People in more than 50 countries on six continents have been outliving Americans for more than 70 years, according to the new research.
“The new study challenges two assumptions that have influenced previous research on the U.S. life expectancy disadvantage,” said study author Dr. Steven Woolf, director emeritus of the Center on Society and Health at Virginia Commonwealth University (VCU).
“First, past studies have usually only compared the United States with a select group of 15 to 20 ‘peer countries,’ largely Anglo-Saxon or Western European countries with high incomes,” Woolf said. “Second, experts typically consider the 1980s or 1990s as the inflection point when growth in U.S. life expectancy began underperforming compared with other countries. However, this analysis shows that premature deaths among Americans are a much larger and older public health issue than previously believed.”
Woolf tracked 80 years of trends using life expectancy estimates from the United Nations, the Human Mortality Database and the U.S. Mortality Database.
He found that in 1933, U.S. life expectancy ranked eighth highest among 16 populous countries. Woolf then examined the pace of growth in life expectancy from 1950 through 2021 in more than 200 countries.
Increases in U.S. life expectancy started slowing from 1950 to 1954. They slowed even further between 1955 and 1973.
Life expectancy for Americans rebounded between 1974 and 1982, slowed for the next 27 years, “flatlined” between 2010 and 2019, and plummeted in 2020 and 2021 because of the COVID-19 pandemic, Woolf's research shows.
U.S. life expectancy ranked 46th among populous countries by 2020.
“We may be one of the richest countries in the world, and we certainly outspend every country on health care, but Americans are sicker and die earlier than people in dozens of countries. We’ll keep falling behind unless we get serious about policy solutions,” said Woolf, who is also a professor of family medicine and population health at the VCU School of Medicine.
At one point or another along the study time frame, 56 countries achieved higher life expectancy than the United States. Among them, 17 countries outranked the United States for more than 50 years.
Most countries that outperformed the United States were in northern and western Europe before 1950, but several southern and eastern European countries surpassed the United States in the 1950s and 1960s.
Asian countries began outliving Americans as early as the 1960s. Several Middle Eastern countries did, too, beginning in the 1990s and continuing into the 2010s.
“If you only compare the United States with 15 high-income countries, you can guarantee that it will never rank worse than 15th,” Woolf said in a university news release. “However, we found that countries with different cultures, forms of governance, societies and economies have all found a way to outperform the United States in terms of health outcomes and life expectancy. Even former Soviet countries in Eastern Europe managed to surpass the United States.”
Woolf also compared life expectancy trends between U.S. states, finding disparities. Growth rates in life expectancy were generally highest in the Northeast and West and lowest in South Central and Midwestern states, according to the research.
“State governments play a large role in promoting the health and well-being of their constituents, and over time we've seen widening disparities in health trends at the state level,” Woolf said. “This is encouraging, as it shows that states are capable of adopting policies that improve health, but it is also discouraging, because many other states that fared poorly in this study are now actively weakening or rolling back such policies.”
The study findings were published online June 1 in the American Journal of Public Health.
The U.S. Centers for Disease Control and Prevention has more on U.S. life expectancy.
SOURCE: Virginia Commonwealth University, news release, June 1, 2023