US Life Expectancy Decreased Significantly Relative to Global Rates

Steven Woolf, MD, MPH

Nearly 60 countries have surpassed the US life expectancy rate since 1933, according to new data.¹

Research from Steven H. Woolf, MD, MPH, of the Center on Society and Health and the department of family medicine and population health at Virginia Commonwealth University, provides new evaluations of US life expectancy relative to other countries in the last 9 decades. Chief among its findings are data showing that, even when life expectancy has climbed in the US, it has generally done so at a lower rate than other countries across all 6 inhabited continents.

Woolf conducted this analysis to help provide perspective into the timing and geographic scale of US life expectancy disadvantage, a component of public health perspective which he stated would help better investigate the potential causes of the issue.

“For example, knowing the years when changes occurred in the slope—the rate of change in US life expectancy—is a prerequisite for future studies of period and cohort effects,” Woolf wrote. “Comparing this “growth rate” with the slope in comparison countries would clarify when and how the US trajectory diverged. Furthermore, examining how life expectancy trends varied across the country can identify states where adverse life expectancy trends were geographically concentrated.”

While prior research has identified the 1980s or 1990s as the time when US life expectancy disadvantage began, such analysis is largely based on a “peer country” comparison between the US and high-income, Western European or Anglo-Saxon nations. “The implicit assumption is that less affluent or developing countries are unlikely to outperform the United States and cannot serve as a benchmark for documenting a US disadvantage,” Woolf wrote. “The validity of either assumption—that only high-income countries surpassed the United States and that the phenomenon began in the 1980s to 1990s—is unclear.”

Woolf merged data from a trio of sources to analyze historical and geographic progression of US life expectancy disadvantage since the 1930s:

• The Population Division of the UN Department of Economic and Social Affairs’ estimated life expectancy for 237 countries from 1950 – 2021
• The Human Mortality Database from the University of California – Berkeley, the Max Planck Institute for Demographic Research, and the French Institute for Demographic Studies
• The US Mortality Database from the University of California – Berkeley

He sought to interpret the amount of countries that have achieved a higher life expectancy than the US, and for how long; how the US’ position relative to other countries changed over time; how the US’ life expectancy rate vary over time, and its timing of divergence; and the comparison of life expectancy among the 50 states relative to other countries.

What Woolf observed was 6 distinct phases of growth in US life expectancy from 1950 – 2021:

1. 1950 – 1954, a period of quick growth (0.21 years per annum)
2. 1955 – 1973, a period of halved growth (0.10 years per annum)
3. 1974 – 1982, a rebound in growth (0.34 years per annum)
4. 1983 – 2009, a longer, halved period of growth (0.15 per annum)
5. 2010 – 2019, a plateau of growth (0.06 per annum)
6. 2020 – 2021, a sharp decrease during COVID-19 (-0.97 per annum)

Over time, the US life expectancy world ranking has evolved from 8th among 16 countries during 1933 analses; 12th in 1950; 29th in 1968; 13th in 1976; 15th in 1983; 32nd in 2009; 40th in 2019; and finally 46th in 2020. The gap in life expectancy between the US and the top-performing populous countries widened from 3.5 years in 1950, to 7.8 years in 2020.

The decrease in US ranking was due to greater average annual increases in life expectancy among other populous countries, Woolf noted; in the latter 3 phases, dozens of countries began to outperform the US life expectancy growth, oftentimes at tripled rates, and many more reported lesser decreases in life expectancy during the COVID-19 pandemic.²

Among US states, the Northeast and West regions often reported greater growth rates than the South Central and Midwest regions from 1959 – 2019, but most particularly during phases 4 and 5. All 50 states contributed to the national decline in life expectancy during phases 4 and 5 overall; not one state outperformed the country’s growth rate.

Among the 56 countries that have outperformed the US’ life expectancy in the observed time period, geographic and societal components of each were diverse. Woolf noted the regions of such bettered countries ranged from East Asia and Central/South America, to Eastern Europe and the Middle East. Another 20 countries were middle-income status or Communist party-ruled when they surpassed the US.

With acknowledgement to the perception that US life expectancy disadvantage correlated with public health issues including the obesity epidemic, opioid crisis, HIV/AIDS epidemic and other pivotal events of the 1980s and 1990s, Woolf noted slowed growth was apparent as early as 1955.

“Understanding the complex reasons for these changes in slope will require further research. Some explanations have emerged for phase 5 (2010–2019), the decade in which US life expectancy plateaued, allowing 7 more countries to surpass the United States,” Woolf wrote. “A 2021 report by the National Academies of Science, Engineering, and Medicine attributed the stagnation in US life expectancy to an increase in mortality rates in midlife (25–64 years). This increase, which no other country experienced, was caused primarily by US deaths from drug overdoses, alcohol-related causes, suicides, and cardiometabolic diseases.”

And although COVID-19 was uniquely impactful on US life expectancy, 39 countries already had higher life expectancy prior to national outbreaks in 2019. Only 6 more countries surpassed the US during the pandemic.

“The pervasiveness of the US health disadvantage, which involves dozens of diseases and causes of death and has lasted decades, suggests that the problem is larger and more enduring than any single health problem (e.g., drugs, firearms, obesity) and likely involves upstream, systemic factors capable of producing widespread effects on health,” Woolf wrote. “Health is not the only domain in which the United States has lost ground to other countries, further indication that systemic obstacles and policy choices may have impeded socioeconomic progress on a more fundamental level.”

Woolf concluded that potential systemic factors related to economic, political, education, cultural and societal outlook may be more greatly contributory toward US life expectancy decreases than previously considered. Though these components of potential future research are vital, the national health disadvantage is impacting livelihood in real-time. The US may improve with consideration to the factors and policies that may have enabled other populous countries to surpass its life expectancy rate over time.

“The crisis has broad implications, affecting not only mortality but also morbidity, with ripple effects on health care costs, workforce productivity, and the economy,” Woolf wrote. “The gravity of the situation may justify intervention even before definitive evidence becomes available.”

References

1. ^{Woolf SH. Falling Behind: The Growing Gap in Life Expectancy Between the United States and Other Countries, 1933-2021. Am J Public Health. 2023;113(9):970-980. doi:10.2105/AJPH.2023.307310}
2. ^{Kunzmann K. US Life Expectancy Significantly Dropped Compared to Peer Countries in 2020. HCPLive. Published April 13, 2022. https://www.hcplive.com/view/us-life-expectancy-significantly-dropped-compared-peer-countries-2020}