‘The US must change course’: Life expectancy gains stall vs. other developed nations

Key takeaways:

• Life expectancy in the U.S. is nearly 3 years less than in England and Wales.
• The effects obesity and overweight on U.S. life expectancy “signals a public health crisis of unimaginable scale,” an expert said.

An overall decline in population health has resulted in the U.S. falling behind in life expectancy gains compared with those of other high-income countries, particularly the U.K., findings from two new reports suggested.

U.S. life expectancy is also projected to stall by 2050, signaling an urgent need for improved health policies and treatment, according to experts.

This decent down the international life expectancy hierarchy has been driven largely by the effects of modifiable risk factors, including dietary risks and the use of drugs, alcohol and tobacco, experts noted.

Recent analyses have captured grim findings regarding the progression of life expectancy, both around the world and in the U.S. As Healio previously reported, one study showed that life expectancy growth slowed to below 0.2 years annually in several countries, making major gains in life expectancy in this century “implausible,” according to researchers.

Another study found that the life expectancy gap in the U.S. increased by 20.4 years from 2000 to 2021, with several diverse populations experiencing marginal growth or even decreases.

Life expectancy forecast ‘rings the alarm’

In the latest Global Burden of Diseases, Injuries, and Risk Factors Study, researchers from the Institute for Health Metrics and Evaluation (IHME) examined mortality, disability and morbidity trends for 371 diseases and injuries and 88 risk factors in the U.S. between 1990 and 2021.

They also forecasted life expectancy in the U.S. for the next couple decades and where it would rank among 203 other countries and territories based on the change.

They found that health-adjusted life expectancy in the U.S. is forecasted to increase from 78.3 years in 2022 to 79.9 years in 2035 and to 80.4 years in 2050.

This increase would lower the global ranking of the U.S. from 49th in 2022 to 66th in 2050.

The swift drop in life expectancy “rings the alarm for immediate action,” Stein Emil Vollset, MD, MPH, DrPH, an affiliate professor from IHME, said in a press release. “The U.S. must change course and find new and better health strategies and policies that slow down the decline in future health outcomes.”

The report, published in The Lancet, also revealed significant decreases in U.S. life expectancy in the last 40-plus years. In 1990, women’s life expectancy in the U.S. ranked 19th overall, before dropping to 47th in 2021. Men experienced a similar decline, falling from 35th in 1990 to 46th in 2021.

Life expectancy among American women is expected to decline further, putting them at 74th overall in 2050. Men are also projected to experience a similar, albeit lesser, decline by that year, falling to 65th.

According to the release, the marginal overall life expectancy increase forecasted in 2050 for the U.S. may be due to positive trends seen across multiple mortality rates, including those from ischemic heart disease (–49.4%), stroke (–40.5%) and diabetes (–35.7%).

However, “our models forecast health improvements slowing down due to rising rates of obesity, which is a serious risk factor to many chronic diseases and forecasted to leap to levels never before seen,” Christopher J.L. Murray, MD, DPhil, IHME director and study co-author, said in the release. “The rise in obesity and overweight rates in the U.S., with IHME forecasting over 260 million people affected by 2050, signals a public health crisis of unimaginable scale.”

US years behind UK in life expectancy

Another report from Johns Hopkins Bloomberg School of Public Health revealed an average U.S. life expectancy of 78.6 years in 2023 compared with 81.3 years in England and Wales, for a difference of 2.7 years.

This gap was larger between men from the U.S. and those from England and Wales (75.9 years vs. 79.3 years) compared with women (81.3 years vs. 83.2 years, respectively).

“There is simply no good reason why people in the U.S. can expect to die nearly 3 years earlier than their counterparts across the Atlantic,” Joshua M. Sharfstein, MD, vice dean for public health practice and community engagement at the Bloomberg School, said in a press release. “If we choose programmatic and policy solutions based on evidence, we will close this gap.”

In the report, researchers examined 2023 data from the U.S. National Center for Health Statistics and the U.K. Office for National Statistics to compare life expectancies and health outcomes between the two countries.

The life expectancy between the U.S. and England and Wales was the same in 1984, at an average of 75 years. However, the life expectancies in the countries slowly began to separate from that point onward — life expectancy in England and Wales reached 77 years in 1994, while the U.S. was a year behind at 76 years.

The difference in life expectancy peaked during 2022, at an average of 4.7 years.

Researchers pointed out that several diseases and adverse health outcomes significantly contributed to the gap, including:

• CVD (57% of the gap);
• drug overdoses (32% of the gap);
• firearm-related homicide and suicide (20% of the gap); and
• motor vehicle crashes (17% of the gap).

Specifically, the analysis calculated the rate of death from CVD as 38% greater in the U.S. vs. England and Wales in 2023, while the rate of death from motor vehicle crashes came in at six times higher and drug overdoses appeared more than three times higher in the U.S.

Younger Americans were particularly vulnerable to these risks vs. their U.K. counterparts, as firearm-related suicide and homicide rates were 485.9 times higher for Americans aged younger than 25 years.

Researchers highlighted approaches to these contributors that could ultimately lower the gap between the countries, such as addressing CVD through clinical and population-based strategies, reducing drug overdoses by providing treatment during incarceration and dispensing methadone, and decreasing homicide and suicide rates by implementing extreme risk protection orders and firearm licensing laws, and investing ongoing mental health services.

Ultimately, “what we do with this information will determine whether this gap grows or shrinks over time,” Alison Gemmill, PhD, MPH, an assistant professor in the department of population, family and reproductive health at the Bloomberg School, said in the release.

References:

• A tale of two countries: The life expectancy gap between the United States and the United Kingdom. Available at: https://americanhealth.jhu.edu/sites/default/files/2024-12/2024%20Life%20Expectancy%20Report.pdf. Accessed Dec. 6, 2024.
• Increases in US life expectancy forecasted to stall by 2050, poorer health expected to cause nation’s global ranking to drop. Available at: https://www.healthdata.org/news-events/newsroom/news-releases/increases-us-life-expectancy-forecasted-stall-2050-poorer-health. Published Dec. 5, 2024. Accessed Dec. 5, 2024.
• Mokdad A, et al. Lancet. 2024;doi:10.1016/S0140-6736(24)01446-6.
• New report: Life expectancy years shorter in the United States compared to the United Kingdom. Available at: https://publichealth.jhu.edu/2024/new-report-life-expectancy-years-shorter-in-the-united-states-compared-to-the-united-kingdom. Published Dec. 3, 2024. Accessed Dec. 6, 2024