that are self-destructive and not promoting health.”

达特茅斯卫生政策与临床实践研究所教授艾伦·米拉认为，这份报告虽揭示出健康普遍恶化状况，但没有一个“确凿证据”。

她说:“在某种程度上，人们更在意的是与切身相关的东西，如经济，精神压力，或是家庭关系不和方面。“人们对自己和自己的未来感到担忧，这导致他们做出一些自残行为，而不是去做有利于身心健康的事情。”

The JAMA report looked at life expectancy and mortality across the country from 1959 through 2017. Final life expectancy numbers for 2018 will soon be released by the U.S. Centers for Disease Control and Prevention. The general trend: Life expectancy improved a great deal for several decades, particularly in the 1970s, then slowed down, leveled off, and finally reversed course after 2014, decreasing three years in a row.

《美国医学会杂志》对1959年至2017年期间全国的预期寿命和死亡率进行了调查。美国疾病控制与预防中心(U.S. Centers for Disease Control and Prevention，简称cdc)很快在2018年公布最终预期寿命数据。总的趋势是，在这几十年期间里，预期寿命在70年代大幅提高，然后下降，逐渐趋稳，最终在2014年之后开出现转折，进而出现连续三年下滑的情况。

The average life expectancy in the United States fell behind that of other wealthy countries in 1998 and since then, the gap has grown steadily. Experts refer to this gap as America’s “health disadvantage.”

There are some factors that manifest themselves only gradually, such as the effects of smoking. For example, in the late 1960s and early ’70s, cigarette companies aggressively marketed to women, and the health effects of that push may not show up for decades.

1998年，美国人的平均预期寿命开始落后于其他富裕国家，此后，这一差距进一步拉大。专家称这种差距为美国的“健康劣势”。

某些影响因素是逐渐显露出来的，比如吸烟。在20世纪60年代末和70年代初，烟草公司大力向女性推销香烟，烟草对健康的影响可能几十年都不会察觉出来。

Princeton professors Anne Case and Angus Deaton, whose much-publicized report in 2015 highlighted the death rates in middle-aged whites, published a paper in 2017 pointing to a widening gap in health associated with levels of education, a trend dating to the 1970s. Case told reporters their research showed a “sea of despair” in the United States among people with only a high school diploma or less. She declined to comment on the new report.

普林斯顿大学教授安妮凯斯和安格斯迪顿在2015年发布的一份的报告令人备受关注，报告着重凸显出中年白人的死亡率。迪顿在2017年发表的一篇论文指出，教育水准与健康水平的差距正在拉大，这一趋势可以追溯到上世纪70年代。凯斯告诉记者，他们的研究显示，在美国，“绝望海洋”中全都是只有高中学历或更低学历的人。但她拒绝就新报告给予置评。

Obesity is a significant part of the story. The average woman in America today weighs as much as the average man half a century ago, and men now weigh about 30 pounds more. Most people in the United States are overweight — an estimated 71.6 percent of the population ages 20 and older, according to the CDC. That figure includes the 39.8 percent who are obese, defined as having a body mass index of 30 or higher in adults (18.5 to 25 is the normal range). Obesity is also rising in children; nearly 19 percent of the population ages 2 to 19 is obese.

肥胖是这一些列问题的重要部分。美国当今女性平均体重与半个世纪前男性的平均体重相当，据疾病控制与预防中心统计，美国大多数人均为超重，20岁以上的人口中有71.6%的人超重。

这些超重人口中包括39.8%的肥胖人群。儿童肥胖率也有上升;2到19岁的人口中有近19%的人属于肥胖。

“These kids are acquiring obesity in their early teen years, sometimes under the age of 10,” said S. Jay Olshansky, a professor of public health at the University of Illinois at Chicago. “When they get up into their 20s, 30s and 40s, they’re carrying the risk factors of obesity that were acquired when they were children. We didn’t see that in previous generations.”

“This isn’t a one-time phenomenon,” he added. “It’s going to echo through time.”

这些孩子在十几岁的时候就得上了肥胖病，有些还不到10岁，”伊利诺伊大学芝加哥分校的公共卫生教授s·杰伊·奥尔山斯基(S. Jay Olshansky)说道。“当他们到了20多岁、30多岁或40多岁的时候，他们在儿童时代埋下的肥胖基因届时就会显现出来。而我们在前几代人身上看不到这一点。”

“这不会只有一次，”他补充道。“它将始终将会在时光中回荡。”