Australians outlive their peers in 5 high income English speaking countries, including the UK and the US, by between 1 to 4 years, finds an analysis of international longevity data, published in the open access journal BMJ Open.
Most of this advantage accrues between the ages of 45 and 84, with death rates from drug and alcohol misuse, screenable/treatable cancers, and cardiovascular and respiratory diseases all lower, the analysis shows.
While high income countries achieved good life expectancy gains during the 20th century, the trends have been much less favourable in the 21st century, even before the COVID-19 pandemic, note the researchers.
Stalled declines in deaths from cardiovascular disease, along with a rising death toll from drug overdoses, mental illness, and neurological disease, are key contributory factors, they explain. And sizeable gaps in life expectancy between the richest and poorest, which are evident in most of these countries, have widened further in recent decades.
While English speaking high income countries have much in common, they also have notable differences, including in their healthcare and welfare systems, inequality, racial and ethnic composition, and history of immigration.
The researchers therefore wanted to know if there were any lifespan differences among Australia, Canada, Ireland, New Zealand, the UK, and the USA, which represent some of the wealthiest economies in the world.
They obtained national life tables from the Human Mortality Database (HMD) for men and women in these countries plus—for context only—Austria, Belgium, Denmark, Finland, France, Germany, Italy, Japan, the Netherlands, Norway, Portugal, Spain, Sweden and Switzerland between 1990 and 2019.
Detailed information on deaths by sex, age, and cause of death were obtained from the World Health Organization Mortality Database for all 6 English speaking countries.
Analysis of the data showed that Australia has been the best performer in life expectancy at birth since the early 1990s, leading its peer countries by 1.26–3.95 years for women and by 0.97–4.88 years for men in 2018.
Specifically, Australia has a 4 to 5 year life expectancy advantage over the USA and a 1 to 2.5 year advantage over Canada, New Zealand, Ireland, and the UK.
For most of the period between 1990 and 2019, Canada had the second highest life expectancy. Most recently, Ireland and New Zealand have matched Canada.
But in every year since 2001, the USA has been the worst performer. And in the most recent decade, the UK generally had the second lowest life expectancy.
Similar trends are observed for life expectancy at age 65, with Australia generally performing the best and the USA the worst, with the USA’s poor life expectancy ranking at age 65 emerging more recently.
The gaps in life expectancy at birth between the best and worst performers widened over time. In 1990, Canadian men and women had the highest life expectancies—74 and 80, respectively; American men and Irish women had the lowest—71 and 77, respectively.
The corresponding gaps were 2.38 and 2.91 years. By 2019, these gaps had doubled to 4.75 years for men and increased by 30% for women to 3.80 years between Australia and the USA.
While women in English speaking countries never ranked among the top performers in female life expectancy between 1990 and 2019 in all 20 high income countries, men—with the exception of the USA— typically have ranked in the top half over the past decade.
And out of all these countries, Australian men ranked in the top 4 in all but 1 year between 1990 and 2019. But American men have had the lowest life expectancy since 2005.
The 65–84 age group typically makes the single largest contribution to life expectancy gaps between Australia and the other 5 English speaking high income countries, ranging from 39% in the USA to 78% in Ireland among women, and from 30% in the USA to 100% in Ireland among men.
While Australians have lower rates of death across nearly all ages, most of their life expectancy advantage accrues between ages 45 and 84.
Ischaemic heart disease, other circulatory diseases, cancers, respiratory diseases, mental illness and neurological disease—mostly Alzheimer’s disease and related dementias—are key contributors to life expectancy gaps in this age group.
But Australia also tends to have a lower death rate from external causes, including drugs and alcohol, screenable/treatable cancers, cardiovascular disease, and flu/pneumonia.
As to life expectancies within countries, Canada and the USA perform the worst, with 13 US states in the lowest category for men and women. On the other hand, all regions in the UK and Ireland have life expectancies above 81 for women and 76.5 for men.
For both men and women, Australia has the lowest within country inequality, especially at ages above 40, followed by Canada. Among women, inequality tends to be highest in New Zealand, Ireland and the USA; among men, it is highest in New Zealand, the UK, and the USA.
The researchers acknowledge that they couldn’t account for differences within local neighbourhoods, and that there may be differences in cause of death coding, particularly at older ages where several conditions may co-exist.
But there are several possible explanations for Australia’s top ranking, they suggest, among which are the country’s high proportion of people born overseas—nearly 30% in 2018.
A low prevalence of smoking might be another, while public health initiatives around gun ownership and mental health, and its highly rated healthcare system, might also explain Australia’s position at the top of the life expectancy league table.
