The National Academies Press

Currently Skimming:

1 Shorter Lives
Pages 25-56

The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.

From page 25... ... This chapter examines mortality from multiple perspectives to pre sent a comprehensive picture of the evidence: we examine mortality rates (the number of deaths from particular causes per 100,000 persons) , life expectancy at various ages, the probability of living to age 50, and years of life lost from particular causes. Read the entire page →
From page 26... ... As of 2009, ischemic heart disease mortality among males in the United States was 129 per 100,000, higher than the other 16 peer countries except Finland (OECD, 2011b) .4 Table 1-1 provides cause-specific mortality rates 2 The panel selected these 17 as "peer countries" because they are most comparable to the United States. Read the entire page →
From page 27... ... . Fig1-1.eps Finland 11 Austria 14 Italy 16 Switzerland 17 Australia 18 Sweden 20 Germany 21 France 23 Canada 23 Spain 24 Norway 27 Denmark 27 Netherlands 28 United States 34 United Kingdom 36 Japan 40 Portugal 46 0 5 10 15 20 25 30 35 40 45 50 Age-Standardized Deaths per 100,000 People FIGURE 1-2 Mortality from communicable diseases in 17 peer countries, 2008. Read the entire page →
From page 28... ... U.S. ALL CAUSES 378.0 420.5 401.2 500.8 446.6 397.7 440.6 383.0 349.3 427.3 425.3 467.7 397.7 409.8 371.2 462.1 504.9 Specific causes Noncommuni- 329.9 372.5 345.8 440.4 377.0 336.4 393.9 342.1 273.0 376.8 363.1 393.9 351.0 357.6 323.3 400.5 418.4 cable diseases Cardiovascular 117.2 154.4 118.6 144.6 163.6 99.2 174.9 132.3 97.4 122.4 132.9 148.2 115.7 150.8 123.1 141.7 155.7 diseasesa Malignant 118.8 123.6 125.8 157.7 106.5 138.4 127.5 124.2 115.1 147.1 130.3 134.3 122.0 116.4 112.7 137.0 123.8 neoplasmsb Other neoplasms 2.9 3.5 2.4 3.6 2.1 5.2 2.8 5.3 3.3 3.6 2.5 2.9 3.7 3.2 2.8 2.9 2.9 Neuropsychiatric 26.2 19.6 28.2 38.8 48.4 34.0 19.5 18.8 7.2 32.7 32.7 16.1 28.2 34.2 33.5 31.7 39.2 conditionsc Respiratory 21.6 15.5 22.4 31.2 12.7 13.3 17.3 17.3 15.8 23.9 25.4 25.6 31.1 15.5 13.4 34.4 34.3 diseases • Chronic 12.8 12.9 15.4 26.8 9.1 5.4 11.9 11.5 4.0 19.0 20.8 10.5 12.6 11.7 9.9 21.5 24.3 obstructive pulmonary disease • Asthma 1.2 0.9 0.5 0.8 0.8 0.8 1.0 0.4 0.7 0.3 1.2 0.6 0.8 0.6 0.5 1.1 0.9 Digestive 13.0 19.4 15.5 29.5 27.2 20.4 25.7 16.4 14.5 17.4 13.7 25.6 21.3 15.1 15.9 26.7 19.8 diseasesd Diabetes mellitus 9.9 17.4 13.4 12.3 5.5 8.1 11.1 12.4 4.5 10.1 7.4 19.3 9.4 9.2 8.2 5.0 15.2 Read the entire page →
From page 29... ... Genitourinary 8.2 5.4 7.6 8.1 3.0 5.7 7.1 5.7 8.0 9.3 7.7 12.2 9.2 4.6 4.0 9.1 12.3 diseasese Endocrine 5.2 8.1 5.1 6.5 1.6 5.8 3.5 4.3 2.6 3.5 3.8 5.3 3.4 3.2 2.7 3.1 7.1 disorders Congenital 3.2 3.9 3.7 4.0 3.6 2.8 2.8 2.8 2.6 3.3 3.4 2.7 2.9 2.7 3.8 3.7 4.3 anomalies Musculoskeletal 2.8 1.5 2.4 3.4 2.3 2.5 1.2 2.0 1.7 2.4 2.6 1.4 3.0 2.1 2.8 3.5 2.9 diseasesf Skin diseases 0.8 0.3 0.5 0.6 0.3 0.9 0.3 0.5 0.3 1.1 0.7 0.1 1.0 0.5 0.5 1.5 0.8 Oral conditions 0.1 0.0 0.0 0.1 0.1 0.0 0.0 0.0 0.0 0.1 0.1 0.0 0.0 0.0 0.0 0.0 0.0 Injuries 30.0 33.6 32.1 33.1 58.5 38.2 25.2 24.6 36.3 22.1 35.6 28.3 23.2 32.2 30.5 25.5 52.8 Unintentional 21.0 21.2 20.6 22.3 38.6 23.3 15.4 19.0 16.1 13.7 25.2 19.3 16.7 19.7 17.2 17.4 35.5 injuries • Road traffic 6.8 6.9 7.8 5.4 5.7 6.6 5.7 8.4 3.8 4.0 5.2 10.0 6.1 4.1 3.8 4.8 13.9 accidents • Poisonings 3.0 0.2 2.1 3.8 13.9 1.6 0.9 0.7 0.6 0.9 6.8 0.2 1.0 3.2 1.9 2.8 8.9 • Falls 3.1 5.3 3.7 2.8 10.1 4.0 4.6 2.2 2.5 4.0 3.7 2.5 2.2 4.1 7.5 3.5 4.4 • Fires 0.3 0.3 0.6 0.9 1.2 0.6 0.3 0.2 0.7 0.3 1.0 0.5 0.3 0.7 0.1 0.5 0.9 • Drowning 0.9 0.8 0.8 0.8 1.8 1.3 0.5 0.6 2.4 0.4 0.8 0.7 0.9 0.9 0.6 0.4 1.2 • Other 6.9 7.8 5.6 8.6 6.0 9.3 3.3 7.0 6.2 4.1 7.7 5.4 6.1 6.7 3.3 5.5 6.2 Intentional 9.0 12.3 11.5 10.8 19.9 14.8 9.9 5.6 20.2 8.4 10.4 9.0 6.5 12.6 13.3 8.0 17.3 injuries • Self-inflicted 7.8 11.8 9.9 10.1 17.7 13.6 9.1 4.5 19.8 7.4 9.7 7.5 5.6 11.7 12.6 6.9 10.3 injuries 29 continued Read the entire page →
From page 30... ... U.S. • Violence 1.3 0.5 1.6 0.8 2.2 1.3 0.7 1.1 0.4 0.9 0.6 1.5 0.9 0.9 0.7 1.1 6.5 • War -- -- -- -- -- 0.0 -- -- -- 0.1 0.0 0.0 -- -- -- -- 0.4 Communi- 18.1 14.4 23.3 27.3 11.1 23.1 21.5 16.3 40.0 28.4 26.6 45.5 23.6 20.0 17.3 36.1 33.7 cable, maternal, perinatal, and nutritional conditions Respiratory infectionsg 7.0 5.7 9.0 13.9 4.0 8.4 10.1 4.7 29.7 16.8 13.8 23.6 9.3 8.9 7.4 23.8 9.7 Infectious and parasitic diseasesh 5.9 4.7 7.6 7.6 4.4 9.0 7.4 6.8 8.1 6.9 9.2 17.5 9.8 7.8 4.7 6.7 15.4 Maternal conditions 0.1 0.0 0.1 0.2 0.1 0.1 0.1 0.0 0.1 0.1 0.1 0.1 0.1 0.1 0.0 0.1 0.4 Perinatal conditions 4.6 3.8 5.9 4.4 2.5 3.6 3.6 3.8 1.3 3.6 3.1 3.4 3.7 2.4 4.8 5.2 7.1 • Prematurity and low birth weight 1.2 1.9 2.0 2.7 0.9 0.6 2.0 1.5 0.4 0.8 0.4 0.9 0.9 0.4 1.4 3.4 3.2 • Birth asphyxia and birth trauma 0.6 0.5 1.1 0.6 0.4 0.8 0.5 1.1 0.4 0.7 0.5 0.8 0.7 0.5 0.7 0.6 0.9 Read the entire page →
From page 31... ... mortality rate for communicable diseases is higher than that of the United Kingdom; Portugal has a higher mortality rate for noncommunicable diseases in general and genitourinary diseases in particular; Denmark has a higher mortality rate for neuropyshicatric disorders; both Denmark and Austria have higher mortality rates for congenital anomalies; Sweden has a slightly higher mortality rate for cardiovascular diseases; Spain has a higher mortality rate for respiratory diseases; and France and Switzerland have higher mortality rates for musculoskeletal diseases. Not listed here are conditions with relatively low mortality rates (e.g., less than 2 per 100,000) Read the entire page →
From page 32... ... . Unintentional injuries are the leading cause of death among Americans, from ages 1-44 (National Center for Health Statistics, 2012) Read the entire page →
From page 33... ... A comparison of the U.S. experience with that of 15 other high-income countries for which 1975–2008 data are available shows that the U.S. Read the entire page →
From page 34... ... A 2005 study reported that U.S. adults aged 15-59 had higher mortality rates than those in nine economically comparable nations: "Compared with other nations in the WHO's mortality database, in the United States 15-year-old girls rank 38th and 15-year-old boys rank 34th in their likelihood of reaching age 60" (enkins and Runyan, 2005, p. Read the entire page →
From page 35... ... CROSS-NATIONAL DIFFERENCES IN LIFE EXPECTANCY Not surprisingly, higher mortality rates affect life expectancy in the United States. Perhaps the single most impressive achievement of the past century is the striking increase in longevity in nearly all parts of the world. Read the entire page →
From page 36... ... . As noted in the Introduction of this report, that earlier report analyzed how life expectancy at age 50 had changed between 1980 and 2007, noting that it had increased by only 2.5 years in the United States compared with increases of 6.4 years in Japan, 5.2 years in Italy, and an average of 3.9 years in nine high-income countries other than the United Read the entire page →
