Role of Cardiovascular deaths on changes in the Longevity Gap Between U.S. and Other Countries.

Abstract

Introduction: Between 2008 and 2019 the gap in life expectancy (LE) between the U.S. and other high-income countries grew significantly, with the reasons for the growth remaining unknown. This study measured the contribution of cardiovascular disease (CVD) mortality in the growth of the gap in LE at age 50 (LE50) between the U.S. and ten other high-income countries.

Methods: Cross-sectional observational study in 2008 and 2019, using Human Mortality Database and World Health Organization data for population aged 50 plus as participants. Actual and counterfactual LE50s were compared to quantify the effect of CVD mortality on the growth in the gap. Two counterfactual LE50s were calculated, one based on a cause-deleted method, and another by applying the U.S. trends to other countries. A decomposition was performed to quantify the combined effects of selected death causes and ages.

Results: The U.S. was the worst-performing country regarding CVD mortality improvements between 2008 and 2019. The LE50 gap between the U.S. and the average of the other high-income countries grew 0.33 years for women, explained entirely by CVD mortality, and 0.79 years for men, 50% of which was explained by CVD mortality. CVD mortality after age 70 was responsible for 81% of the growth of the gap among women, while for men CVD mortality after age 70 contributed 36%.

Conclusions: The slow rate of decline of CVD mortality in the U.S. was the main driver of the growth of the LE50 gap between the U.S. and other high-income countries, so prevention of those deaths is critical.