“Australia performs well, but still has room for improvement, particularly in the area of reducing inequalities among its indigenous populations,” and in its rates of obesity, say the researchers.
But they conclude: “Overall, Australia offers a potential model for lower-performing Anglophone countries, such as the USA and UK, to follow to reduce both premature mortality and inequalities in life expectancy.”
Method of Research
Observational study
Subject of Research
People
Article Title
Life expectancy and geographic variation in mortality: an observational comparison study of six high-income Anglophone countries
Article Publication Date
13-Aug-2024
UNIVERSITY PARK, Pa. — Despite being home to some of the world’s most dangerous animals, Australia has led the English-speaking world in life expectancy for the last three decades. As for other high-income Anglophone countries, the Irish saw the largest gains in life expectancy, while Americans have finished dead last since the early 1990s, according to a team of social scientists led by a Penn State researcher.
The team published their findings today (August 13) in the journal BMJ Open.
“One lesson we Americans can learn about life expectancy from looking at comparable countries is where the frontier of best performance lies,” said Jessica Ho, associate professor of sociology and demography at Penn State and senior author on the paper. “Yes, we’re doing badly, but this study shows what can we aim for. We know these gains in life expectancy are actually achievable because other large countries have already done it.”
The researchers compared life expectancy in the United States, Canada, Ireland, the United Kingdom, Australia and New Zealand using data from the Human Mortality Database and the World Health Organization Mortality Database between 1990 and 2019. They analyzed the data by sex, age and 18 individual and comprehensive cause of death categories, including cancers, drug- and alcohol-related deaths, firearms and motor vehicle collisions.
They also examined life expectancy within each country to identify geographical inequalities in life expectancy by region.
The researchers found that Australians had the longest life expectancy at birth over the study period, with women living nearly 4 more years and men 5 more years than their American counterparts. The Irish showed the largest gains in life expectancy, with men’s lifespans increasing by approximately 8 years and women’s lifespans by more than 6.5 years. Americans had the shortest life expectancy at birth, with women living an average of almost 81.5 years and men an average of nearly 76.5 years in 2019.
The United States also showed some of the largest geographical inequalities in life expectancy compared to the other countries, according to the researchers. Women and men in California and Hawaii had some of the highest life expectancies at birth, with women averaging 83 to 83.9 years and men averaging 77.5 to 78.4 years. States in the American Southeast saw some of the lowest life expectancies at birth of all subnational regions studied, with women averaging 72.6 to 79.9 years and men averaging 69.3 to 74.4 years.
“One of the main drivers of why American longevity is so much shorter than in other high-income countries is our younger people die at higher rates from largely preventable causes of death, like drug overdose, car accidents and homicide,” said Ho, who is also an associate of Penn State’s Social Science Research Institute.
In midlife — the 45 to 64 age range — some of these causes continue, like high death rates from drug- and alcohol-related mortality, Ho explained, adding that Americans also see higher rates of cardiovascular disease mortality.
“Some of the latter could be related to sedentary lifestyle, high rates of obesity, unhealthy diet, stress and a history of smoking,” she said. “It’s likely that these patterns of unhealthy behaviors put Americans at a disadvantage in terms of their health and vitality.”
Australia offers the U.S. a model for improving its life expectancy, Ho added. Like the U.S., Australia is large in terms of land area and has a comparable history of personal vehicle ownership. The two countries have some cultural similarities, including historically greater use of firearms. However, Australia implemented a number of policies in recent decades including gun law reforms that helped vault them to the top of the life expectancy rankings.
“What the study shows is that a peer country like Australia far outperforms the U.S. and was able to get its young adult mortality under control,” Ho said. “It has really low levels of gun deaths and homicides, lower levels of drug and alcohol use and better performance on chronic diseases, the latter of which points to lifestyle factors, health behaviors and health care performance.”
Ho said policies like investing in public transit infrastructure, adding more roundabouts and having fewer large cars on the road could decrease traffic deaths in the United States. More support for programs designed to reduce drug dependence and reducing barriers to treatment and prevention of drug overdose could help lower drug-related mortality, she said. And having a strong combination of public health effort, health care access and community interventions to encourage healthier lifestyles and the use of preventive medicine could reduce cardiovascular disease mortality, she added.
“Australia is a model for how Americans can do better and achieve not only a higher life expectancy but also lower geographic inequality in life expectancy,” Ho said.
Rachel Wilkie, a doctoral student at the University of Southern California, also contributed to this research. The National Institute on Aging of the National Institutes of Health supported this work.
