Lancet Study on Life Expectancy by 2030 Confirms Poor US Performance

The highly-respected medical publication, The Lancet, released an important new study yesterday, Future life expectancy in 35 industrialised countries: projections with a Bayesian model ensemble (hat tip Emma). To the extent it was noticed by the media, this Google News search show that coverage focused on how life expectancies are expected to continue to rise, to the degree that the projected best performer, South Korea, will have better than 50% odds an expected lifespan of 90 years for women.

However, the focus on the high performers, which after South Korea are, in order, France, Spain, and Japan, gives short shrift to the continuing fall in the relative performance of the US, which Lancet projects as landing solidly in third world terrain in terms of women’s life expectancies. Men show better relative results and do well now by global standards, but they show a much bigger expected relative fall in the upcoming decade plus.

If you look at the data charts, the big reason is that the researchers project the US to show very little in the way of improvement, while they anticipate many other countries to register big gains, to the degree that they leapfrog the US. Japan is even more stagnant, but it now ranks so high that the relative fall is not as dramatic.

This is the high resolution version of analysis of life expectancy at birth as of 2010 and projected to 2030; you can see view it at Lancet here.

Even with the microtype, you can see that in the 2010 chart, the US has ten countries with lower life expectancies, such as the Czech Republic, Poland Cratia, Serbia, Mexico, and Macedonia. By 2030, the US is forecast to have slipped further, with Poland and the Czech Republic having pulled ahead.

By contrast, men in the US do well by global standards, and one wonders if that reflects biases in treatment. The press has recently started to discuss how certain conditions are chronically underdiagnosed in women, such as heart disease (this was a pet peeve of my first MD, who was a cardiologist). Similarly, most non-psychiatric clinical trials, unless they are of women-only ailments, are conducted on male-only subjects, meaning the efficacy and typical dosages may not translate well to women. Another well-documented bias in the US (and query whether this is less true elsewhere) is that women complaining of pain or sub-clinical conditions are regularly seen as being hypochondriacs, and doctors push antidepressants as the remedy (I’ve had this happen even after making clear I have high pain tolerance and my medical history shows I rarely seek treatment), while this is apparently less common for men.

Even so, you can see the Lancet team also anticipates a big fall in relative standards for US men:

By 2030, the only first world countries with lower forecast life expectancies for men are Austria, Finland, and Belgium (despite having a glitzy central city where rich natives and visitors congregate, Singapore also has large sections where much less affluent Indians and Malays live).

Although forecasting is always a fraught exercise, the paper does seem to be robust from a methodological standpoint; I hope the data experts will weigh in. It has intriguing detail, such “Contributions of mortality decline in three age groups (0–29 years, 30–64 years, and 65 years and older) towards the projected increase in life expectancy at birth.” From the text:

Early life expectancy gains in South Korea, which has the highest projected life expectancy, and previous to that in Japan, were driven by declines in deaths from infections in children and adults; more recent gains have been largely due to postponement of death from chronic diseases.These gains were due to broad-based inclusive improvements in economic status18 and social capital (including education) in both countries, which improved childhood and adolescent nutrition (eg, as seen by South Korea and Japan having achieved some of the largest gains in adult height over the past century), expanded access to primary and secondary health care, and facilitated rapid scale-up of new medical technologies. South Korea has also maintained lower body-mass index and blood pressure than most western countries, and lower smoking in women. Finally, South Korea and Japan might have lower health inequalities (eg, for cancer and cardiovascular disease mortality, and for self-reported health status) than some of their western counterparts, especially for women. Other countries with high projected life expectancy are benefiting from one or more major public health and health-care successes. Examples include high-quality health care that improves prevention and prognosis of cardiovascular diseases and cancers, very low infant mortality, low rates of road traffic injuries and smoking (eg, Australia, Canada, and New Zealand), and low body-mass index (eg, French and Swiss women) and blood pressure (eg, Canada and Australia).

Its penultimate paragraph puts the US in focus:

By contrast, projected life expectancy is lower in countries with higher levels of young adult mortality and major chronic disease risk factors, and possibly less effective health systems. These countries also tend to have higher social inequalities, which might lower national life expectancy by affecting the entire population or through the poor health of the worst-off social groups and communities, which in turn affects the national average. Notable among poor-performing countries is the USA, whose life expectancy at birth is already lower than most other high-income countries, and is projected to fall further behind such that its 2030 life expectancy at birth might be similar to the Czech Republic for men, and Croatia and Mexico for women. The USA has the highest child and maternal mortality, homicide rate, and body-mass index of any high-income country, and was the first of high-income countries to experience a halt or possibly reversal of increase in height in adulthood, which is associated with higher longevity. The USA is also the only country in the OECD without universal health coverage, and has the largest share of unmet health-care needs due to financial costs. Not only does the USA have high and rising health inequalities, but also life expectancy has stagnated or even declined in some population subgroups. Therefore, the poor recent and projected US performance is at least partly due to high and inequitable mortality from chronic diseases and violence, and insufficient and inequitable health care.

