Greater mortality variability in the United States in comparison with peer countries

Abstract

BACKGROUND Over the past several decades, US mortality declines have lagged behind other highincome countries. However, scant attention has been devoted to how US mortality variability compares with other countries. OBJECTIVE We examine trends in mortality and mortality variability in the US and 16 peer countries from 1980 through 2016. METHODS We employ the Human Mortality Database and demographic techniques-with a focus on patterns in the interquartile (IQR), interdecile (IDR), and intercentile (ICR) ranges of survivorship-to better understand US mortality and mortality variability trends in comparative perspective. RESULTS Compared to other high-income countries, the US: (1) mortality ranking has slipped for nearly all age groups; (2) is losing its old age mortality advantage; (3) has seen growth in relative age-specific mortality gaps from infancy through midlife; and (4) exhibits

Social Inequality and the Future of US Life Expectancy

“…Trends in life expectancy among the population as a whole do not necessarily reflect the health and mortality experiences of key sociodemographic groups, some of which have seen declines far earlier than the national-level decrease observed in recent years (Montez & Zajacova 2013). Perhaps most worrisome, increased variability in life expectancy-while receiving less attention than declines-has been extensively documented by social demographers as evidence of a growing rift in the longevity prospects for different segments of the US population (Brown et al 2012, Crimmins & Zhang 2019, Gillespie et al 2014, Rogers et al 2020, Sasson 2016b, Shkolnikov et al 2011a.…”

“…Many recent studies have reached a similar conclusion concerning the disproportionate impact of early deaths on US life expectancy (Ho & Preston 2010, Ho & Hendi 2018, Vaupel et al 2011). Most strikingly, Rogers et al (2020) find that compared with its peer countries, the United States has 60% higher age-specific mortality among adults in their 20s, and it is the only high-income nation where 1% of deaths occur before age 20 and 10% of deaths occur before age 60. While the United States is similar to its peers in reducing chronic disease mortality among older adults, Shkolnikov et al (2011a) single out higher US mortality at younger ages from causes of death linked to inequality-such as homicides, drug overdoses, accidents, and communicable diseases (NRC 2013)-as the leading explanation for the life expectancy gap between the United States and its peers.…”

“…Perhaps most troublingly, recent research on US mortality emphasizes the widening disparities among younger Americans as the driving force behind diverging life expectancies. Innovations may reduce biologically rooted mortality at older ages, but mortality at younger ages is almost exclusively a product of social determinants (Braudt et al 2019, Gillespie et al 2014, Rogers et al 2020. Years of data and evidence definitively show how social inequality-in the form of both socioeconomic and racial/ethnic stratification-leads to countless lost years of life at younger ages in the United States, accounting for much of its lower life expectancy relative to other wealthy nations (NRC 2013).…”

Trends in lifespan variation across the spectrum of rural and urban places in the United States, 1990–2017

“…Although mortality rates in the United States have declined steeply since the early 1900s ( Bastian, Tejada, and Arias 2020 ), mortality levels in the US remain an outlier in an international context and lag behind other high-income countries in terms of mortality improvements, age-specific mortality rates, and life expectancy ( Ho, 2013 ; Ho & Hendi, 2018 ). A primary contributor to the United State's low ranking is greater variability in the average age of death due to premature mortality ( Edwards & Tuljapurkar, 2005 ; Rogers et al, 2020 ; Vaupel et al, 2011 ) Geographic inequality in life expectancy is growing and appears to be contributing to stagnating mortality improvement in the US as a whole ( Fenelon, 2013 ). These differences are evident at multiple geographic levels but growing urban-rural mortality differences are of particular concern.…”

“…In most high-income, low-mortality nations, there has been a long-term decrease in lifespan variation, though with substantial between-country differences in variation ( Canudas-Romo, 2008 ; Edwards and Tuljapurkar 2005 ; Smits and Monden 2009 ). Additionally, international comparison studies show that the United States has higher lifespan variation than other high-income countries, even with similar life expectancies ( Aburto et al, 2020 ; Crimmins et al, 2010 ; van Raalte et al, 2018 ; Rogers et al, 2020 ; Vaupel, Zhang, and van Raalte 2011 ). These studies suggest that although there is a strong inverse relationship between life expectancy and lifespan variation, the strength of this association is not fixed.…”