Warnings rise that nation’s younger people are far sicker than they should be

bloodtest-300x200Lights are flashing and alarms are blaring. A health care nightmare is growing before us and threatens the future of the nation: Younger people — those under age 40 or even age 50 — are sicker than they should be, and their conditions are worsening, not improving, especially with the destructive coronavirus pandemic.

An independent and highly respected federal advisory panel has just recommended a drop in the age at which doctors should screen overweight adults for diabetes and prediabetes, urging that a fasting blood test or possibly a glucose tolerance test be given to these patients and lifestyle questions be posed to them at age 35, not at 40 years old, as was the previous advice.

The United States Preventive Services Task Force (USPSTF) — elite specialists who review tests and screenings for their effectiveness and usefulness and issue recommendations that hold big sway, notably with insurers — said that diabetes poses serious and growing risks to young adults. They can benefit from earlier interventions, such as changes in diet and lifestyle, that can prevent prediabetes from developing into a chronic, and potentially debilitating or even fatal condition. As experts reported in an accompanying editorial, published in an online section of the Journal of the American Medical Association:

“The diabetes epidemic in the U.S. continues unabated hand in hand with the concurrent epidemics of obesity and physical inactivity. At present, there are about 34 million U.S. adults living with type 2 diabetes (10.2% of the US adult population). Another 88 million U.S. adults have abnormal glucose levels that fall short of a diabetes diagnosis (an additional 34.5% of the adult U.S. population). These numbers reflect the fact that nearly 75% of U.S. adults have a body mass index …in the overweight or obese range, and 45% engage in no moderate- or vigorous-intensity physical activity in a typical week. Despite convincing evidence supporting guidelines for lifestyle change and medical therapy, progress in the control of diabetes-related risk factors (i.e., hypertension, dyslipidemia, hyperglycemia) has plateaued, or, in some cases, may have worsened. As a result, millions of individuals remain at risk for the microvascular and macrovascular complications of diabetes, disability, and early mortality. The gaps in receipt of recommended care are greater for younger adults (aged 18-44 years) and members of at-risk racial and ethnic groups (American Indian/Alaska Native, Asian American, Black, Hispanic/Latinx, and Native Hawaiian/Pacific Islander adults) than for other adults.”

These conclusions echo a Reuters investigation that found that more than 100,000 Americans died of diabetes last year, an increase of 17% over the year previous and a 29% increase among those ages 25-44. The news service reported that its scrutiny of information on the disease shows that diabetes is “out of control.”

A second screening shift, urging earlier testing for colon cancer

The age-shift on diabetes screening also was the second in recent months for the USPSTF, which late last year dropped its recommended  age at which patients should undergo testing, including colonoscopies, for colorectal cancer — to 45 from 50.

Earlier detection of bowel issues could save lives, the USPSTF reported, with the influential medical group issuing a draft screening guidance and posting it online for public and expert comment. Clinicians have reported for a while now that they are seeing more cases of colorectal cancers in younger patients, and their treatment might have better outcomes if it could be started earlier, too

Early detection and treatment of cancers may be helpful — or may not. It also may be counter-intuitive but it bears repeating: As the National Cancer Institute has noted, “more screening does not necessarily translate into fewer cancer deaths and … some screening may actually do more harm than good.”

The American Cancer Society earlier had lowered its recommended age for colorectal screening. But the USPSTF provides an important check on tests and screenings with its independent evaluations. Those have included the panel’s decision to advise about the need for lesser testing with care for breast and prostate cancer.

The pandemic’s heavy toll for younger patients

Still, patients and the public may wish to take note of the lowered-age screening advisories, combined with new information about the changing coronavirus pandemic. As USA Today reported:

“America’s delta-driven surge of Covid-19 has entered a deadlier phase. Cases are rising in 42 states, the lowest such number in six weeks. But deaths are now increasing in 43 states – the worst tally since December, before America’s deadliest month of the pandemic, a USA Today analysis … shows. U.S. deaths in the week ending Monday totaled 7,225. By comparison, about 5,400 Americans died in the Pearl Harbor and 9/11 attacks combined. The face of who is dying is also changing quickly. Deaths are increasingly centered among white non-Hispanic people … Most other racial and ethnic groups now have a smaller share of deaths, but white non-Hispanics, which represent about 61.1% of all deaths during the pandemic, made up 68.8% of the deaths reported so far in July and August. Meanwhile, the share of deaths among young people is jumping, too: Those in their 30s and people 18 to 29 have roughly tripled their share of deaths in July and August, preliminary Centers for Disease Control and Prevention tallies show.”