From page 37... ... Figure 1-5 shows that, among peer countries, male life expectancy at birth in the United States ranked near the bottom in 1980 and at the bottom in 2006. Figure 1-6 shows that female life expectancy, which had been near the median in 1979, ranked at the bottom in 2006. Read the entire page →
From page 38... ... Peer Countries (N = 16) Cause of Death United States Unweighted Mean Range Death Rates Above Average Cardiovascular diseasesa 155.7 133.6 97.4-174.9 Neuropsychiatric conditionsb 39.2 28.1 7.2-48.4 Respiratory disease 34.3 21.0 12.7-34.4 Infectious and parasitic diseases 15.4 7.7 4.4-17.5 Diabetes mellitus 15.2 10.2 4.5-19.3 Genitourinary diseasesc 12.3 7.2 3.0-12.2 Endocrine disorders 7.1 4.2 1.6-8.1 Congenital anomalies 4.3 3.3 2.6-4.0 Musculoskeletal diseasesd 2.9 2.4 1.2-3.5 Nutritional deficiencies 1.0 0.7 0.1-2.0 Skin diseases 0.8 0.6 0.1-1.5 Maternal conditions 0.4 0.1 0.0-0.2 Perinatal conditions 7.1 3.7 1.3-5.9 Unintentional injuriese 35.5 20.4 13.7-38.6 Intentional injuries 17.3 11.4 5.6-20.2 Death Rates at or Below Average Malignant neoplasmsf 123.8 127.3 106.5-157.7 Digestive diseasesg 19.8 19.8 13.0-29.5 Respiratory infections 9.7 12.3 4.0-29.7 Other neoplasms 2.9 3.3 2.1-5.3 Oral conditionsh 0.0 0.0 0.0-0.1 Sense organ diseasesh 0.0 0.0 0.0 NOTE: Higher death rates shown in bold. Read the entire page →
From page 39... ... U.S. older adults had among the lowest age-specific mortality rates of 17 peer countries: this pattern has been observed in every decade since 1960, suggesting that the underlying cause is not a recent phenomenon. Read the entire page →
From page 40... ... counties still compared unfavorably with the best-performing high-income countries. Merging 3,147 counties into 2,357 county clusters suitable for statisti cal analysis, researchers found that only 33 counties had a male life expectancy that exceeded the average of 10 leading countries, and only 8 counties had a higher female life expectancy (Kulkarni et al., 2011) Read the entire page →
From page 41... ... One study found that black and Native Americans in some regions had mortality rates that were almost twice that of the OECD countries with the highest mortality rates (Murray et al., 2006) Read the entire page →
From page 42... ... male life expectancy at birth relative to 21 other high-income countries, 1980-2006. NOTES: Red circles depict newborn life expectancy in the United States. Read the entire page →
From page 43... ... Fig1-6.eps NOTES: Red circles depict newborn life expectancy in the United States. Grey circles depict life expectancy values for Australia, Austria, Belgium, Canada, Den mark, Finland, France, Iceland, Ireland, Italy, Japan, Luxembourg, the Netherlands, New Zealand, Norway, Portugal, Spain, Sweden, Switzerland, the United Kingdom, and West Germany. Read the entire page →
From page 44... ... One summary measure of mortality in this age group is the prob ability that a 15-year-old will die before reaching age 50 (given current age-specific mortality rates) Read the entire page →
From page 45... ... These results confirm a U.S. mortality gap for females across the life span. Read the entire page →
From page 46... ... . than in other countries with a similar overall life expectancy (Shkolnikov et al., 2003) Read the entire page →
