US exceptionalism? International trends in midlife mortality

Abstract

Background Rising midlife mortality in the USA has raised concerns, particularly the increase in ‘deaths of despair’ (due to drugs, alcohol and suicide). Life expectancy is also stalling in other countries such as the UK, but how trends in midlife mortality are evolving outside the USA is less understood. We provide a synthesis of cause-specific mortality trends in midlife (25–64 years of age) for the USA and the UK as well as other high-income and Central and Eastern European (CEE) countries. Methods We document trends in midlife mortality in the USA, UK and a group of 13 high-income countries in Western Europe, Australia, Canada and Japan, as well as seven CEE countries from 1990 to 2019. We use annual mortality data from the World Health Organization Mortality Database to analyse sex- and age-specific (25–44, 45–54 and 55–64 years) age-standardized death rates across 15 major cause-of-death categories. Results US midlife mortality rates have worsened since 1990 for several causes of death including drug-related, alcohol-related, suicide, metabolic diseases, nervous system diseases, respiratory diseases and infectious/parasitic diseases. Deaths due to homicide, transport accidents and cardiovascular diseases have declined since 1990 but saw recent increases or stalling of improvements. Midlife mortality also increased in the UK for people aged 45–54 year and in Canada, Poland and Sweden among for those aged 25–44 years. Conclusions The USA is increasingly falling behind not only high-income, but also CEE countries, some of which were heavily impacted by the post-socialist mortality crisis of the 1990s. Although levels of midlife mortality in the UK are substantially lower than those in the USA overall, there are signs that UK midlife mortality is worsening relative to that in Western Europe.

Why is life expectancy in England and Wales falling behind? A cause-of-death decomposition approach.

“…Compared to high-income peers, the United Kingdom had relatively low mortality due to transport accidents, suicide, and homicide mortality, though some increases were visible in recent years, including among other external causes of death (Dowd et al, 2024).…”

“…The United States and its mortality divergence from high-income peers has informed much of our current understanding of international life expectancy shortfalls (Dowd et al, 2024;Ho, 2022;Woolf, 2023). "Deaths of despair" (Case & Deaton, 2015)-deaths from alcohol, drugs, and suicide-have dominated the narrative about the lack of improvements in USA longevity, but other evidence suggests that slowing improvements in cardiovascular and metabolic mortality are a more significant contributor to the USA life expectancy stagnation (Masters et al, 2018;Mehta et al, 2020).…”

Causes of excess deaths in the US relative to other wealthy nations, 1999-2020: a population autopsy

“…Prior studies have focused on specific years, 3,4 causes of death, [5][6][7] or age groups. 8 However, none has offered a comprehensive analysis encompassing all leading causes of death over the last two decades and extending into the COVID-19 pandemic.…”