None of this is news to anyone who has been paying attention. But it is nevertheless disappointing to see the major press organs in the US ignore this important report.

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38 comments

  1. PlutoniumKun

    Very interesting. One thing I’d note about US rates is that what is often not discussed is that the US is well down the list worldwide for consumption rates for two of the biggest killers – cigarettes and alcohol. In both cases, significantly less than ‘healthier’ countries like Japan and France. My guess is that this is a cultural thing, perhaps related to religion. So if you add in that factor, US performance looks even less impressive.

    Re: Singapore. Its poor performance is surprising, especially as so far as I know many of the poorer people you see at the fringes of Singapore are often not citizens (guest workers) so presumably are not counted in those figures. But one thing I’ve seen from travelling in Asia is that prosperous urban Asians are often amazingly inactive. A combination of climate, cheap transport and lack of open space means that they just don’t move very much. I once went to explore a cave in Thailand with a tour group – a bunch of younger Singaporeans and Taiwanese were with us and they were panting and struggling after just a few dozen rock steps, they were really shockingly unfit.

    Its also hard not to notice that some of the best womens performances are in countries we tend to think of as culturally quite patriarchal. I suspect the reason is women in those countries pick up fewer bad habits like smoking and drinking, and maybe even stay at home mums are healthier.

    The relatively poor performance of Scandinavian countries is striking, especially Finland, when Canada does very well (so it can’t really be attributed to climate and long winters). I would guess its down to diet (most I know seem quite averse to vegetables), but maybe there is something else going on there.

    Reply
    1. visitor

      Finland: alcohol consumption is high, and the average diet contains lots of salt and fat (both bad re cardiovascular diseases). Smoked fish is also popular (and bad re stomach cancer).

      Reply
    2. Foppe

      PK:

      I would guess its down to diet (most I know seem quite averse to vegetables),

      Yes. (Sadly, hardly anyone is willing to take that seriously.)

      Reply
  2. Deadl E Cheese

    When I said that the conservative hegemony wants a selection of albino-only, internally unified Morlocks to replace the human race and the liberal hegemony wants a multiracial, internally tolerant coalition of Morlocks to replace the human race, this is exactly what I meant.

    99% of conservative, liberal, reactionaries, and libertarians who served in government for the past 40 years should be flayed alive for literally killing people to line oil and tech billionaires’ pockets.

    Reply
  3. Atalanta69

    Getting excited about projections seems like the demographic equivalent of booking the profits before they emerge, Enron-style. Given that nearly every person I know over a certain age seems to have at least one serious illness (not to mention the many sickly younger people) I’m somewhat sceptical about this putative improvement. I am of course aware that the plural of anecdote is not data, before anyone points it out!

    Reply
    1. JCC

      As far as anecdotes are concerned, though, when you visit the rest of the high income countries do you also see every person over a certain age with at least one serious illness?

      Or are your anecdotal observations USA-based only?

      Reply
      1. PlutoniunKun

        Every French person I know complains endlessly about their health and aches and pains, but they still manage long lives. Must be the wine.

        Reply
        1. oho

          more walking, less American-style snacking. more dairy, tighter social cohesion. (besides the health care of course)

          the research on the health benefits wine isn’t panning out as a magic elixir.

          Reply
      2. Atalanta69

        Nope, I’m in the UK, where 1 in 3 are projected to be diagnosed with some form of cancer in their lifetimes, and the sufferers are getting younger all the time. Not to mention the high incidence of heart disease, arthritis, diabetes, anxiety issues, chronic pain, intestinal problems etc… I am in my forties and I barely know anyone who is really healthy – even those a lot younger than me.

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  4. Gman

    Reading this reminds of the height of the Cold war era story of the Communist and the Capitalist trying to outdo each other whilst discussing the superiority of their own systems over the other.

    The Communist rather pompously says to the Capitalist, ‘of course, you care more about your money, whereas we care about our people.’

    ‘That’s probably true,’ said the Capitalist, ‘we lock up our money and you lock up your people.’

    Cue hollow laughter.

    Ironically nowadays America, or small disproportionately wealthy and influential part of it, has become increasingly adept at doing both, even managing to turn a healthy profit from the latter as well as the former, and healthcare is no different. It is arguably the least efficient health care system in the world.