From page 47... ... , and more recently, lower death rates from cardiovascular diseases from age 35 onward (Cutler and Miller, 2004; Riley, 2001) Read the entire page →
From page 48... ... Because deaths in high-income countries are assigned to various causes of death by medical certifiers using internationally accepted criteria, it is possible to examine how life expectancy varies cross-nationally by cause. In this section, the panel presents an analysis of years of life Read the entire page →
From page 49... ... Rankings are based on all-cause mortality rates for 2006-2008. Data for this figure were drawn from (1) Read the entire page →
From page 50... ... Although communicable diseases and nutritional conditions are no longer a leading cause of premature deaths in most highincome countries, the United States still fares poorly in this category. The gap in years of life lost from noncommunicable diseases -- which includes heart disease, cancer, and other conditions not caused by infections -- is also large. Read the entire page →
From page 51... ... ; the WHO Mortality Database (downloaded July 18, 2011, last updated March 25, 2011) ; and Statistics Canada (downloaded July 22, 2011, data released February 23, 2010) Read the entire page →
From page 52... ... The drug-related causes category is included to illustrate the excess years of life lost from drug-related causes of death in the United States relative to other countries. Data for this figure come from the Human Mortality Database (downloaded July 18, 2011, last updated July 13, 2011) Read the entire page →
From page 53... ... Data for this figure come from the Human Mortality Database (downloaded July 18, 2011, last updated July 13, 2011) ; the WHO Mortality Database (downloaded July 18, 2011, last updated March 25, 2011) Read the entire page →
From page 54... ... , diseases, excluding 8% HIV, 2% HIV, 2% Residual, Noncommunicable diseases, excluding 7% CVD, 10% Suicide, 4% Perinatal Homicide, 19% condiƟons, 13% TransportaƟon related accidents, 18% NontransportaƟon related accidents, 16% FIGURE 1-15 Contribution of cause-of-death categories to difference in years of Fig1-15.eps life lost before age 50 between the United States and the mean of 16 peer countries, males, 2006-2008. NOTES: Because of the overlap with other cause-of-death categories, drug-related causes are not included as a separate category in this figure, which shows mutually exclusive contributions of specific causes of death (see NOTES in Figure 1-13) Read the entire page →
From page 55... ... ; the WHO Mortality Database (downloaded July 18, 2011, last updated March 25, 2011) ; and Statistics Canada (downloaded July 22, 2011, data released February 23, 2010) Read the entire page →
From page 56... ... Although the poor ranking of U.S. life expectancy at birth is partly attributable to relatively higher mortality rates after age 50, that is not the entire story: the United States compares unfavorably on mortality rates up to age 75. Read the entire page →

From page 25...

... This chapter examines mortality from multiple perspectives to pre sent a comprehensive picture of the evidence: we examine mortality rates (the number of deaths from particular causes per 100,000 persons) , life expectancy at various ages, the probability of living to age 50, and years of life lost from particular causes.

1 Shorter Lives Pages 25-56

1 Shorter Lives
Pages 25-56