Jennifer E. Layden

Forecasts of life expectancy are an important component of public policy that influence age-based entitlement programs such as Social Security and Medicare. Although the Social Security Administration recently raised its estimates of how long Americans are going to live in the 21st century, current trends in obesity in the United States suggest that these estimates may not be accurate. From our analysis of the effect of obesity on longevity, we conclude that the steady rise in life expectancy during the past two centuries may soon come to an end.

Estimates of future life expectancy strongly influence public policy on age-based entitlement programs such as Social Security and Medicare. Although recent estimates of how long Americans will live in this century have predicted an increase, the authors believe that current trends in obesity in the United States may end the slow but steady increase in life expectancy that has taken place in the past 2 centuries. In the past 3 decades, the rise in life expectancy at birth has decelerated in the context of historical trends. Recent exploration by experts, including mathematical demographers, predicts a more rapid rate of increase in life expectancy for the U.S. population than has been anticipated. At present, however, there is no life-extending technology that might lead to much higher estimates of life expectancy and, even if such technology is developed, it would have to be widely implemented before influencing statistics on population levels. Potential technology does not warrant revising forecasts of life expectancy. Since the 1970s, obesity has become approximately 50% more prevalent per decade. Fully two thirds of U.S. adults now are obese or overweight. Extreme obesity has increased at a particularly rapid rate. Obesity is associated with an increased risk of type 2 diabetes, coronary heart disease, cancer, and other conditions. Being overweight in childhood increases the risk of death from any cause and also death from cardiovascular disease in men and cardiovascular morbidity increases in both men and women. Unless measures are taken to halt the rising prevalence of obesity, an increased risk of many fatal and nonfatal conditions can be expected as people become older. The authors have estimated the effect of obesity on life expectancy in the United States by determining the reduction in death rates that would occur should every person who currently is obese were to lose enough weight to achieve an “optimal” body mass index of 24 kg/m2. A conservative estimate is that life expectancy at birth in the United States would, if there was no obesity, be higher by 0.33 to 0.93 year for white males, 0.30 to 0.8 year for white females, 0.30 to 1.08 year for black males, and 0.21 to 0.73 year for black females. If current rates of death associated with obesity remain the same in this century, life expectancy would decline from one third to three fourths of a year. This is greater than the negative effect of all accidental deaths combined, and in time it probably would rapidly approach—or exceed—the negative effects on life expectancy of ischemic heart disease or cancer. Young people today may live less healthy and possibly shorter lives than their parents. The authors believe that the life-shortening effect of obesity could increase to 2 to 5 years or even more in the coming decades as younger obese individuals carry their increased mortality risk into middle age and old age.

BACKGROUND: E-cigarettes are battery-operated devices that heat a liquid and deliver an aerosolized product to the user. Pulmonary illnesses related to e-cigarette use have been reported, but no large series has been described. In July 2019, the Wisconsin Department of Health Services and the Illinois Department of Public Health received reports of lung injury associated with the use of e-cigarettes (also called vaping) and launched a coordinated public health investigation. METHODS: We defined case patients as persons who reported use of e-cigarette devices and related products in the 90 days before symptom onset and had pulmonary infiltrates on imaging and whose illnesses were not attributed to other causes. Medical record abstraction and case patient interviews were conducted with the use of standardized tools. RESULTS: There were 98 case patients, 79% of whom were male; the median age of the patients was 21 years. The majority of patients presented with respiratory symptoms (97%), gastrointestinal symptoms (77%), and constitutional symptoms (100%). All case patients had bilateral infiltrates on chest imaging. A total of 95% of the patients were hospitalized, 26% underwent intubation and mechanical ventilation, and two deaths were reported. A total of 89% of the patients reported having used tetrahydrocannabinol products in e-cigarette devices, although a wide variety of products and devices was reported. Syndromic surveillance data from Illinois showed that the mean monthly rate of visits related to severe respiratory illness in June through August of 2019 was twice the rate that was observed in the same months in 2018. CONCLUSIONS: Case patients presented with similar clinical characteristics. Although the definitive substance or substances contributing to injury have not been determined, this initial cluster of illnesses represents an emerging clinical syndrome or syndromes. Additional work is needed to characterize the pathophysiology and to identify the definitive causes.

BACKGROUND: The causative agents for the current national outbreak of electronic-cigarette, or vaping, product use-associated lung injury (EVALI) have not been established. Detection of toxicants in bronchoalveolar-lavage (BAL) fluid from patients with EVALI can provide direct information on exposure within the lung. METHODS: BAL fluids were collected from 51 patients with EVALI in 16 states and from 99 healthy participants who were part of an ongoing study of smoking involving nonsmokers, exclusive users of e-cigarettes or vaping products, and exclusive cigarette smokers that was initiated in 2015. Using the BAL fluid, we performed isotope dilution mass spectrometry to measure several priority toxicants: vitamin E acetate, plant oils, medium-chain triglyceride oil, coconut oil, petroleum distillates, and diluent terpenes. RESULTS: State and local health departments assigned EVALI case status as confirmed for 25 patients and as probable for 26 patients. Vitamin E acetate was identified in BAL fluid obtained from 48 of 51 case patients (94%) in 16 states but not in such fluid obtained from the healthy comparator group. No other priority toxicants were found in BAL fluid from the case patients or the comparator group, except for coconut oil and limonene, which were found in 1 patient each. Among the case patients for whom laboratory or epidemiologic data were available, 47 of 50 (94%) had detectable tetrahydrocannabinol (THC) or its metabolites in BAL fluid or had reported vaping THC products in the 90 days before the onset of illness. Nicotine or its metabolites were detected in 30 of 47 of the case patients (64%). CONCLUSIONS: Vitamin E acetate was associated with EVALI in a convenience sample of 51 patients in 16 states across the United States. (Funded by the National Cancer Institute and others.).