U.S. life expectancy gains are expected to stagnate by 2050 as health care advances fail to keep pace with other countries

The US is failing to keep pace with dozens of countries around the world due to the steady decline in healthcare progress, according to a detailed analysis of all fifty states and Washington DC published in The Lancet.

Researchers at the Institute for Health Metrics and Evaluation (IHME) have created health estimates and forecasts (the most likely future) of life expectancy, mortality and morbidity from more than 350 diseases and injuries and 68 risks in the US from 1990 to 2050 .

Life expectancy improvement in the US is slow, global rankings are falling

Life expectancy (LE) in the US is predicted to increase from 78.3 years in 2022 to 79.9 years in 2035 and to 80.4 years in 2050 for all genders combined. This modest increase lowers the country’s global ranking from 49th in 2022 to 66th in 2050 among the 204 countries and territories included in the most recent Global Burden of Disease (GBD) Survey..

Nationally, mortality rates for many leading causes of death declined between 1990 and 2021, particularly ischemic heart disease, cancer and stroke. This has contributed to the improvement in life expectancy.

Despite the progress the US has made over the past three decades, the country is predicted to continue to rank lower than other countries in the world in the average number of years a person can be expected to live in good health. Known as healthy life expectancy or health-adjusted life expectancy (HALE), the global ranking is expected to fall from 80th in 2022 to 108th in 2050.

The health of women in the US is lagging behind that of other comparable countries at a faster rate than that of men. Women’s HALE is predicted to decline by 2050 in 20 states, including Ohio, Tennessee, and Indiana. Only three states remain unchanged: Arizona, Idaho and North Dakota. This gender gap is mainly due to slow increases or no changes in life expectancy for women and HALE, rather than major improvements for men.

The global ranking for U.S. female LE is predicted to drop to 74th by 2050. That’s a substantial drop from 19th in 1990 and 51st in 2022. The U.S. estimates for LE men will expected to rank 65th globally by 2050, down from 35th in 1990 and from 51st in 2022. This lower ranking places the US below almost all high-income countries and some middle-income countries.

When LE in the best and worst performing US states is compared to the other 203 GBD countries and territories, the states’ global rankings also fell over the forecast period. If Hawaii were a country and compared to all 203 other countries and territories around the world, the 1990 LE would rank fourth worldwide, the highest LE in the US.

This ranking dropped to 29th in 2022 and is expected to drop to 43rd in 2050. And while New York is predicted to have the highest LE in the US by 2050, ranking 41st in the world, it is still down from 33rd in the US. 1990 and in 2022.

The slight increase in US LE projected in 2050 is due to a decline in mortality rates, including a 49.4% decline in ischemic heart disease mortality rates, a 40.5% decline in stroke mortality rates and a 35.7% decrease in diabetes mortality rates.

“Despite modest increases in life expectancy overall, our models predict that health improvements will slow due to rising rates of obesity, which is a serious risk factor for many chronic diseases and is predicted to rise to levels has never been seen before,” said co-senior author Professor Christopher JL Murray, Director of IHME.

“The rise in obesity and overweight rates in the US, with IHME predicting more than 260 million people will be affected by 2050, signals a public health crisis of unimaginable proportions.”

Alarming predictions about US mortality rates and causes of death

The country is also facing other alarming trends. From 1990 to 2021, the US recorded an 878% increase in the death rate (from 2.0 deaths to 19.5 deaths per 100,000) due to substance use disorders, including opioid use disorders, amphetamine use disorders, in cocaine use and a group of other drug use disorders.

The mortality rate is predicted to increase by a further 34% between 2022 and 2050 (from 19.9 deaths to 26.7 deaths per 100,000). That is the highest death rate from drug use in the world and more than twice as high as the next highest country, Canada.

“The stark contrast predicted for the next thirty years comes after a joint effort among federal, state, and local government agencies and health care systems, launched after the opioid crisis was declared a public health emergency in 2017. The opioid epidemic is far from over. and greater effectiveness and continued expansion of programs to prevent and treat drug abuse are still needed,” said lead author Professor Ali Mokdad of IHME.

The most important factors predicting mortality and morbidity in the US

IHME researchers produced several future scenarios to explore how the US could experience less devastating consequences of some health outcomes. If major risk factors such as obesity, high blood sugar and high blood pressure were eliminated by 2050, 12.4 million deaths could be prevented in the US.

That said, if these risk factors were eliminated globally, the health gains would not be enough for the US to improve its global standing, and the country would still lag behind some comparable countries. Some countries, such as Canada, are so far ahead of the US that if these risks were eliminated in the US alone, the US LE would overtake Canada’s.

However, our scenarios estimate that addressing one risk factor could still save millions of lives. For example, if smoking in the US alone were reduced to the level of the lowest smoking rates, the country could have 2.1 million fewer deaths by 2050. If the country managed to reduce high body mass index levels and high blood sugar levels during the same thirty years, it could prevent 1.4 million people from dying.

“The US’s rapid decline in the global rankings from 2022 to 2050 sounds the alarm for immediate action. The US must change course and find new and better health strategies and policies that slow the decline in future health outcomes,” said co-senior author Dr. Stein Emil Vollset, affiliated professor at IHME.

IHME recommendations

IHME provides these estimates and forecasts to policymakers, health professionals and the public to encourage all people living in the United States to work together to create a healthier and stronger nation. Leaders from all sectors and industries can also use the forecasts to prepare for the potential economic impact.

“Poor health hurts the economy as the country suffers from a reduced workforce, lower productivity and higher health care costs for businesses and their employees. That leads to lower GDP and an opportunity for comparable countries with stronger economies to overtake the US, creating a ripple effect around the world, both financially and geopolitically,” said Dr. Murray.

IHME’s scientific evidence has historically shown that increasing access to preventive medical care is critical for early detection and disease management. Early intervention can also reduce complications and lower healthcare costs.

“All Americans must have access to quality health care through universal health care coverage to prevent disease, stay healthy, and be protected from financial hardship, regardless of their income,” said Dr. Mokdad.

Previous IHME studies have also suggested that the higher the level of education people achieve, the lower the risk of death, because more education leads to less risk-taking and more informed decisions. However, local leaders still need to invest their time and money in community health care, where disparities can be better addressed through personalized care and tailored community programs.

GBD

This study is the most extensive model study into the health status of the American population. It predicts a spectrum of determinants, such as disease causative agents, demographic forces and risk factors. In addition, we model future scenarios and their potential impact on the health of Americans in each state.

The GBD 2021 study and all GBD visualization tools such as GBD foresight, GBD resultsAnd GBD Compare are available online.