Falling Behind: The Growing Gap in Life Expectancy Between the United States and Other Countries, 1933-2021

Abstract

Objectives. To document the evolution of the US life expectancy disadvantage and regional variation across the US states. Methods. I obtained life expectancy estimates in 2022 from the United Nations, the Human Mortality Database, and the US Mortality Database, and calculated changes in growth rates, US global position (rank), and state-level trends. Results. Increases in US life expectancy slowed from 1950 to 1954 (0.21 years/annum) and 1955 to 1973 (0.10 years/annum), accelerated from 1974 to 1982 (0.34 years/annum), and progressively deteriorated from 1983 to 2009 (0.15 years/annum), 2010 to 2019 (0.06 years/annum), and 2020 to 2021 (-0.97 years/annum). Other countries experienced faster growth in each phase except 1974 to 1982. During 1933 to 2021, 56 countries on 6 continents surpassed US life expectancy. Growth in US life expectancy was slowest in Midwest and South Central states. Conclusions. The US life expectancy disadvantage began in the 1950s and has steadily worsened over the past 4 decades. Dozens of globally diverse countries have outperformed the United States. Causal factors appear to have been concentrated in the Midwest and South. Public Health Implications. Policies that differentiate the United States from other countries and circumstances associated with the Midwest and South may have contributed. (Am J Public Health. 2023;113(9):970-980. https://doi.org/10.2105/AJPH.2023.307310).

FIGURE 1—

Change Over Time in (a) US Life Expectancy and (b) US Life Expectancy Gap and Rank Relative to Populous Countries (Population > 500 000): 1950–2021 Note. Phase 1 = 1950–1954; phase 2 = 1955–1973; phase 3 = 1974–1982; phase 4 = 1983–2009; phase 5 = 2010–2019; phase 6 = 2020–2021. Bars plot the difference in life expectancy between the United States and the populous country (population > 500 000) with the highest life expectancy in the given year. The country with the highest life expectancy was Norway in 1950–1962 and 1976–1977, Sweden in 1963 and 1965–1975, the Netherlands in 1964, Japan in 1978–2007, Macao in 2008–2010, and Hong Kong in 2011–2021. The line graph plots US rank relative to other populous countries, with higher rank denoting lower US life expectancy. Source. Author’s calculations based on UN data.

FIGURE 2—

Populous Countries That Achieved Higher Life Expectancy Than the United States and Calendar Years of Dominance: 1950–2021 Note. Shaded bars depict the calendar years during which populous countries (populations > 500 000) experienced higher life expectancy than the United States; interruptions in bars reflect periods when the United States recovered its advantage (experienced higher life expectancy). A more detailed version of this figure (Figure A, available as a supplement to the online version of this article at http://www.ajph.org) includes each country’s ranking, by year, among populous countries, showing how the relative position of countries surpassing the United States progressed over time. Source. Author’s calculations based on UN data.

FIGURE 3—

Mean Changes in Life Expectancy by State During (a) Phase 4, 1983–2009, and (b) Phase 5, 2010–2019: United States Note. The maps depict mean changes in life expectancy per annum that states experienced over the years comprising phase 4 (1983–2009), when increases in US life expectancy slowed, and phase 5 (2010–2019), when US life expectancy stagnated. Source. Author’s calculations based on US Mortality Database.