Trendspotting: Life Expectancy: America Falling Further Behind Western Europe

NewsWire: 1/24/22

• Since 2012, the life expectancy gap between American blacks and whites has stopped narrowing. Also, the life expectancy of white Americans has fallen further behind that of Western Europeans, especially at lower income levels. (PNAS)
• NH: Get ready for a good news-bad news story--though I warn you in advance that the bad news is pretty bad. Get ready as well to enjoy an unusually vivid depiction of recent trends in mortality by race and income in both America and Western Europe.
• All this is the result of a wonderfully thorough data analysis conducted by a large team of economists and healthcare experts working in U.S. and European universities with support from the U.K.'s prestigious IFS. The research was published last August in PNAS (Proceedings of the U.S. National Academy of Sciences) after first appearing as an NBER working paper.
• Looking at the United States and six affluent western European nations (England, France, Germany, Netherlands, Norway, and Spain), the team was able to determine the mortality rate in each nation by poverty rate and by age group for every year between 1990 and 2018. For the United States only, the team was also able to segment out blacks and whites. Poverty, in each nation, was tagged by the average poverty rate in the county or equivalent locality in which the decedent lived. 
• OK. Now for the good news. The mortality gap between black and white Americans hugely narrowed over these 28 years--though it mostly narrowed over the earlier 1 period. The gap narrowed at all income levels, from the poorest to the most affluent. And it narrowed mostly due to lower mortality rates--that is, longer life expectancy--among black Americans. For infants under age 5, for example, the black mortality rate fell by half, a dramatic improvement indeed.
• See "The Gap in Life Expectancy Between Blacks and Whites Has Narrowed," and "Education Now Ahead of Race in Determining Life Expectancy."
• We're going to get to the graphics in a moment. But now for the bad news. And this bad news comes in several pieces.
• First, improvements in life expectancy for all three groups--whites, blacks, and Europeans--have been much slower in the more recent 2005-2018 period. Since 2012, in fact, life expectancy has actually declined slightly for both whites and blacks (in America) while it continues to rise, though more slowly, in Europe. Also, life expectancy has been rising faster in Europe than among American whites throughout the whole period. In 1990, these two were equal, at about 76 years. In recent years life expectancy has risen to just over 82 years in Western Europe, while peaking at no higher than 79 among American whites.

   

• Second, the mortality gradient by poverty (higher mortality for the poor than for the rich) is much steeper in America, both for whites and for blacks, than it is in Europe.
• Third, while the mortality gradient has become less steep over time for blacks and children in America, it has become steeper for American working-age and elderly adults. In Europe, the gradient has changed very little over time for most age groups, though it has flattened out entirely for children.
• We can observe all of these gaps and trends in action by looking at what has happened over time in each age bracket. Let's start with infants under age 5.

• This is mostly a good-news story for American blacks. As you can see, black infant mortality has fallen by roughly 50% over these 28 years. That's massive. White infant mortality has also fallen by nearly 50%, but from a much lower level. Most of these declines were due (in the 1 period) to the more attentive and protective child-rearing practices that accompanied the appearance of "Millennials." Some were also due to the '90s-era spread of universal eligibility for means-tested prenatal and child healthcare and for women and children's nutrition benefits. Note that Europe's infant mortality rate is now significantly below that of American whites at all income levels.
• Now let's look at kids age 5 to 19.

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• Here's another mostly good-news "Millennial" story, with nearly all of the improvement happening before 2005. That's when we witnessed very large reductions in teen deaths from homicide, suicide, and drug abuse. Again, the improvement was largest for blacks. And the mortality gradient by poverty flattened noticeably. Europe, meanwhile, made sizeable improvements in youth mortality in both periods. By 2018 Europe achieved an almost perfectly flat mortality gradient--meaning that the very poorest kids had the same (low) mortality as the very richest kids. Today, the poorest kids in Europe enjoy a mortality rate roughly one-third lower than the richest white kids in America.
• Now let's move on to look at working-age adults, age 20 to 64.

