When it comes to life expectancy in high-income English-speaking countries, a new study has found that America has sat in last place since 2001. Despite its plethora of deadly animals, Australia remains the best performer and, the researchers say, should serve as a model for how the US can do better.
Life expectancy in wealthier countries, driven by factors like their behavior, socioeconomic trends and the availability of health services, is a good indicator of the health profile of a population. For example, in 1900, the average life expectancy was 32 years; in 2021, it was 71. That improvement is attributable to advances in medicine, public health, and living standards.
In a new study, researchers from the University of Southern California and Pennsylvania State University (Penn State) examined life expectancy across six high-income English-speaking countries – the US, UK, Ireland, Canada, Australia, and New Zealand – to see how each one ranks.
“One lesson we Americans can learn about life expectancy from looking at comparable countries is where the frontier of best performance lies,” said Jessica Ho, associate professor of sociology and demography at Penn State and the study’s senior author. “Yes, we’re doing badly, but this study shows what we can aim for. We know these gains in life expectancy are actually achievable because other large countries have already done it."
The researchers obtained data on the six countries between 1990 and 2018, taken from the Human Mortality Database and the World Health Organization Mortality Database. For context, they also looked at data from other high-income countries between 1990 and 2019: Austria, Belgium, Denmark, Finland, France, Germany, Italy, Japan, the Netherlands, Norway, Portugal, Spain, Sweden and Switzerland. These countries were not included in the rest of the analysis; they were just used to see how the six English-speaking countries ranked among the broader set of 20 countries.
With the six Anglophone countries, the researchers analyzed the data by sex, age, and 18 mutually exclusive and comprehensive cause of death categories, including various cancers, heart disease, drug- and alcohol-related deaths, infectious diseases, firearm-related deaths and deaths from motor vehicle accidents. They not only compared the data between countries but examined life expectancy within each country to identify regional inequalities.
Australia topped the list in life expectancy, with Aussie women outliving American women by almost four years and Aussie men outliving American men by nearly five years. For most of the study period, Canada had the second-highest life expectancy, but, most recently, Ireland and New Zealand caught up to the Great White North. In the last 10 years, the UK generally had the second-lowest life expectancy. Australia’s life expectancy advantage over Canada, New Zealand, Ireland and the UK was one to 2.5 years. In every year since 2001, the US was the worst performer.
Looking at the cause of death contributors, the researchers’ analysis showed that while Australians had lower rates of death across almost all ages, the Australian life expectancy advantage accrued between the ages of 45 and 84. Death rates from external causes, such as drug and alcohol misuse, screenable and/or treatable cancers, heart disease, and flu/pneumonia, were lower.
Perhaps unsurprisingly, in the 25 to 44 age group, drug overdose, other external causes and cancers dominated. Drug overdose was the largest contributor to the gap for the US and also contributed to the gaps for Canada and the UK. Motor vehicle accidents contributed to the gaps for the US and New Zealand, but other countries experience lower mortality than Australia. Australian women had an advantage in cancer mortality compared with all other countries except Canada. Firearm-related deaths are only key contributors to the gap between American and Australian women.
“One of the main drivers of why American longevity is so much shorter than in other high-income countries is our younger people die at higher rates from largely preventable causes of death, like drug overdose, car accidents and homicide,” Ho said.
In the 45 to 64 age group, heart disease, other circulatory diseases, cancers, and lung diseases were key contributors to mortality rates. Drug overdoses continued to make a sizable contribution to US and UK shortfalls. Moving from younger to older age groups, the researchers noted a shift from external causes (such as drug overdose and firearm-related deaths) and perinatal conditions and congenital abnormalities as key contributors to circulatory diseases, lung diseases, cancers, mental disorders and nervous system diseases.
“Some of the latter could be related to sedentary lifestyle, high rates of obesity, unhealthy diet, stress and a history of smoking,” said Ho. “It’s likely that these patterns of unhealthy behaviors put Americans at a disadvantage in terms of their health and vitality.”
When they compared geographic variations in life expectancy within each country, Canada and the US had the lowest-performing regions; 13 US states were in the lowest category for men and women. Australia performed particularly well except in the Northern Territory, which has a larger Indigenous population than other states or territories. There, life expectancy was 6.20 years lower for men and 4.96 years lower for women compared to the highest-performing state.
Looking at the evenness of the spread of mortality within each country, Australia was found to have the lowest within-country inequality for men and women, especially in those over 40, followed by Canada. For women, inequality was highest in New Zealand, Ireland, and the US. For men, it was highest in New Zealand, the UK, and the US.
“What the study shows is that a peer country like Australia far outperforms the US and was able to get its young adult mortality under control,” Ho said. “It has really low levels of gun deaths and homicides, lower levels of drug and alcohol use and better performance on chronic diseases, the latter of which points to lifestyle factors, health behaviors and health care performance.”
The researchers proposed several reasons why life expectancy is higher in Australia than in other high-income English-speaking countries. One factor is immigrants, who made up 30% of the population in 2018 and who tend to have a higher life expectancy than those who are native-born, therefore positively contributing to national life expectancy. Australia has also created strong public health initiatives around drug and alcohol misuse and mental health and has strict gun laws. Finally, the advantages seen in relation to heart and lung diseases, cancers, and congenital conditions are linked to superior healthcare performance in terms of cancer screening and treatment, influenza vaccination, and heart disease prevention, diagnosis and treatment.
“Australia is a model for how Americans can do better and achieve not only a higher life expectancy but also lower geographic inequality in life expectancy,” said Ho.
The study was published in the journal BMJ Open.
Source: Penn State
