Why the US has lower life expectancy than other countries

By Naveed Saleh, MD, MS, for MDLinx
Published January 15, 2020

Key Takeaways

Life expectancy refers to the mean number of years lived by a cohort of denizens under the assumption that mortality remains steady moving forward in time. Life expectancy is a point of pride among some countries and serves as a metric for quality of life.

However, life expectancy in the United States is not a point of pride, which may seem counterintuitive, given that no other nation spends more on healthcare than the United States (a whopping 16% of the GDP). Per the Peterson-KFF Health System Tracker, life expectancy in the United States in 2017 was 78.6 years vs 82.3 years in other comparable nations.

So, what gives?

By the numbers

The United States’ poor standing in life expectancy was notably demonstrated in a 2017 study published in The Lancet, which showed that the United States is falling well behind other industrialized countries in terms of longevity.

The investigators employed a combination of 21 forecasting models to determine age-specific mortality in 2030 for both men and women in 35 industrialized countries with reliable death registration. According to the authors, the models “were formulated to incorporate features of death rates in relation to age and birth cohort, and over time, as well as statistical considerations such as extent of smoothing over age and birth cohort, and how much weight to give to older data-points compared with more recent ones.”

Overall, for the 35 countries studies, life expectancy was projected to increase by at least 85% for men and 65% for women. However, in the United States, these gains are expected to be among the lowest.

Various other sources reinforce the reality that life expectancy in the United States is disquietingly lower than in other countries. According to the World Factbook, a reference resource curated by the CIA, the United States ranks #43 in terms of life expectancy.

Major reasons

One of the reasons why life expectancy in the United States is lower than in other industrialized nations is because of an under-performing healthcare system, according to a report by the National Research Council. Drops in life expectancy are especially pronounced in US adults aged 50 years and older.

Although life expectancy is lower in the United States compared with other developed countries, the US excels in cancer screening, 5-year cancer survival, heart attack/stroke survival, and prescription treatment of hypertension and hypercholesterolemia. Nevertheless, these measures reflect outcomes after a disease develops and not through prevention, which may still be poor in the United States.

“Evidence that the major diseases are effectively diagnosed and treated in the US does not mean that there may not be great inefficiencies in the US health care system,” wrote the authors. “A list of prominent charges include fragmentation, duplication, inaccessibility of records, the practice of defensive medicine, misalignment of physician and patient incentives, limitations of access for a large fraction of the population, and excessively fast adoption of unproven technologies.”

It should be noted that these cited inefficiencies exert variable effects on longevity, with some disproportionately contributing to ballooning healthcare costs.

Minor reasons

In the same report by the National Research Council, factors identified to play more minor roles in decreased US life expectancy included higher infant mortality rates and increased rates of violence among adults.

Other researchers, however, also cite the opioid epidemic as contributing to lower US life expectancy. In 2017, more than 70,000 people died of drug overdoses in the United States, which translates to an incidence of 21.7 deaths per 100,000. Most of these deaths occurred among adults aged 25-54 years.

Suicide has also been on the rise. In 2017, over 47,000 Americans killed themselves, which represented a ~33% rise in rates from 1999. Of note, men are three times more likely to commit suicide than women, and suicide rates in urban areas are higher than in rural areas.

In 2017, there was also a jump in deaths from influenza and pneumonia, which totaled 5.9% of US deaths overall. This historic rise hearkens back to the influenza pandemic of 1918.

Low life expectancy has not always been the status quo in the United States. In 1980, life expectancy in the US was on par with other countries. However, during the ensuing years, the US gained a scant 4.9 years compared with a rise of 7.8 years in other comparable countries, per the Peterson-KFF Health System Tracker.

What can be done?

Can the United States turn it around? According to The Lancet authors, the United States is the only industrialized country without universal health coverage, and it also has the largest share of unmet healthcare needs due to financial costs. However, even if the United States addressed these two problems, there’s no guarantee that it would rise again to the top of nations in terms of life expectancy.

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