 

• These are a pretty grim series of charts. They testify to the absence of any significant improvement in American working-age mortality since 2005: Mortality has gotten a bit better for blacks and a bit worse for whites. The mortality gradient for whites has steepened in the most recent period. In 2018, remarkably, the poorest Europeans in this age bracket had a lower mortality rate than the most affluent American whites.
• As NW readers know, this is a topic we've often discussed. Age-adjusted mortality across all U.S. age brackets last peaked in 2014. But among working-age adults, it last peaked in 2010 and has been falling faster. What's driving this deterioration? Poor lifestyles and poor nutrition; rising rates of obesity, type-2 diabetes, and chronic disease generally; more economic insecurity, perhaps tied to rising income and wealth inequality; and an epidemic in so-called "deaths of despair" (deaths due to suicide, drug abuse, alcohol, or chronic liver disease).
• Many of these trends have generational drivers: Boomers and Xers have been taking their high-risk habits with them into later phases of life where they are replacing prior generations (G.I.s and Silent) who had stabler, more risk-averse lifestyles. See "Adults Under Age 65 Driving Decline in U.S. Life Expectancy," "Chronic Pain Keeps Rising," "Alcohol-Related Deaths Continue Growing Among Whites," and "Dementia Rising Among Boomers." 
• When we look for drivers of U.S. life expectancy gains by specific age across the entire 1 period, we find a very different pattern among American blacks and whites. For blacks, sizeable mortality reductions have occurred at nearly every age. But for whites, the gains are mainly among infants and teens--and among the late-middle aged and elderly. For whites, in other words, there was little or no mortality improvement over these 28 years between the early 20s and mid-50s.

 

• It is in these middle-adult years where blacks have gained most on whites in mortality. Blacks also gained impressively on whites with improvements in perinatal mortality (infant deaths under age 1).
• Why have blacks gained so much on whites in the middle-adult years? One reason, clearly, is that they started out with much higher mortality rates. Better access to elementary healthcare services, such as treatment for hypertension, has played a critical role. Another reason is that blacks have been less prone than whites to the rising epidemic  of "deaths of despair." Until about a decade ago, this was almost entirely a white-people problem--although over the last several years blacks have been "catching up" with whites in such deaths, especially in drug-abuse deaths.

 

• Alright, now let's look at the so-called "young elderly," age 65 to 79, which is the oldest age group examined by the PNAS research team.

• The news here is a lot better. Over age 65, both white and black Americans have continued to register striking life expectancy improvements in both periods. Just as the youth improvements have been driven by generations that came along after Xers, these senior improvements have been driven mostly by generations that came along before Boomers. (See "U.S. Life Expectancy Declines Again.") As we have pointed out elsewhere, mortality rates for Americans over age 65 continue to fall. While the U.S. is now well behind the developed-country (OECD) average in life expectancy at birth, Americans remain well above the average in life expectancy at age 80. (See our "Global Demography Review" in 2021, deck slides 43-45.)
• Still, even in this age bracket, we notice a few disquieting trends. Since 2005, among American whites, the mortality gradient has clearly steepened--no doubt pushed in this direction by first-wave Boomers moving past age 65. Also, once again, we see a widening gap between America and Europe. Back in 1990, the mortality lines for American whites and for Europeans in this 65-79 age bracket were virtually identical. Today, a widening gap has emerged between them, especially at the low-income end.
• A few recent feature stories have leaned heavily on this report.  "Why Americans Die So Much" was the title of a recent Atlantic essay by Derek Thompson. The Institute for Policy Studies, a left-leaning policy foundation, issued a report called "Why Do Europeans Live Longer than Americans?" In most of these stories, the authors express astonishment at the PNAS team's findings. The IPS author writes, "A just-published study from a global team of 27 social scientists from 13 different developed nations offers up some numbers that will take most Americans completely by surprise."
• Only that's not really the case. Among demographers, most of this is old news--unwelcome perhaps, but not new. We have been covering it for years. What the PNAS study accomplishes is to clarify the trends in exquisite detail by country, race, time period, and income.
• Does the report unfairly show America at a disadvantage? Perhaps, in some respects. The authors compare America with six of the most affluent nations in Western Europe. America would look somewhat better if it were compared against all of Europe. Yet keep this in mind: Even if these six are affluent, they are not especially high longevity--at least for Europe. Germany, England, and the Netherlands are pretty much middle-of-the-pack. If the researchers had chosen Italy, Ireland, Portugal, or Greece (or more Scandinavian nations), the European performance would have looked even better.
• What's more, the authors separate out whites and blacks in America and show that American whites alone are trailing citizens of all races in these European nations. America would have looked worse if blacks and whites had been combined. American whites, moreover, would have looked worse if the authors had separated out Hispanics (who have higher life expectancies than non-Hispanic whites). But the authors chose not to do this, probably because the data were unavailable.
• Oh, and maybe it would be gratuitous of me to point out one further fact: America's life expectancy fell even further behind Europe's during the pandemic of 2020 and 2021. So that's a further mortality penalty we will struggle to work off after the pandemic is over. Look at this chart comparing U.S. mortality rates for blacks, whites, and Hispanics through 2020 with the average mortality across 16 "peer countries" (mostly European).

• All told, I would say Americans should just listen and let these dolorous facts speak for themselves. It doesn't really matter much how anyone tries to spin them. They don't look good from any angle.

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