The US longevity gap is becoming a chasm.
For decades, life expectancy in the States has lagged behind rich countries like Japan, Switzerland and Australia, with Americans dying younger than their peers abroad.
Now, a landmark “autopsy” analyzing the deaths of more than 63 million people has identified two key factors contributing to shorter life spans across the country, as experts warn the trend is getting worse.
In the study, researchers compared the US with 17 peer nations and found that between 1999 and 2022, about 12.7 million deaths in Americans could have been avoided if death rates were the same as those countries.
And the problem is not going away. Annual “excess deaths” in the US have tripled over a 23-year period, rising from about 346,000 in 1999 to 905,159 in 2022.
Two major factors: rising rates of cardiovascular disease, and an increasing number of “deaths of despair,” or those linked to drugs, alcohol and suicide.
Digging deeper, the researchers found that circulatory diseases such as heart attacks and strokes were the leading cause of excess death in nearly every year they studied.
That mortality improved for a time, falling between 1999 and 2009. But while rates continued to decline in other rich countries, the trend reversed in the US, rising sharply from 2009 to 2022.
Breaking down the numbers further, the researchers found that the rise in cardiovascular disease deaths among adults aged 45 to 64 began a full decade earlier than among older adults.
The findings suggest that long-term, multifactorial factors, including higher rates of obesity and changes in diet, may play a major role.
“As we look at this, we find, and this paper rightly points out, that compared to older adults, the rate and rates of heart disease and death start at an earlier age,” Dr. Neil Shah, a cardiologist at Northwell Health, told The Post.
“To deal with this, I think as a country, from a policy perspective, we need to figure out how we’re going to get patients into preventive care and preventive screening, so that we can use medications and counseling that really make a difference to prevent these late cardiovascular outcomes.”
A similar pattern emerged for diabetes, kidney disease and other metabolic conditions, which saw more stable deaths in the 2000s before rising sharply after 2010 and continuing until 2022.
In 2022, the US death rate from circulatory and metabolic diseases was 1.63 and 2.25 times higher than in other rich countries, respectively – and together, these conditions accounted for more than half of all excess deaths.
“All of these are joint cardiometabolic progressions rather than separate diseases,” said Shah, who was not involved in the new study. “Or in other words, each of these things affects the other.”
Although circulatory and metabolic diseases accounted for the majority of excess deaths during the study period, the fastest growing category was “deaths of despair,” especially among men.
“‘Death of hopelessness’ is an umbrella term for many behavioral, psychological and social factors that drive people to unhealthy behaviors and unhealthy coping strategies that have health consequences, including death,” explained Dr. Xavier Jimenez, director of consulting psychiatry, addiction medicine and chronic pain at Northwell Long Island Jewish Medical Center.
“This could be a range of things. It could be drug use to check their reality. It could be bad eating. It could be poor social choices, not seeking mental health care, maybe escaping a variety of other behaviors that occur. And that ultimately leads to death, unfortunately.”
In the US, deaths from drug poisoning, alcohol-related causes and suicide have risen from rates similar to peer countries in 1999 to more than 130,000 overdose deaths in 2022 alone.
“Death of despair” was the main reason for the widening death gap among those under 45.
“This study is amazing. I, frankly, am not surprised by the findings,” said Jimenez. “Unresolved behavioral health concerns affect people and contribute to a large proportion of deaths from alcoholism, disorderly conduct, suicide, violence and accidents.”
Taken together, deaths from heart disease and drug, alcohol and suicide accounted for about 24% of the increase in excess deaths during the study period – with the largest increase among those under 44.
The Covid-19 pandemic also exacerbated excess deaths in 2020 and 2021, with the coronavirus accounting for nearly one in five excess deaths during that period.
The researchers found that other causes were also elevated during the epidemic, including circulatory disease, metabolic conditions, drug poisoning, alcohol-related deaths and suicide.
This, they suggest, may reflect disruptions in medical care, deteriorating mental health, wider social pressures and in some cases, incorrect classification of Covid-related deaths as other causes.
“Covid-19 has actually exacerbated the desperation that was already there before the pandemic,” Jimenez said.
“If you remember, we had the opioid crisis, we had the political transition, the economic downturn, and then Covid-19 came and it took its toll, reduced access to care, created enormous burdens and stress, not to mention the physical consequences,” he continued.
“So, it makes sense that during the pandemic and a few years after, you see it contribute to the desperation that was felt and accelerated by these processes.”
Looking ahead, Jimenez and Shah advocate increasing access to routine preventive care, addressing physical, behavioral and psychological conditions early before they lead to downstream outcomes.
“We always say an ounce of prevention is worth a pound of cure,” Shah said.
The most recent data suggests that an American born in 2024 can expect to live to be 79 years old on average – the highest since national tracking began in 1900.
But that still lags behind peer countries like Switzerland, where life expectancy is around 84, and Japan, where it’s around 85.
