Explaining Lower Than Expected Life Expectancy in the US

Despite being the world's richest country and despite the fact that the average American pays much more per person for health care than anyone else in the world, US life expectancy is not even in the top 20 in the world, as I have mentioned before. But why does the US lag behind others? Although a seemingly obvious answer had been that African-Americans on average lack the same access to health care as do whites, that difference--although real--had never been able to close the gap. Now a doctoral student in demography at the University of Pennsylvania, Jessica Ho, has helped us unlock this puzzle in a paper just published in the journal Health Affairs (subscription required). The story is summarized by futurity.org:

The new study finds that excess mortality among Americans younger than 50 accounted for two-thirds of the gap in life expectancy at birth between American males and their counterparts and two-fifths between females and their counterparts in the comparison countries.

Most of the excess mortality of those younger than 50 was caused by noncommunicable diseases, including perinatal conditions, such as pregnancy complications and birth trauma, homicide, and unintentional injuries including drug overdose, which Ho says is a striking finding of the study.

“These deaths have flown under the radar until recently,” Ho says. “This study shows that they are an important factor in our life expectancy shortfall relative to other countries.”

She points out that the majority of the drug overdose deaths stemmed from prescription drug use.

Ho says her study underscores the importance of focusing on policies to prevent the major causes of deaths below age 50 and to reduce the social inequalities that lead to them.

It is no surprise, of course, that her dissertation committee includes Samuel Preston, who quite literally wrote the book on how different causes of death shape a nation's life expectancy. Most recently, he was part of the National Research Council committee that published an important report on "U.S. Health in International Perspective: Shorter Lives, Poorer Health."

Ho's contribution is incredibly important, but we still have that other one-third of the life expectancy gap to explain...