Why is life expectancy in the US lower than in other rich countries?

A few years old, but still relevant to today:

Americans have a lower life expectancy than people in other rich countries despite paying much more for healthcare. We explore the number of factors which might explain this difference.

by Max Roser

October 29, 2020

Why do Americans have a lower life expectancy than people in other rich countries, despite paying so much more for health care?

The short summary of what I will discuss below is that Americans suffer higher death rates from smoking, obesity, homicides, opioid overdoses, suicides, road accidents, and infant deaths. In addition to this, deeper poverty and less access to healthcare mean Americans at lower incomes die at a younger age than poor people in other rich countries.

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Other possible reasons could be because of the very defensive medicine and because of a big incentive to make profit in medicine that this leads to many unnecessary interventions which of course also come with risks. Over here in the Netherlands when I was in med school mid to late 90s, we were taught not to run random checkups like they do in the US because running tests for a condition of which the a priori chance of being positive is low you’ll mostly find false positives

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How depressing. To summarize, the US is the worst in almost every category. As a basis for comparison, annually, the US has about 1000 deaths/100k population. Compared to the second worst country the US has this many greater annual deaths per 100k people: smoking (18 deaths), obesity (19), homocides (4), opioids (9), road accidents (5). Suicides and infant mortality also contribute, with the US having some of the worst numbers among industrialized countries.

Just by getting our numbers down in those 5 categories to the second worst country numbers, the US could save 55 of those 1000 deaths. Getting the US down to average would probably save 100 of those 1000 people. It reminds me of that Onion headline, “No way to prevent this, says only nation where this regularly happens.”

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“Their calculations found that in the years between 2000 and 2018, 35 big drug companies received a combined revenue of $11.5 trillion, with a gross profit of $8.6 trillion. The pharmaceutical companies’ profits are really indistinguishable, statistically, from those of technology companies. The difference is that people need drugs to live.”

Really, to “live” or to keep a very sick society ALIVE? The sick care US model.

No surprise here, the top “living” drugs prescribed to Americans, the very vast majority interventions for lifestyle mediated:

Cholesterol
Blood Pressure
Diabetes

I was in Switzerland a month ago…very rare to see obesity in the general population. They rank 4th in longevity, but very close to a top country in the world for longevity. The US 46th. Just imagine the US rate without the pharma crutch.

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Globally, the medical systems in all developed countries (and even more so in undeveloped countries) focus on “sick care” - waiting until people get sick before they really treat them. Though I guess with universal healthcare as in all other developed country but the USA - you at least get regular checkups and early treatment for health problems (for people with poor or non-existent health coverage), before the problems get really bad and lifespan limiting. But generally, yes, I agree the healthcare system needs to move from what might be called a “defensive posture” to an “offensive posture” - i.e. truly targeting disease risk minimization as early as possible, and not just waiting for it to happen before doing anything.

Cost of medicine in the US is a huge issue, the US pays the highest for its drugs of any country.

Its going to be really interesting how this issue of lifespan / life expectancy in different countries plays out in the next 50 years as longevity drugs and therapies become more prevalent.

Obviously - most of the people on this forum are much, much more aware of their health and lifespan options and choices and will likely be in the top 1% of lifespan improvements compared to the regular population.

But as I was reviewing the data and writing up the article on the MBS/Saudi $ Billion / year Hevolution Foundation plans, I began thinking about how this acceleration of the field might play out at a population level. Its a little bit like how the Internet impact all aspects of business during the first two decades after adoption took off in the late 1990s. It quickly became obvious in the business world that “network effects” were a dominant force in driving success in Internet business; the more users / vendors a marketplace (e.g. Craigslist, eBay, Amazon, Facebook) had, the more people wanted to visit it, the more people wanted to visit it, the more vendors wanted to use it, etc… so a very rapid transition to monopoly for many segments of the market.

It doesn’t take a huge leap of faith to see that a similar positive feedback loop / market dynamic could take place in the Longevity Therapeutics / Life Expectancy “market” and society more broadly. It seems likely that wealth inequality and lifespan inequality will be mutually reinforcing; the more money you have, the more you will spend on health / longevity therapeutics and therefore the longer you live, the longer you live the more money you can make, the more wealth you can accumulate…

We can already see hints of this trend already in the US … Peter Attia is a great popularizer of longevity science, and I’ve also heard that he business model for his medical clinic is functioning as a high-end concierge medical clinic type service where he charges clients $160,000 per year for his lifespan / healthspan maximization service. Peter Diamandis and Craig Venter have started the company Human Longevity Inc focused on a similar area: The company maps clients’ genomes and subjects them to regular full-body MRI scans and various blood tests to fight diseases associated with aging. The service starts at $7,500 and rises to $19,000 for a “platinum” package. As the geroscience / longevity biotech progresses over the next decade, I suspect we’ll see a lot more of this types of businesses. The key issue that people are trying to overcome is that the cycle time for biotech / medical innovation (clinical trial cycles that take years, patent protection that is 20 years, etc.) is all relatively slow compared to the human lifespan, so it will be worth a lot to people to be relatively early adopters (but not too early) for the latest longevity technologies that are a good match for their personal biology / genotype.

