CVD, drugs, guns, crashes – hazards hinder life expectancy care for Americans

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Heart disease, drugs, guns and car wrecks have shortened American life expectancy when compared with the people of England and Wales.

Average life expectancy is 78.6 years for Americans, or 2.7 years less than 81.3 years for people living in England and Wales, according to “A Tale of Two Countries: The Life Expectancy Gap Between the United States and the United Kingdom.” The analysis of 2023 data was published this week by the faculty of the Bloomberg American Health Initiative of the Johns Hopkins Bloomberg School of Public Health.

“There is simply no good reason why people in the U.S. can expect to die nearly three years earlier than their counterparts across the Atlantic,” Bloomberg American Health Initiative Director Joshua M. Sharfstein, MD, said in a news release. Sharfstein is vice dean for Public Health Practice and Community Engagement at the Bloomberg School. “If we choose programmatic and policy solutions based on evidence, we will close this gap.”

Similarities and differences

In 1984, life expectancy was the same for people in the United States and in England and Wales, collectively the United Kingdom. In 2024, they share similarities in urbanization, a service sector economy, amount of immigrant population, median age and smoking rates.

But a longevity gap has been widening between the nations for years. By 2019, a baby born in the United Kingdom would expect to live 81.4 years, more than 2.5 years longer than the 78.8 year life expectancy in the United States, the report said.

The United States is wealthier, but does not guarantee access to health care for citizens. The United States has a larger population of racial and ethnic minority groups. Americans have greater amounts of obesity and incarceration, which are associated with greater rates of illness, the report said.

As of 2023, American life expectancy dipped to 78.6 years, while life expectancy in England and Wales slide to 81.3 years. The COVID-19 pandemic claimed more lives in the United States early on, but that difference faded by 2023, the report said.

What’s killing Americans?

So what are the contributing factors?

• Cardiovascular disease – 57% of the gap

Cardiovascular disease (CVD) including preventable heart attacks and strokes, are the leading cause of death for Americans. The U.S. population is larger, but the effects of CVD are disproportionate to the number of people. In 2023, the age-adjusted death rate was 240 per 100,000 people in the United States, compared with 173.5 per 100,000 people in England and Wales.

• Drug overdose – 32% of the gap

Since 2000, more than 1 million Americans have died of drug overdose. The deaths are slowing, but the national death toll remains more than 100,000 a year, the report said.

Based on population, the nation’s overdose death rate was 31.6 per 100,000 people, or more than triple the rate of 9.3 deaths per 100,000 people in the United Kingdom.

• Firearm-related homicide and suicide – 20% of the gap

The rate of gun-related homicide and suicide spiked 34% from 2014 to 2023 in the United States. Gun-related injuries have surpassed motor vehicle crashes as the leading cause of death for children, adolescents and young adults since 2017, the report said.

Last year, the United States had an age-adjusted death rate of 13.3 gun-related deaths per 100,000 people. In England and Wales, there were 90 firearm-related deaths for a rate of 0.1 per 100,000 people.

Guns were involved in approximately one in two teen suicides in the United States, which had an age-adjusted death rate of 10 per 100,000 people for youths aged 15 to 19 years. England and Wales had no firearm-related teen suicide, and a rate of 5.79 deaths per 100,000 people for the same age range, the report said.

• Motor vehicle crashes – 17% of the gap

In the United States, approximately 125 people die every day in car, truck and other motor vehicle accidents. The 2023 total hit 45,973 fatalities, the report said.

That year, adjusting for age and population, the U.S. death rate was 13.3 per 100,000 population. The United Kingdom’s rate was 2.2 per 100,000 people.

As for crash survivors, non-fatal injuries requiring care tallied up medical costs worth $430 billion, the report said.

What about cancer?

The researchers found Americans are less likely to die of cancer than people in England or Wales. The per 100,000 people death rate was 147.2 for the United States, 186.1 for the United Kingdom. The researchers noted premature deaths from heart disease could claim lives before a cancer diagnosis is made for Americans.

Potential solutions

The report offered potential solutions to the health issues.

• Reduce CVD through clinical and population-based strategies. Interventions to control hypertension and hyperlipidemia will offer the fastest and greatest return on investment, with medications that are effective, available and affordable.
• Dispense methadone in pharmacies and treat addiction in jails and prisons. That already happens in the United Kingdom, where any clinician is permitted to prescribe methadone. American opioid treatment programs are good, but often are limited in geographic reach and inconvenient for patients, the report said.
• Implement firearm licensing laws and use extreme risk protection orders. The United Kington has stringent gun laws that would be unconstitutional in the United States. However, firearm purchase licenses and extreme risk protection orders that temporarily restrict gun access to people at risk of harming themselves or others, likely would pass judicial scrutiny.
• Develop a national community mental health infrastructure. The American mental health care system “is a patchwork of services” that are difficult to navigate, costly and understaffed. However, Certified Community Behavioral Health Centers could be a model for a “one-stop shop” for mental health care that supplements crisis counseling provided on the 988 call line.
• Implement at least three measures to prevent traffic crashes. Intelligent speed adaptation is a system that warns drivers of speed limits and going faster than allowed. Passive impaired driving prevention technology also could be built into new cars and trucks. Driver’s licensing procedures could include training and testing for hazard perception for all new drivers.

“Understanding and addressing these causes – using policies and programs based on evidence – is the path to longer life expectancy and a healthier United States of America,” the report said.