Younger Americans die earlier and live in poorer health than their counterparts in other developed countries, with far higher rates of death from guns, car accidents and drug addiction, according to a new analysis of health and longevity in the US.
Researchers have known for some time that the US fares poorly in comparison with other rich countries, a trend established in the 1980s, but most studies have focused on older ages, when the majority of people die.
The findings were stark. Deaths before age 50 accounted for about two-thirds of the difference in life expectancy between males in the US and their counterparts in 16 other developed countries, and about one-third of the difference for females. The countries in the analysis included Canada, Japan, Australia, Germany and Portugal.
The 378-page study by a panel of experts convened by the Institute of Medicine and the National Research Council is the first to systematically compare death rates and health measures for people of all ages, including US youths. It went further than other studies in documenting the full range of causes of death, from diseases, to accidents, to violence. It was based on a broad review of mortality and health studies and statistics.
The panel called the pattern of higher rates of disease and shorter lives “the US health disadvantage,” and said it was responsible for dragging the country to the bottom in terms of life expectancy over the past 30 years. US men ranked last in life expectancy among the 17 countries in the study, and US women ranked second-to-last.
“Something fundamental is going wrong,” said Steven Woolf, chair of the Department of Family Medicine at Virginia Commonwealth University, who headed the panel. “This is not the product of a particular administration or political party. Something at the core is causing the US to slip behind these other high-income countries. And it’s getting worse.”
Car accidents, gun violence and drug overdoses were major contributors to American lives lost before the age of 50.
The rate of firearm homicides was 20 times higher in the US than in the other countries, according to the report, which cited a 2011 study of 23 countries. And though suicide rates were lower in the US, firearm suicide rates were six times higher.
Sixty-nine percent of all US homicide deaths in 2007 involved firearms, compared with an average of 26 percent in other countries, the study said.
“The bottom line is that we are not preventing damaging health behaviors,” said Samuel Preston, a demographer and sociologist at the University of Pennsylvania who was on the panel. “You can blame that on public health officials, or on the healthcare system. No one understands where responsibility lies, but put it all together and it is creating a very negative portrait.”
Panelists were surprised at just how consistently Americans ended up at the bottom of the rankings.
The US had the second-highest death rate from the most common form of heart disease, the kind that causes heart attacks, and the second-highest death rate from lung disease, a legacy of high smoking rates in past decades. US adults also have the highest diabetes rates.
Youths fared no better. The US has the highest infant mortality rate among these countries, and its young people have the highest rates of sexually transmitted diseases, teen pregnancy and deaths from car crashes. Americans lose more years of life before age 50 to alcohol and drug abuse than people in any of the other countries.
Americans also had the lowest probability overall of surviving to the age of 50.
The report’s second chapter details health indicators for youths where the US ranks near or at the bottom. There are so many that the list takes up four pages.
Chronic diseases, including heart disease, also played a role for people under 50.
“We expected to see some bad news and some good news, but the US ranked near and at the bottom in almost every heath indicator. That stunned us,” Woolf said.
There were bright spots. Death rates from cancers that can be detected with tests, like breast cancer, were lower in the US. Adults had better control over their cholesterol and high blood pressure. And the very oldest Americans — above 75 — tended to outlive their counterparts.
The panel sought to explain the poor performance. It noted the US has a highly fragmented healthcare system, with limited primary care resources and a large uninsured population. It has the highest rates of poverty among the countries studied.
Education also played a role. Americans who have not graduated from high school die from diabetes at three times the rate of those with some college education, Woolf said.
In the other countries, more generous social safety nets buffer families from the health consequences of poverty, the report said.
Still, even the people most likely to be healthy, like college-educated Americans and those with high incomes, fare worse on many health indicators.
The report also explored less conventional explanations. Could cultural factors like individualism and dislike of government interference play a role? For example Americans are less likely to wear seat belts and more likely to ride motorcycles without helmets.
The US is a bigger, more heterogeneous society with greater levels of economic inequality and comparing its health outcomes to those in countries like Sweden or France may seem lopsided. However, the panelists said that the US spent more on healthcare than any other country in the survey. And as recently as the 1950s, Americans scored better in life expectancy and disease than many of the other countries in the current study.