Violence plays a role in shorter U.S. life expectancy

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Younger Americans die earlier and live in poorer health than their counterparts in other developed countries, with far higher rates of death from guns, car accidents and drug addiction, according to a new analysis of health and longevity in the United States.

Researchers have known for some time that the United States fares poorly in comparison with other rich countries, a trend established in the 1980s. But most studies have focused on older ages, when the majority of people die.

The findings were stark. Deaths before age 50 accounted for about two-thirds of the difference in life expectancy between males in the United States and their counterparts in 16 other developed countries, and about one-third of the difference for females.

The countries in the analysis included Canada, Japan, Australia, Germany and Portugal.

The 378-page study by a panel of experts convened by the Institute of Medicine and the National Research Council is the first to systematically compare death rates and health measures for people of all ages, including U.S. youths.

The report went further than other studies in documenting the full range of causes of death, from diseases to accidents to violence. It was based on a broad review of mortality and health studies and statistics, with most statistics in the report from the late 1990s through 2008.

The panel called the pattern of higher rates of disease and shorter lives "the U.S. health disadvantage," and said it was responsible for dragging this country to the bottom in terms of life expectancy over the past 30 years.

U.S. men ranked last in life expectancy among the 17 countries in the study, at 75.6 years, and U.S. women ranked second-to-last, at 80.7 years.

"Something fundamental is going wrong," said Steven Woolf, a physician who is chairman of Virginia Commonwealth University's Department of Family Medicine, who headed the panel. "This is not the product of a particular administration or political party. Something at the core is causing the U.S. to slip behind these other high-income countries. And it's getting worse."

This nation's health disadvantages have economic consequences. They lead to higher costs for consumers and taxpayers as well as a workforce that remains less healthy than that of other high-income countries. "With lives and dollars at stake, the United States cannot afford to ignore this problem," the report said.

Car accidents, gun violence and drug overdoses were major contributors to years of life lost by Americans before age 50.

The rate of firearm homicides was 20 times higher in the United States than in the other countries, according to the report, which cited a 2011 study of 23 countries. And though suicide rates were lower in the United States, firearm suicide rates were six times higher.

Gun violence is just one of many factors contributing to lower U.S. life expectancy, but the finding took on urgency because the report comes less than a month after the shooting deaths of 20 children and six adult staff members at an elementary school in Newtown, Conn.

The United States has about six violent deaths per 100,000 residents. None of the 16 other countries included in the review came anywhere close to that ratio. Finland was closest to the U.S. ranking, with slightly more than two violent deaths per 100,000 residents.

Sixty-nine percent of all U.S. homicide deaths in 2007 involved firearms, compared with an average of 26 percent in other countries, the study said.

The researchers said there is little evidence that violent acts occur more frequently in the United States than elsewhere. It's the lethality of those attacks that stands out.

"One behavior that probably explains the excess lethality of violence and unintentional injuries in the United States is the widespread possession of firearms and the common practice of storing them [often unlocked] at home. The statistics are dramatic," the report said.

Panelists were surprised at just how consistently Americans ended up at the bottom of the rankings.

The United States had the second-highest death rate from the most common form of heart disease, the kind that causes heart attacks, and the second-highest death rate from lung disease, a legacy of high smoking rates in past decades. U.S. adults also have the highest diabetes rates.

Youths fared no better. The United States has the highest infant mortality rate among these countries, and its young people have the highest rates of sexually transmitted diseases, teen pregnancy and deaths from car crashes. Americans lose more years of life before age 50 to alcohol and drug abuse than people in any of the other countries.

Americans also had the lowest probability overall of surviving to age 50. The report's second chapter details health indicators for youths where the United States ranks near or at the bottom. There are so many that the list takes up four pages.

Chronic diseases, including heart disease, also played a role for people under 50.

"We expected to see some bad news and some good news," Dr. Woolf said. "But the U.S. ranked near and at the bottom in almost every heath indicator. That stunned us."

"The bottom line is that we are not preventing damaging health behaviors," said University of Pennsylvania demographer and sociologist Samuel Preston, who was on the panel. "You can blame that on public health officials or on the health care system. No one understands where responsibility lies. But put it all together and it is creating a very negative portrait."

There were bright spots. Death rates from cancers that can be detected with tests, such as breast cancer, were lower in the United States. Adults had better control over their cholesterol and high blood pressure. And the very oldest Americans -- above 75 -- tended to outlive their counterparts.

The panel sought to explain the poor performance. It noted the United States has a highly fragmented health care system, with limited primary care resources and a large uninsured population.

It has the highest rates of poverty among the countries studied.

Education also played a role. Americans who have not graduated from high school die from diabetes at three times the rate of those with some college, Dr. Woolf said. In the other countries, more generous social safety nets buffer families from the health consequences of poverty, the report said.

Still, even the people most likely to be healthy, such as college-educated Americans and those with high incomes, fare worse on many health indicators.

The report also explored less conventional explanations. Could cultural factors such as individualism and dislike of government interference play a role? Americans are less likely to wear seat belts and more likely to ride motorcycles without helmets.

"We have a culture in our country that, among many Americans, cherishes personal autonomy and wants to limit intrusion of government and other entities on our personal lives and also wants to encourage free enterprise and the success of business and industry. Some of those forces may act against the ability to achieve optimal health outcomes," Dr. Woolf said.

science

Associated Press contributed.


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