What does society look like if the top 1% of the wealthiest have life expectancies that increase 10%, 30% or 60% faster than the life expectancy increases of the bottom 95% of the population? Prices for longevity technologies may come down over time, but the wealthy will repeatedly and regularly get the most effective and expensive therapies as they become available, so the “lifespan inequality gap” will always grow. It would be interesting for some PHD students to model these different scenarios out over time and see what the results are.

How long will it be before human society starts looking like that of the bee colony, where the queen bee lives 5 to 10 times longer than the worker bees?

Then there are also second-order effects that could and should be looked at… Does the motivation of a much longer life (as the lifespans of the top %0.1 starts to diverge significantly from the mean) motivate more violence / social instability? What happens to capitalism and entrepreneurship where the difference between the winner and loser in a given market means not just much nicer houses and yachts, but potentially many dozens of years of healthy life? Does it result in an even more “no holds barred” deadly type of capitalism more like the historic Russia Oligarch model of the 1990s and 2000s, where people will do anything to become the oligarch?

I hope this isn’t what happens, but I suspect it will. When I read that the Saudi Royal family spends $1.5 million for a health checkup at the Mayo Clinic I realized that if the Saudi Royal family will spend $1.5 million on a simple health checkup, what are the limits they would spend to get an additional 30 to 100 years of healthy life? I suspect we have that answer now with MBS’s $Billion/year investment in Longevity Biotech / Geroscience. And this “willingness to spend” on longevity will increase dramatically, I suspect, as longevity science becomes more clinically validated. So you have a potential exponential growth in spending in this market over the next 20 years.

What do other people think about this? Maybe I’m being too alarmist on this issue.

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Smaller countries like Germany, Sweden, and Switzerland have different social norms.
When I lived in Germany in the '80s and '90s you were expected to keep your lawn cut.
If you did not, a neighbor would gladly report you to the local Burgermeister and you would receive a nastygram. In the U.S. this only happens if you live in a restricted community.

The German culture was more health-oriented, shopping daily for fresh produce, going on Volkmarches, et. The Germans had a totally different attitude towards medicine. They didn’t camp out at the local doctor’s office every time they had a sniffle.
The company I worked for paid for German healthcare when I was there and I was amazed that the doctors actually saw me on time and the waiting rooms weren’t full. I once had an appointment for the surgical removal of a basal cell carcinoma on my scalp at a Dermatologie-Klinik in Bad Cannstatt. I went to the address and room number I was given and there was one chair in the hallway by the room number I was given. The door was locked, so I sat down. The door opened and I was invited in at the precise time I was given.

In the U.S wealthy people have developed social norms of “looking good”. “You can never be too thin.” (We want to look good in our nice clothes). Poor people do not seem to have much peer pressure to “look good” or be healthy. Why is that?

So for me, one of the main differences is that we are a very large country with diverse social populations and social norms. You will notice that Russia and most of what was the USSR have even lower life expectancies than the U.S. and for many of the same reasons, not just because they are poor. Though I personally don’t like big pharma, I don’t think they are the root cause.

Now that I have that out of the way, I think I will go have a hot dog for the Fourth of July.

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An even more worrying possibility is that the high US expenditure in healthcare is masking an even worse problem. It would be wonderful if all this spending was worthless or even detrimental. We could stop without consequence. But who knows, maybe Americans are so unhealthy due to lifestyle factors that all this money is actually keeping the numbers from being even worse.

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See the image above that better stratifies life expectancy.

We are the absolute best in the world if one can afford it. That’s why rich Europeans only come here to the US at say MD Anderson (or MSK etc) to pay $1,000,000+ for cutting-edge cell-based, gene-based therapy that can add 10+ years of life with 90%+ cancer remission rates and skip their own healthcare system.

This doesn’t mean the single-payer system is bad at all. In fact, I think the system is broken and I support single-payer - with some caveats.

