The improvements in life span have been dramatic. However since the middle of the last decade things have stalled in different countries.(See Newsletter #211 The End of Longevity Improvement) Analysis from the University of Oxford shows that there is a growing problem in the young and middle age groups. The USA has become an outlier in this space. Is the USA an exception or a sign of things to come?

The Oxford demographers have looked at changes in mortality across different age bands. These were 25-44, 45-54 and 55-64. They looked across different countries and assembled data from two groups of countries. The first are a group of high-income countries in western Europe plus Canada, Australia and Japan. The second group are seven countries from Central and Eastern Europe (the CEE). They used these groups as comparators. They looked at different causes of death. They were able to look at data starting from 1990 and stopped in 2019 before COVID.

Trends in Overall Death Rates

Most countries have shown a decline in mortality since 1990. They moved at different rates. The most dramatic improvements have come in the CEE countries. These started from a higher base. By 2019 deaths from “any cause” were still higher in the CEE countries than the average higher income country. (For example, twice as high for men in these different age groups).

The US however is an exception. US midlife mortality actually worsened relative to both peer and CEE countries. Especially amongst young age groups and females. Improvements in mortality for US women aged 25–44 years have stalled since 1990. In the late 1990’s mortality rates rose above the CEE countries. Improvements stalled for men in this age group in 2011. By 2019 their mortality levels were higher than any CEE country. Compared to the peer group of affluent countries young people were dying at a rate 2.5 times higher. In the 45-54 age group they were nearly twice as high (88%).

Cars, Guns and Drugs

We might assume from the media that the USA is the exception because of the prevalence of guns and drugs and its love of cars. Certainly death from guns is orders of magnitude higher in the USA. Homicide rates were fifteen times higher than CEE countries. Drug related deaths are anything from three to fifteen times higher depending on age. Deaths from road accidents are starting to rise relative to peer countries. However together these cannot account for the scale of the differences.

Across most other causes of death, America is falling behind. Suicides in 1990 were comparable in the US to both peer groups. They are now orders of magnitude higher. Alcohol related deaths are still the highest in the CEE countries. The rates however are declining. The USA started in 1990 below both peer groups. Since 2000 it has not matched improvements elsewhere. It is now above both peer groups in many age groups. These causes have been dubbed “deaths of despair”. The problem however goes deeper.

Improvements in cardiovascular disease mortality plateaued. This was especially the case in that youngest age group. Both comparison groups continued to improve. Prevalence is now higher than peer countries and many CEE countries. The US is slipping behind in other major areas. Respiratory diseases mortality is now higher than any comparison group. The obesity problems are all over the world. However, US death rates related to diabetes have fallen behind wealthy peers.

An Exception or a Lead Indicator?

The USA may be the big exception, but other countries seem to be following. The UK fared better than the USA in absolute terms. However, its performance worsened over time compared with its high-income peers. Sadly, this was particularly in this younger age group. Mortality in UK males aged 25–44 years was mostly flat between 1990 and 2003 and then rose. Older age groups are starting to follow.

In Canada, all-cause mortality among people aged 25–44 years has risen since 2013. Poland and Sweden have seen small increases in midlife mortality in the past few years. Again this is among males aged 25–44 years.

The UK issue has been blamed on a period of austerity. Investment in healthcare per citizen plateaued and, in some areas, declined. There are still huge differences in mortality depending on level of deprivation.

Are we reaching a point where Society is refusing to foot an every larger healthcare bill? Costs are mainly rising because of the ageing population not because of those in mid-life. The roll back of Obamacare in the US comes in January. For many it will double or quadruple their healthcare costs. Many cannot afford it.