Explaining Divergent Levels of Longevity in High-Income Countries (2011) / Chapter Skim
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10 Conclusions
10 Conclusions
Pages 142-153
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From page 142... ...
What is perhaps more surprising is that large differences did not exist among many high-income countries around 1950, that the divergence discussed in this report began relatively abruptly around 1980, and that it has taken so long for this divergence to be recognized and analyzed. If one examines trends in life expectancy at various ages across countries, it becomes clear that the divergence has occurred for both men and women and at ages above and below 50.
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From page 143... ...
It should be noted, however, that the risk factors for heart disease, diabetes, and stroke overlap with those for Alzheimer's disease, and it is possible that the trend in deaths due to mental disorders is related to some of the same underlying factors. Although mortality from heart disease played little role in the divergent trends in life expectancy -- because even 50 years ago the United States already had much higher levels of mortality from heart disease than the other countries examined for this study -- it accounts for about half the current gap between the United States and the countries with highest life expectancies; therefore, this condition should be a focus of efforts to bring U.S.
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From page 144... ...
Ultimately, all of these potential risk factors will need to be examined in an integrated framework across the entire life course, taking account of the effects of differences in socioeconomic status, behavioral risk factors, and social policy, as well as effects across particular cohorts and periods. Smoking appears to be responsible for a good deal of the divergence in female life expectancy.
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From page 145... ...
Other specific risk factors also are surely important, but their effects are even more difficult to quantify. The panel found some evidence to suggest that adults aged 50 and over in the United States are somewhat more sedentary than those in Europe, but the research base is insufficient even to identify a reasonable range of uncertainty in estimates of the contribution of physical activity to international differences or trends in mortality.
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From page 146... ...
As a result, measures of inequality in mortality that combine distributions with rates indicate that the United States is not unusual in the size of its mortality differentials by educational attainment. Determining the role of socioeconomic inequality in the divergence in life expectancy among high-income countries is more difficult than determining its role in mortality levels, although it appears to have played some role.
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From page 147... ...
As a result, the level of life expectancy at age 50 in the United States has fallen below that of countries with lower levels of smoking. However, the imprint of smoking has started to recede in the United States among males, contributing to a more rapid reduction in mortality than would have occurred had its imprint been constant or rising (Wang and Preston, 2009)
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From page 148... ...
If we are approaching a biological limit to the length of life, future gains will become more difficult to achieve, and one might expect to observe an inverse association between the current level of life expectancy and the rate of improvement in the following decade. Figures 10-1a and 10-1b show the relationship between these two variables for males and females for 22 countries over the past five decades, using life expectancy at age 80 as the basic mortality indicator.
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From page 149... ...
plotted against average Fig 10-1b.eps annual future change in e80 the following decade (R2 = 0.01) for selected countries.
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From page 150... ...
The main focus of the report has been on a limited set of potential explanations -- obesity, physical activity, smoking, social contacts and integration, health care, hormone replacement therapy, and socioeconomic and geographic inequality -- the factors that the panel identified initially as most promising. The panel addressed some other hypotheses, such as the role of alcohol, in part in its analysis of specific causes of death, but was unable to examine other possible explanations, such as the role of the nutritional content of the diet.2 With respect to the behavioral risk factors that were investigated, a reliable marker of the damage from smoking exists -- mortality rates from lung cancer.
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From page 151... ...
Studies that take advantage of natural experiments, such as increased cigarette taxes, changes in the use of hormone therapy, or the introduction of health care reform, can sometimes serve as valuable supplements to randomized controlled trials. In addition to studying individual behavioral risks, this study has examined the role of broader, systemic factors, including health care systems, levels of inequality, and the quality of social relations.
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From page 152... ...
Likewise, Barker (1998) has assembled evidence showing that intrauterine growth retardation, low birth weight, and premature birth have a causal relationship with the origins of hypertension, coronary heart disease, and noninsulin-dependent diabetes in later life.
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From page 153... ...
It is clear, however, that failures to prevent unhealthy behaviors are costing Americans years of life compared with their counterparts in other wealthy countries.
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