    No country in the world spends more per capita on healthcare, apart from Switzerland, and yet unlike Switzerland, the US is perpetually languishing near the bottom of world league tables in terms number of patients treated successfully per dollar spent.

    The post capitalist US still inevitably chooses to look after its money, but clearly the few that have most of it, either implicitly or explicitly, would rather many of its people in this gloriously free post communist era would just get a wiggle on and die.

    Reply
    1. DH

      The old joke doesn’t work anymore. The US now has the highest incarceration rate in the world so we are locking up our money and our people now. We have 4.4% of the world’s population and 22% of the prisoners. The incarceration rate has quadrupled since 1975.

      The Southern states have much higher incarceration rates than most of the rest of the country. I assume this means they don’t read the bible and follow the 10 commandments very well in those states.

      The high incarceration rate might play a role in the low life expectancy numbers as well.

      https://en.wikipedia.org/wiki/United_States_incarceration_rate

      Reply
  5. Altandmain

    I’m surprised as a Canadian male about these projections and frankly, the 2010 results.

    First, I’m shocked that Canada is doing so well for males, as I never felt that the overall healthiness of Canadians was anything to brag about. We have an obesity problem here. While we are not as fat as the US, we still have a serious problem here. We also have issues with other health problems.

    It does seem like female life expectancy is not that good, although it’s still at the 75-ish percentile, The disparity though is a point of concern.

    Why for example is the UK doing so poorly, despite the presence of the UK’s NHS system?

    Other challenges facing Canada
    We have a doctor shortage here, and our healthcare system in each province does need reform. I’d argue we need more care and universal dental care too. Granted the problems are vastly over-exaggerated by right-wing Americans against universal healthcare (or as it is known in the US “single payer”), but they are still there.

    Like the US, we have our own marginalized populations – our Aboriginals (like Native Americans). Australia and New Zealand also suffer from a marginalized Aboriginal population, like we do. It’s a really big tragedy.

    I see other problems in Canada that are actually worse than the US. There’s less investment in employee training for example and capital goods. I think we have Dutch Disease as well thanks to our tar sands.

    Finally, unemployment is high here (myself included).

    Closing thoughts
    It just surprises me that Canada is doing ok according to these charts. I especially find the performance of Canadian males hard to believe.

    Maybe it’s a case that other nations are doing badly, rather than Canada doing well.

    Reply
    1. Altandmain

      Another thing I should note is that inequality is a very serious problem here in Canada as well. I believe it may still be growing.

      Actually it would be very interesting to compare the life expectancies of those in the 90% richest percentile (ex: the top 10%) versus the poorest 10%.

      Equally interesting would be to see the gap for each country. I suspect there will be a strong correlation with inequality.

      Also, why do the Nordic nations have such a mediocre performance (Denmark, Sweden, Finland, and Norway)? I always thought that they were doing much better than we were.

      The one I’m not surprised is Australia, which I’ve always thought of as healthier than Canada (we seem to be trading blows though when it comes to males and they do better than us when it comes to females).

      Reply
      1. Yves Smith Post author

        Nordic countries have a lot of drinking due to the long and dark winters. The winters may also lead directly to more auto accidents independent of drinking.

        Reply
        1. polecat

          Lack of Vitamin D might (due, in part, to those long winters) may also be a factor in the health of people living in the northern latitudes, be they in Europe, or North America …

          .

          Reply
          1. PlutoniumKun

            The anomaly to this is Canada, which suggests its not the long winters alone. My guess would be diet – on my few visits to Sweden and Denmark I’ve noticed that there seems to be very little vegetable and fruit in daily diets there, its just not the local taste. There is a lot of evidence that your 5 (or more) a day is absolutely crucial when it comes to heart disease and many cancers.

            Reply
        2. Altandmain

          The interesting thing though is that Canada is pretty cold in the winter too. We aren’t as far North latitude wise, but much of Canada where most people live is significantly colder.

          Most Canadians live close to the US border, but even then it is colder than most of the more densely populated cities of Scandinavia (I’m thinking cities like Stockholm, Oslo, Malmo, Copenhagen, Gothenberg, etc).

          Of course Canada is a huge nation and there are warmer parts like Vancouver, BC, but most of Canada is a lot colder I’d say.

          I don’t know about the drinking though.

          Reply
    2. ChrisPacific

      New Zealand is doing better these days at being an integrated society. I think part of that has been the realization by a lot of New Zealanders that Maori culture is (a) part of New Zealand culture and (b) an asset to all of us in a lot of respects. Certainly when it comes to safeguarding the commons, I’ll take kaitiakitanga (guardianship) over publicly-sanctioned looting by corporation any day.

