In an earlier post, I examined excess mortality in the USA and its causes in the covid period in comparison with a group of the five largest European countries: Germany, France, Italy, Spain and the United Kingdom (“Europe 5”). Based on data for the period 2010-2021, I examined trends in life expectancy at birth for the USA, Switzerland, Australia and a combined group of five European countries. I found that life expectancy at birth in the USA in 2021 was nearly 8 years lower than that for Australia and Switzerland, and 6 years lower than that for the five largest European countries. Additionally, the USA showed a continued decling in life expectancy from 2020 to 2021 whereas Switzerland and the Europe 5 showed an increase from 2020 to 2021 likely associated with the availability of covid vaccines.  Data for these countries is now available for 2022, and I have updated my analysis to see what has happened.

The USA now also shows the beginnings of a rebound in life expectancy in 2022, though it is nowhere close to the 2019 life expectancy yet. US life expectancy in 2022 was 4.7 years lower than that for Europe5, 6.1 years lower than Australia, and 6.6 year lower than Switzerland.

I combined data on a population-weighted basis for five large European countries (labelled Europe 5 in the graph above) to create a composite, whose combined population size is very similar to that of the United States. Grouping these larger European countries  to provide a mortality standard also creates a larger and more diverse population for comparison with the USA. Comparison with single smaller countries may be confounded by difference in various factors affecting mortality such as climate, diet, social history, and healthcare delivery.

I include data for Switzerland and Australia and have also included them in the graph below. Why?  Because these are the two countries I have lived in for substantial parts of my life, and also are two countries with very high life expectancies in the top 10 countries globally.

These differences may not seem particularly large to many so I have put them into context by doing some disease elimination calculations for the USA.  Using the USA national life table for the year 2019 together with estimates of the cause of death distributions by age and sex for the USA in 2019 (taken from the IHME GBD2019 study data available here), I estimated the increase in US life ex, not quite pectancy resulting from the elimination of deaths for particular causes across all age groups. The results are summarized in the table below for selected causes.

Complete elimination of all deaths due to cancer at all ages would increase US life expectancy at birth by 3.4 years- Complete elimination of cardiovascular diseases (heart disease, strokes, etc) would increase US life expectancy by 4.0 years, not quite enough to raise US life expectancy to that of the population of the Europe 5 countries in 2022. To raise the US life expectancy to that of Switzerland in 2022 would require eliminating all cardiovascular disease deaths plus 50% of cancer deaths. That would amount to eliminating nearly 60% of all US deaths.

It might seem surprising that the elimination of 60% of deaths would result in “only” a 6.5 year increase in life expectancy. This is because in countries with high life expectancies, the vast majority of deaths occur at older ages where the age-specific death rate is rising almost exponentially. A large reduction in an age-specific death rate thus means that the age cohort only needs to live another six or seven years before their death rate reaches the same level as it was at the earlier age prior to the disease elimination.

The reasons for the US life expectancy being so far behind the average for Europe5 are largely the same as those I identified in my previous post: overweight and obesity, drug use and overdose, suicide, homicide, and lack of health insurance. Covid has become less important but overdose deaths have increased substantially since 2020.

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