Younger people, notably those ages 30-49, have resisted campaigns for coronavirus vaccines, and, especially among those in poorer health to start, the disease has taken a terrible toll on them as the Delta variant has proved highly contagious and destructive. Experts have described how this strain has made the young “sicker and quicker.” And even among those who recover from a bout with the virus, “long Covid” may pose health issues for them for a year or more, research shows. As Time magazine reported:

“Among those hospitalized for Covid-19, 68% reported at least one continued, Covid-19-related symptom six months after their first symptoms appeared. While this percentage decreased by the 12-month mark, it remained relatively high, at 49%. And overall, patients who had been hospitalized for Covid-19 self-reported being in poorer health and having lower quality of life—including mobility issues— compared to controls. The most common symptom patients reported 12 months later was fatigue or muscle weakness; other issues included sleep disturbances, changes in taste and smell, dizziness, headache, and shortness of breath. Certain symptoms were actually worse at the 12-month mark than they were earlier on in the study: the proportion of patients reporting breathing problems increased slightly, from 26% to 30%, from six months to a year following their first symptoms. The patients also filled out questionnaires about their mental health, and while 23% reported feeling anxious or depressed six months after their first symptoms appeared, 30% did so at a year.”

Research building on less healthy younger folks

Even before the pandemic, experts were expressing concern about the poor health of younger Americans. As researchers at Ohio State University reported:

“Recent generations show a worrying decline in health compared to their parents and grandparents when they were the same age, a new national study reveals. Researchers found that, compared to previous generations, members of Generation X and Generation Y showed poorer physical health, higher levels of unhealthy behaviors such as alcohol use and smoking, and more depression and anxiety. The results suggest the likelihood of higher levels of diseases and more deaths in younger generations than we have seen in the past, said Hui Zheng, lead author of the study and professor of sociology at The Ohio State University. ‘The worsening health profiles we found in Gen X and Gen Y is alarming,’ Zheng said …

“To measure physical health, the researchers used eight markers of a condition called metabolic syndrome, a constellation of risk factors for heart disease, stroke, kidney disease and diabetes. Some of the markers include waist circumference, blood pressure, cholesterol level and body mass index …The researchers found that the measures of physical health have worsened from the Baby Boomer generation through Gen X (born 1965-80) and Gen Y (born 1981-99).”

As the pandemic has hit harder at younger people, it has put great strains on them. That’s because they may have fewer resources, including savings and health insurance, to fall back on as they try to bounce back from a coronavirus infection, especially if it is serious enough to get them hospitalized with average bills of $73,000 for their care. Insurers also are slowly rolling back waivers that covered costs of coronavirus care. The Trump Administration, notably, also promoted “skinny” health insurance plans for younger Americans. Those plans call for lower monthly premiums, making them seem more affordable. But they do not carry protections afforded under the Affordable Care Act for pre-existing conditions and other key aspects of treatment. Patients with skinny plans too often find that when they need it most, when they suffer major injury or illness, their health insurance pays for next to nothing.

Not good. In my practice, I see not only the harms that patients suffer while seeking medical services, but also their struggles to access and afford safe, efficient, and excellent health care, especially as they grapple with skyrocketing prices for prescription medications — too many of which turn out to be dangerous drugs.

Diabetes has been a worsening disease for some time now. Still, politicians and regulators somehow have managed to turn a blind eye to Big Pharma’s profiteering and legal gamesmanship with medications to deal with the condition, notably insulin.

As for younger Americans, they and we must put in a lot harder work to improve their health and fitness. We need to address the causes of their excess stress and anxiety, while seeking ways to see they stop smoking, eat better, consume intoxicants responsibly, sleep well, and get much more exercise.

We need them to be well for their sake — and our own. While the economy has rebounded after pandemic lockdowns, employers report serious, persistent labor shortages. Experts say this may be partly explained by the pandemic’s terrible death toll (now at least 635,000 or so) and the debilitation among the 39 million infected. That has combined with high numbers of older workers taking early retirement or leaving the workforce earlier than planned. Working women continue to struggle in juggling jobs and caring for children and family members. The country, to thrive in the days ahead, will need all good hands on deck, and we need to determine how to keep us all healthy on the job and in our lives.

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