      Reply
    3. Praedor

      The UK is doing less well than you expect because the New Labor (neoliberals) and the Conservatives (neoliberals) have gutted incomes for the working class AND are well into gutting the effectiveness of the NHS.

      Pull the social safety net rug out from under the workers that are being shafted by neoliberal policies AND tear the heart out of the healthcare system (to so devastate it, like the GOP and the US Post Office) so that it fails and they can force privatization down everyone’s throat all while saying, “See? Government can’t do anything!”

      Reply
  6. Anonymous

    Here’s a question: do you really want to live to be 90 years old, or older? I certainly don’t. Sure there are some outliers who are fully functional, maintaining an active social life, going on walks, playing golf, keeping close ties with family and friends – but these few are the outliers. The vast majority of nonagenarians I come into contact with as a physician “live” in some manner of assisted-living facility or nursing home, have significant restrictions in terms of their ability to do activities of daily living (getting out of bed, bathing, clothing themselves, etc), have lost their faculties of sight and hearing, suffer from advanced dementia, and/or are relatively isolated from family and friends. When they do fall and require an operation – for example – a hip fracture, family can often not be found or live thousands of miles distant from the patient.

    Life expectancy is a reasonable metric to track, but really, some measure of quality-adjusted life expectancy (years of high-quality life, free from disability or disease) is in my opinion a better measure. I suspect that in America we lag, and will continue to lag, in both measures.

    Reply
    1. Yves Smith Post author

      My mother is 89 and would disagree with you vehemently, as would her 89 year old friend and that friend’s 94 year old husband. My mother is cognitively fine, needs a hearing aid, and has trouble getting around (she no longer drives and has balance issues). Her female friend has had some mini-stokes and isn’t as sharp as she was but gets around with a walker and also still enjoys her life. The 94 year old may be in the best shape of all three. He still drives and seems cognitively unimpaired.

      Having said that, I agree with your point on Alzheimers. Historically, there were always some people who lived into their 80s and 90s, and yet the descriptions you see of senility in history and literature don’t resemble the personality-erosion of Alzheimers. I have a strong suspicion there are environmental causes, and no one wants to go there because the liability would be massive.

      Reply
    2. PlutoniumKun

      I think age is irrelevant, its all down to quality of life. I know people in their 60’s who have quite a miserable existence due to constant ill health (usually self inflicted from bad lifestyle choices), while my 100 year old aunt is tough and has a good quality of life – she loves the hunky physio who comes once a week to massage her, she still walks to the shop and does 20 minutes a day on a bike machine.

      But certainly longevity is over rated – I think most people would prefer to stay active to a reasonable age and then drop dead, rather than face a few decades of declining faculties. But I don’t think its an ‘either/or’ decision mostly – healthy people live longer and have better of quality of life. There is though the exception whereby peoples lives are unnecessarily prolonged through excessive interventions, but thats another story.

      Reply
  7. Elizabeth

    Perhaps another factor to take into account about why the U.S. is doing so poorly with regards to mortality rates is that people here are overtreated and overmedicated – often with fatal side effects. Also, being in a hospital is a high risk event because of infections acquired, medical mistakes, and mistakes in administering medication. Hospital equipment often carries risk of being non-sterile and people end up with infectious diseases or fatal complications.

    I don’t know if the countries who do much better in mortality rates have these issues, but I’d be willing to bet they don’t have all of them. Also, living in the U.S. carries incredible levels of stress for many people – the effects of inequality do great harm.

    Reply
  8. ChrisPacific

    I wonder why the Japanese distributions are so strongly bimodal, especially for women? Does Japanese society have a strong division between categories of people with different life expectancies – say wealthy and poor, or native Japanese vs. ‘foreign’? Or is it an artefact of the methodology? It would be interesting to see a breakdown on that point.

    It shows up in a few others as well to a lesser degree (Netherlands, Norway, Denmark, Slovakia…)

    Reply
    1. Altandmain

      Tobacco consumption may play a role.

      There isn’t the stigma against Japanese men smoking there is in North America. By contrast relatively few Japanese women smoke.

      Women seem to live a couple of years longer everywhere, but the gap is a couple years larger in Japan.

      Reply
      1. Praedor

        Women have always had a longer life expectancy, all things being equal. It’s part of a subtle sex difference. We are not the same creatures, through and through, with a mere penis or vagina as differentiation. There are biological sex consequences/benefits that will not go away simply by equalizing diet, exercise, etc. The difference is real and always has been, always will be.

