The 3 big reasons why Americans don't live as long as their peers abroad

Policymakers should take notice, study authors say

Car accidents, gun-related deaths, and drug overdoses account for nearly half of the life-expectancy gap between men in the United States and those in other high-income countries—and nearly 20% of the gap in women—according to a new study published in JAMA.

Researchers from the National Center for Health Statistics (NCHS) and Johns Hopkins University used 2012 data from the World Health Organization (WHO) and the U.S. National Vital Statistics System to understand what causes Americans to live about two years less, on average.

They study compared the United States with 12 other developed nations, including Denmark, Germany, Japan, Spain, and the United Kingdom.

Men in the United States had a life expectancy of 76.4 years in 2012, compared with 78.6 years for men in the other countries. For women, life expectancy was 81.2 years compared with 83.4 years.

Many examinations of the life-expectancy gap have focused on issues such as health care access, obesity, and other lifestyle factors. But the new JAMA study looked specifically at the role played by car accidents, gun-related deaths, and drug overdoses—all of which are disproportionately common in the United States.

If such causes of deaths were factored out, the life expectancy gap would fall significantly, the researchers found. For men:

  • Gun-related deaths accounted for 21% of the gap;
  • Drug poisoning accounted for 14%; and
  • Car accidents accounted for 13%.

Overall, those causes of death caused 48% of the male life-expectancy gap. Meanwhile, among women:

  • Gun-related deaths accounted for 4% of the gap:
  • Drug poisoning accounted for 9%; and
  • Car accidents accounted for 6%.

Overall, those causes of death caused 19% of the female life-expectancy gap.


Andrew Fenelon, the lead author of the study and a senior service fellow at NCHS, says that even though the causes of death examined in the study account for only 4% of overall deaths in the United States, they have an outsized influence on life expectancy because of when in life they usually occur. "When young people die, they lose many more years of life than older people," he explains. "So the things that kill younger people may be more important for life expectancy."

Why one hospital will treat gun violence like it treats alcoholism

The study suggests that policymakers should look beyond "traditional health spending" to improve life expectancy in the United States. 

Ellen Meara, associate professor of health policy and clinical practice at the Dartmouth Institute for Health Policy and Clinical Practice, says the JAMA study should prompt policymakers to ask why U.S. life expectancy has been lagging since the 1980s. "It's not like we can't achieve what other countries have," she says.

David Katz, president of the American College of Lifestyle Medicine and director of the Yale University Prevention Research Center, says efforts to address car accidents and fight prescription drug misuse are making progress—albeit slowly. "Whether or not the cold, hard calculus of epidemiology is enough to provoke meaningful action related to guns remains to be seen," he adds (Johnson, "Wonkblog," Washington Post, 2/9; Reinberg, HealthDay/U.S. News & World Report, 2/9; Storrs, CNN, 2/9).

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