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We do pay more for brand names. But it’s slightly more accurate to say we pay much less for generics than other countries, including Canada.

Yes - the higher the income, the longer the life expectancy, and the faster that life expectancy is growing each year. The good news, is that men are trending strongly at meeting women’s life expectancies…

Bl0V5z1IYAA-_NX



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I would add that these graphs do not take into account net worth, so it’s probably even higher. “Household income percentile” can be misleading, especially in some areas where low 6 figures can be considered “low income”.

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I’d also add if a low-income population here had perfect medical information and prevention strategies, they would still have a better shot than someone around upper middle income to extend lifespan and health span.

The reason is that patient assistance programs are not that hard to qualify and they could move to a different state to qualify for benefits from academic centers with some of the best physicians.

There are a lot of centenarians in Loma Linda, CA btw with a median income of 39,086.

And, when we look at the big picture - we’re all doing a lot better than people in the 1800s :smile:
And we don’t want to live in Africa…


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Another issue is rich people getting scammed. Happens much more often than I originally thought.

I’ve seen a billionaire’s wife fall for a $50,000 vitamin C infusion therapy clinic for breast cancer because she did not want partial breast surgery.

Full-body MRI actually gives false assurance since they are not using the right MRI modality in the right place (i.e. contrast vs no-contrast). OTC WGS is still inferior to CLIA-certified WGS.

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Absolutely… the wealthy are frequently not the most health-savvy.

Even things that are not obvious scams… my be of limited value.

When I look at this:

Peter Diamandis and Craig Venter have started the company Human Longevity Inc focused on a similar area: The company maps clients’ genomes and subjects them to regular full-body MRI scans and various blood tests to fight diseases associated with aging. The service starts at $7,500 and rises to $19,000 for a “platinum” package.

You have to wonder how much value most of the customers are getting out of yearly MRI scans, full genome mapping, etc. Just based on probabilities, most people will likely get little value in the short term from these (it seems), but a few percent will get a lot of value.

As long as its a small percent of your net assets, it doesn’t matter if it provides little value though.

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If one wanted even more value, I suspect one may travel to India and save yourself ~>$18,000 out of $19,000 for the same value in whatever that platinum package may entail.

It could be a nice baseline to have in a very very limited situation (I’m thinking <1% of people will get a lot of value), especially if it was 100x cheaper, but otherwise, I suspect it will end up being falsely reassuring, especially if a non-radiologist physician is too quick to assume there’s nothing wrong because they don’t often read or understand how radiology slides work. :slight_smile:

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New post by Blagosklonny:

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I don’t know how many people have lived outside the US. One thing you notice when returning is how ungodly fat Americans are! Nothing like it anywhere else in the world.
We could speculate on causes for this (USDA food pyramid e.g) but it needs to be addressed.
Covid could have been a lot less severe if the government had focused on helping people learn how to eat right and exercise but…

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Regarding Costs of healthcare in the USA:

We created three “bins” of treatments, sorted according to their health benefit per dollar of spending. The category with the greatest benefit includes low-cost antibiotics for bacterial infection, a cast for a simple fracture, or aspirin and beta blockers for heart attack patients. Not all treatments in this category are inexpensive. Antiretroviral drugs for people with HIV may cost $20,000 per year, but they are still a technology home run because they keep patients alive, year after year.

A second category of technology includes procedures whose benefits are substantial for some patients, but not all. Angioplasty, in which a metal stent is used to prop open blocked blood vessels in the heart, is very cost-effective for heart attack patients treated within the first 12 hours.

A third category includes treatments whose benefits are small or supported by little scientific evidence. These include expensive surgical treatments like spinal fusion for back pain, proton-beam accelerators to treat prostate cancer, or aggressive treatments for an 85-year-old patient with advanced heart failure. The prevailing evidence suggests no known medical value for any of these compared with cheaper alternatives. Yet if a hospital builds a $150 million proton accelerator, it will have every incentive to use it as frequently as possible, damn the evidence.

So it’s not just “technology” that is driving our rising health-care costs; it’s the type of technology that is developed, adopted, and then diffused through hospitals and doctor’s offices. Much of the increase in observed longevity is generated by the first category of treatments. Most of the spending growth is generated by the third category, which the U.S. health-care system is uniquely, and perversely, designed to encourage. Unlike many countries, the U.S. pays for nearly any technology (and at nearly any price) without regard to economic value. This is why, since 1980, health-care spending as a percentage of gross domestic product has grown nearly three times as rapidly in the United States as it has in other developed countries, while the nation has lagged behind in life-expectancy gains.