        Reply
        1. Oregoncharles

          As far as actually living longer, things weren’t equal enough until the last few generations; women regularly died in childbirth, so unless there was a catastrophic war, their life expectancy was considerably less – though the difference you invoke may have turned up in old people, where there is presently a large difference. One theory is that they evolved to be tougher because they needed to be, and because they’re more important: the birthrate depends on the number of fertile females, not males, so males are expendable. Women are more resistant to both cold and famine. Most of the Donner Party survivors were women.

          Incidentally, the life expectancy difference recently reversed in certain demographics; there was an article and discussion about it on NC, quite recently, but now I can’t remember the details.

          Reply
          1. Praedor

            Sure. That’s why I qualified my statement with “all things being equal”. If women are treated as second class citizens of low worth (Islamic countries and the like) then they are bound to die young from entirely avoidable issues (childbirth being dominant).

            A single male can impregnate 100s of females a month but a female can only, at best, be pregnant once every 9+ months, thus, males are easily dispensible, as a whole, while females are not, evolutionarily speaking.

            Reply
    2. ChrisPacific

      Sorry, I should perhaps have been a bit clearer. By “bimodal” I meant that the data ‘clustered’ around two points, rather than just one. I’m not talking about differences between men and women, but the light green/dark green/blue shading in the 2030 projections showing the overall distribution being averaged.

      So to take the Japanese women in 2030 projection, for example, you see that they’ve projected a lot of deaths around age 86, a lot around age 91, and comparatively fewer in between. Unless you think that there is something special about the ages 87 to 90 (which seems unlikely) that typically means that you are sampling two different populations with different underlying distributions. I was curious as to what those might be. I suppose it could be smokers vs. nonsmokers, but if relatively few Japanese women smoke then I wouldn’t expect to see it showing up in such a pronounced way.

      Reply
      1. PlutoniumKun

        I’m not sure the specifics of the study and I’m no statistician, but I see there are a few bimodal results there and there doesn’t seem a common pattern to them. I suspect its due to certain specific assumptions made in the study (e.g. will female smoking follow a general downward trend or trend towards the male mean?) which have resulted in two diverging probabilities.

        Reply
  9. Kalen

    Well, all those statistics are misleading and are being wrongly interpreted tacitly assuming growth of population.

    While as a matter of fact most top listed countries facing collapse of native population (non-recent immigrants) like for example Japan and S. Korea. It results in so-called inverted pyramid of the demographic structure, meaning few births and few young people and lots of older people and growing their ranks, living longer.

    In Japan for already many years number of deaths in higher than number of births but not because number of death surged it is not, but because the number of birth collapsed.

    In fact within next 15 years all those leading countries will experience demographic surge wave that artificially increased their life expectancy to break and massively collapse the entire population and its life expectancy.

    In fact we are facing situation in many countries that the death rate for population between 40-60 y.o. is now comparable or higher than the death rate of population between 60-80 y.o. while death rate 80-100 y.o.population is only slightly higher then 60-80 y.o. which mean that they continue to live past 80. When current 80-100 y.o. enter the bio-limit of life their population will rapidly collapse breaking the wave because by that time big part of population of current 40-60 y.o will be dying en mass as well, many never reaching 60-80 y.o population range.

    It is the last 30 years of brutal unfettered globalism, collapse of civil societies and the abandonment of development or maintenance life prolonging social infrastructure (not only engineering infrastructure) as well as collapsing of the reliable guaranteed retirement systems robbed by global oligarchs and many other reasons.

    These are causing premature deaths in younger population whose productive years have been reduced from 40 to 20 in last decades who arriving at age of 45-55 are promptly discarded from the workforce replaced by young people engaged into a trash contracts, precarious unstable “geek” or “sharing” economy boosting enormously social stress that in short years kills them.

    In fact Europe is plagued with demographic process of collapsing nations and desperately seek immigrants to plug the demographic holes but not to avail while causing further erosion of social cohesiveness disturbing civic society and cultural continuity that is a important factor in prolonging people lives as well.

    Only when we understand why world population exploded since early to mid XX century i.e massive investment in social infrastructure, mass access to medical advances, human rights, job growth fueled by politically motivated unsustainable economic growth as well as more egalitarian distribution of wealth in a wake of cold war competition, we will understand the reverse process of exploding inequality we are facing in last 30 years and understand dire consequences of it to live expectancy of the population.

    This reverse process of collapsing social infrastructure will likely lead to collapse of word population in following five decades via this mechanisms as well via plagues, wars and starvation. Unless global oligarchic elite is overthrown we are facing a global dark age similar to original European dark age that saw 50% of population collapse.

    Reply

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