Faltering survival improvements at young-middle ages in high-income English-speaking countries: population-level period and cohort analyses

Abstract

ABSTRACTObjectiveTo quantify mortality trends in six high-income English-speaking countries (Australia, Canada, Ireland, New Zealand, UK, USA) - including by age, sex, period, cohort and major cause - and compare them with other high-income countries (HICs).DesignPeriod and cohort analysis using population-level demographic data.Setting6 high-income Anglophone countries and the average for 14 other HICs.ParticipantsAll-cause mortality data from the Human Mortality Database (1970-2021) and cause-specific death counts from the WHO Mortality Database (2017-19), disaggregated by sex, age group and major cause of death.Main outcome measuresTrends in longevity measures (period life expectancy at birth, 0-50 years, and at age 50 years) and lifespan inequality were estimated for 1970-2021. The contribution of causes of death was measured by calculating life-years lost and decomposing differences in life expectancy between each Anglophone country and the average for other HICs in the pre-pandemic period. The impact of differential cohort survival on current differences in longevity was assessed by calculating the gap in truncated cross-sectional average length of life.ResultsHaving improved consistently from the 1970s, life expectancy in all English-speaking countries except Ireland stalled in the pre-pandemic decade, mainly due to stagnating or increasing mortality at young-middle ages. Relative to other HICs, those born in Anglophone countries since the 1970s experienced relative mortality disadvantage, largely attributable to injuries, including suicides, substance-related and cardiovascular mortality. In contrast, older cohorts enjoyed advantages for females in Australia and Canada and for males in all Anglophone countries except the USA.ConclusionsThe striking disadvantage of young adults in English-speaking countries relative to other HICs should be seen as an emerging and avoidable threat to efforts to improve health equity. Population health policies should be adapted to meet this challenge. Post-pandemic mortality and life expectancy trends in Anglophone countries require further monitoring.WHAT IS ALREADY KNOWN ON THIS TOPICIn the decade before the Covid-19 pandemic, many high-income countries (HICs) experienced a slowdown in longevity improvements.The UK and especially the US have seen some of the most unfavourable trends in life expectancy in recent times.Socio-economic inequalities and the impact of austerity policies, the high prevalence of obesity and long-term cohort effects of smoking, together with an ongoing epidemic of opioid overdose mortality, are identified as the possible determinants of the adverse mortality trends in individual countries.WHAT THIS STUDY ADDSEach of the English-speaking countries, except for men in Ireland, has experienced a marked mortality disadvantage for those under 50 years (born since the early 1970s) relative to the average of other HICs.In 2017-19, losses in life expectancy at birth due to elevated mortality at younger ages relative to other HICs ranged from 0.15 years for Australian women to 2.06 years for US men.This contrasts with the generally better performance of the English-speaking countries at older ages, particularly for men.