US Mortality in an International Context: Age Variations

Abstract

Compared to other developed countries, the United States ranks poorly in terms of life expectancy at age 50. We seek to shed light on the US’s low life expectancy ranking by comparing the age-specific death rates of 18 developed countries at older ages. A striking pattern emerges: between ages 40 and 75, US all-cause mortality rates are among the poorest in the set of comparison countries. The US position improves dramatically after age 75 for both males and females. We consider four possible explanations of the age patterns revealed by this analysis: (1) access to health insurance; (2) international differences in patterns of smoking; (3) age patterns of health care system performance; and (4) selection processes. We find that health insurance and smoking are not plausible sources of this age pattern. While we cannot rule out selection, we present suggestive evidence that an unusually vigorous deployment of life-saving technologies by the US health care system at very old ages is contributing to the age-pattern of US mortality rankings. Differences in obesity distributions are likely to be making a moderate contribution to the pattern but uncertainty about the risks associated with obesity prevent a precise assessment.

In Amenable Mortality—Deaths Avoidable Through Health Care—Progress In The US Lags That Of Three European Countries

“…This is consistent with findings that older Americans benefit from intensive screening and treatment provided under Medicare, 30,31 so that cancer survival does not decline markedly with increasing age in the United States, as it does in many European countries. 32 However, some caution is required.…”

The role of smoking on mortality compression

“…Nevertheless, the earlier PGW model was found to overestimate smokingattributable mortality at the oldest ages (85+) (Ho and Preston 2010;Preston, Glei, and Wilmoth 2011), especially for women (Rostron 2010). We used the coefficients in the later PGW publication, which excluded ages 85+ from the model fit and proposed using the average of age coefficients 70-74, 75-79, and 80-84 as the regression coefficient for ages 85+ (Preston, Glei, and Wilmoth 2011).…”

Mortality Crossover

“…Death rates, however, began to converge around age 65, and above age 80 the U.S. rates fell below those of the European countries and Japan. More recently, Ho and Preston (2010) similarly showed that although U.S. male and female age-specific death rates in 2005 were among the highest among 17 OECD countries between ages 40 and 70 for males and 40 and 75 for females, at older ages the U.S. death rates rose less sharply than in most comparison countries and above age 90 the U.S. death rates were among the lowest.…”

“…It has been further shown that mortality crossovers between two populations can occur even when the age pattern of mortality is the same for all individuals, but the distribution of frailty varies among them. Mortality will rise less rapidly with age in a population with a greater degree of heterogeneity at the same mean level of frailty (Vaupel, 2010 cited in Ho andPreston, 2010).…”

“…Other potential explanations for this pattern include cohort differences in education, immigration, access to health care, and health behaviors as well as more extensive medical interventions in the United States than in other OECD countries at the oldest ages (Manton and Vaupel, 1995;Ho and Preston, 2010).…”