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Lagging U.S. life expectancy ranking blamed on health system

Oct. 9, 2010
Courtesy of the Commonwealth Fund
and World Science staff

The Un­ited States is fall­ing sharply be­hind in world­wide rank­ings of life ex­pect­an­cy, and short­com­ings in the U.S. health care sys­tem may be to blame, sci­en­tists say.

Re­search­ers stu­dy­ing the is­sue con­clud­ed that obes­ity, smok­ing, traf­fic ac­ci­dents and hom­i­cide can’t ac­count for the drop—“lead­ing us to be­lieve that fail­ings in the U.S. health care sys­tem, such as costly spe­cial­ized and frag­ment­ed care, are likely play­ing a large role,” said Pe­ter Muen­nig of Co­lum­bia Uni­vers­ity, lead au­thor of the stu­dy.

In the re­search, which ap­pears in the Oct. 7 on­line is­sue of the jour­nal Health Af­fairs, Muen­nig and co-au­thor Sher­ry Glied of Co­lum­bia cite the grow­ing lack of health insur­ance among Amer­i­cans as a pos­si­ble cul­prit.

The study looked at health spend­ing, be­hav­ior­al risk fac­tors like obes­ity and smok­ing, and sur­viv­al rates for men and wom­en ages 45 and 65 in the U.S. and 12 oth­er in­dus­t­ri­al­ized na­tions.

While the U.S. has achieved gains in 15-year sur­viv­al rates dec­ade by dec­ade from 1975 to 2005, the re­search­ers found that oth­er coun­tries en­joyed even great­er gains. So the U.S. slipped in the rank­ing, even as per cap­i­ta health care spend­ing rose at more than twice the rate of the oth­er coun­tries.

Around 1950, the Un­ited States ranked 5th for life ex­pect­an­cy at birth for wom­en and 10th for men among de­vel­oped coun­tries, ac­cord­ing to re­search cit­ed by Muen­nig and Glied. The most re­cent fig­ures, from the CIA World Fact­book, rank the Un­ited States 22nd among those same coun­tries.

Muen­nig and Glied found si­m­i­lar trends in the 13 coun­tries that they stud­ied, though they only ex­am­ined 15-year sur­viv­al rates for peo­ple at age 45 and 65. 

When they com­pared risk fac­tors, they found very lit­tle dif­fer­ence in smok­ing habits be­tween the U.S. and the com­par­i­son coun­tries—in fact, U.S. smok­ing rates de­clined more quickly than most oth­er coun­tries. 

And while peo­ple are more likely to be obese in the U.S. than else­where, this was al­so the case in 1975, when the U.S. was less far be­hind in life ex­pect­an­cy, the in­ves­ti­ga­tors not­ed. More­o­ver, they said, the pe­rcentage of obese peo­ple ac­tu­ally grew faster in most of the oth­er coun­tries be­tween 1975 and 2005.

Hom­i­cide and traf­fic deaths, mean­while, have ac­counted for a sta­ble share of U.S. deaths over time, and can’t ex­plain the drop in life-ex­pect­an­cy rank­ing, the sci­en­tists said.

The most likely re­main­ing ex­plana­t­ion is flaws in the health care sys­tem, said Muen­nig and Glied, point­ing to the role of un­reg­u­lat­ed fee-for-service pay­ments and high re­li­ance on spe­cial­ty care amid sky­rock­et­ing costs.

“It was shock­ing to see the U.S. fall­ing be­hind oth­er coun­tries even as costs soared ahead of them,” said Muen­nig. “But what really sur­prised us was that all of the usu­al suspects—smok­ing, obes­ity, traf­fic ac­ci­dents, and hom­i­cides—are not the cul­prits.”

The study was funded by the Common­wealth Fund, a pri­vate found­a­tion based in Wash­ing­ton, D.C.

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The United States is falling sharply behind in worldwide rankings of life expectancy, and shortcomings in the U.S. health care system may be to blame, scientists say. Researchers studying the issue concluded that obesity, smoking, traffic accidents and homicide can’t account for the drop—”leading us to believe that failings in the U.S. health care system, such as costly specialized and fragmented care, are likely playing a large role,” said Peter Muennig of Columbia University, lead author of the study. In the research, which appears in the Oct. 7 online issue of the research journal Health Affairs, Muenning and co-author Sherry Glied of Columbia cite the growing lack of health insurance among Americans as a possible culprit. The study looked at health spending, behavioral risk factors like obesity and smoking, and survival rates for men and women ages 45 and 65 in the U.S. and 12 other industrialized nations. While the U.S. has achieved gains in 15-year survival rates decade by decade from 1975 to 2005, the researchers found that other countries enjoyed even greater gains. So the U.S. slipped in the ranking, even as per capita health care spending rose at more than twice the rate of the other countries. Around 1950, the United States ranked 5th for life expectancy at birth among women and 10th among men among developed countries, according to research cited by Muennig and Glied. The most recent figures, from the CIA World Factbook, rank the United States 22nd among those same countries. Muenning and Glied found similar trends in the 13 countries that they studied, though they only examined 15-year survival rates for people at age 45 and 65. When they compared risk factors, they found very little difference in smoking habits between the U.S. and the comparison countries—in fact, U.S. smoking rates declined more quickly than most other countries. And while people are more likely to be obese in the U.S. than elsewhere, this was also the case in 1975, when the U.S. was less far behind in life expectancy, the investigators noted. Moreover, they said, the percentage of obese people actually grew faster in most of the other countries between 1975 and 2005. Homicide and traffic deaths, meanwhile, have accounted for a stable share of U.S. deaths over time, and can’t explain the drop in life-expectancy ranking, the scientists said. The most likely remaining explanation is flaws in the health care system, said Muennig and Glied, pointing to the role of unregulated fee-for-service payments and high reliance on specialty care amid skyrocketing costs. “It was shocking to see the U.S. falling behind other countries even as costs soared ahead of them,” said Muennig. “But what really surprised us was that all of the usual suspects—smoking, obesity, traffic accidents, and homicides—are not the culprits.”