問題究竟出在哪？美國人正以驚人的速度英年早逝_風聞

【來源龍騰網】

正文原創翻譯：

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

“問題嚴重”，美國人正以驚人的速度英年早逝

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)

布萊恩·本森在加州貝克斯菲爾德克恩縣驗屍官辦公室中搬運一名44歲婦女的屍體。在這名女子的公寓裏發現的藥物中包括處方麻醉劑。

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.

美國的年輕人和中年人，在過去的十年裏因自殺、服藥過量、肝臟疾病和許多其他原因導致死亡率一直在上升,導致美國整體預期壽命連續三年下降。根據週二（注：11月26日）發表的一項研究，《過去60年的死亡率數據令人觸目驚心》。

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.

這篇發表在《美國醫學會雜誌》(Journal of The American Medical Association)上的報告立即受到了外界研究人員的關注，因為它完全解釋了一個仍是個謎的趨勢:美國人的長壽歷史出現倒退

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.

儘管美國在醫療保健方面的投入遠超其他任何國家，但美國25歲至64歲年齡段的人口死亡率卻不降反升，預期壽命持續下降，而其他富裕國家在延長壽命方面普遍取得了進展。雖然在研究初期強調了非西班牙裔白人死亡率的上升，但目前研究結果涵蓋了不同性別、種族和民族。從年齡組來看，從2010年到2017年，25歲到34歲的人羣中死亡率上升幅度最大，達到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.

這項研究的公佈定會在政壇上引起軒然大波，因為死亡率上升的地區在很大程度上與2020年總統大選競爭激烈的州和地區重疊

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.

該研究稱，自2010年以來，估計共有3.3萬例“意外死亡”，其中約三分之一發生在俄亥俄州、賓夕法尼亞、肯塔基和印第安納四個州中，其中前兩個州是總統選舉關鍵搖擺州。在這十年中，工作年齡人口死亡率上升百分比最大的州是新罕布什爾州，為23.3%，這裏還是一個初選州。

“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.

該報告主要作者、弗吉尼亞聯邦大學社會與健康中心名譽主任史蒂文·h·伍爾夫(Steven H. Woolf)説，“死亡率應該會像其他國家一樣下降。”“事實上，這個數字還在繼續攀升，這説明問題相當嚴重。”

他説，問題涉及很多因素。阿片類藥物的流行是這些憂心數字的主要原因，但遠非唯一原因。研究發現，在阿片類藥物氾濫成為全國性悲劇之前，距今久遠的上世紀80年代，預期壽命的增加(主要是嬰兒死亡率降低)即開始減緩。

“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.”

 伍爾夫説道"部分原因可能是肥胖，吸毒成癮，或因開車分心。“鑑於這一趨勢的廣度和普遍性，“這説明，造成健康問題的原因一定是系統性的，在許多不同層面上，適齡工作的成年人都存在一些導致健康問題的根本原因。”

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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.

從2010年到2017年，美國適齡勞動人口的全因死亡率——即每10萬人死亡——上升了6%。（注：全因死亡率，既“所有死因的死亡率”,是指一定時期內各種原因導致的總死亡人數與該人羣同期平均人口數之比。

總體而言，男性的全因死亡率高於女性，但該報告揭示了一些令人不安的趨勢。婦女的死因正一度向在男人中流行的疾病傾斜，儘管男子的死亡人數仍在增加。

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.

從1999年至2017年，中年女性死於藥物過量的風險增加了486%;同一時期，男性的患病風險增加了351%。女性自殺以及與酗酒相關的肝病風險也相對增加。

研究表明，白人、西班牙裔和非洲裔美國人的中年死亡率分別於2010年、2011年和2014年開始上升。

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.

這項將多方調查結果整合在一起的研究得到外界的研究人員讚賞，它對美國的死亡率趨勢全面進行了審視。

“這份報告具有普遍相關性。它對整個社會都有廣泛的影響，”非研究小組的成員，哈佛大學公共衞生教授Howard Koh説道。

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.”

達特茅斯衞生政策與臨牀實踐研究所教授艾倫·米拉認為，這份報告雖揭示出健康普遍惡化狀況，但沒有一個“確鑿證據”。

她説:“在某種程度上，人們更在意的是與切身相關的東西，如經濟，精神壓力，或是家庭關係不和方面。“人們對自己和自己的未來感到擔憂，這導致他們做出一些自殘行為，而不是去做有利於身心健康的事情。”

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.

《美國醫學會雜誌》對1959年至2017年期間全國的預期壽命和死亡率進行了調查。美國疾病控制與預防中心(U.S. Centers for Disease Control and Prevention，簡稱cdc)很快在2018年公佈最終預期壽命數據。總的趨勢是，在這幾十年期間裏，預期壽命在70年代大幅提高，然後下降，逐漸趨穩，最終在2014年之後開出現轉折，進而出現連續三年下滑的情況。

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，美國人的平均預期壽命開始落後於其他富裕國家，此後，這一差距進一步拉大。專家稱這種差距為美國的“健康劣勢”。

某些影響因素是逐漸顯露出來的，比如吸煙。在20世紀60年代末和70年代初，煙草公司大力向女性推銷香煙，煙草對健康的影響可能幾十年都不會察覺出來。

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.

普林斯頓大學教授安妮凱斯和安格斯迪頓在2015年發佈的一份的報告令人備受關注，報告着重凸顯出中年白人的死亡率。迪頓在2017年發表的一篇論文指出，教育水準與健康水平的差距正在拉大，這一趨勢可以追溯到上世紀70年代。凱斯告訴記者，他們的研究顯示，在美國，“絕望海洋”中全都是隻有高中學歷或更低學歷的人。但她拒絕就新報告給予置評。

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.

肥胖是這一些列問題的重要部分。美國當今女性平均體重與半個世紀前男性的平均體重相當，據疾病控制與預防中心統計，美國大多數人均為超重，20歲以上的人口中有71.6%的人超重。

這些超重人口中包括39.8%的肥胖人羣。兒童肥胖率也有上升;2到19歲的人口中有近19%的人屬於肥胖。

“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.”

這些孩子在十幾歲的時候就得上了肥胖病，有些還不到10歲，”伊利諾伊大學芝加哥分校的公共衞生教授s·傑伊·奧爾山斯基(S. Jay Olshansky)説道。“當他們到了20多歲、30多歲或40多歲的時候，他們在兒童時代埋下的肥胖基因屆時就會顯現出來。而我們在前幾代人身上看不到這一點。”

“這不會只有一次，”他補充道。“它將始終將會在時光中迴盪。”