US life expectancy is projected to sink to 66th in the world in the coming decades, according to a major new study.
Despite being one of the wealthiest nations, Americans already die younger than their equivalents in almost 50 countries.
But ‘alarming trajectory of health challenges’, which includes rampant obesity, drug use and firearm suicides, is going to widen that gap, according to research in the Lancet.
The researchers found life expectancy for men and women in the US is expected to rise from 78.3 years in 2022 to 79.9 years in 2035 and 80.4 years in 2050 for both men and women.
The slight projected increase is linked to medical advances and doctors getting better at screening and treating chronic diseases like cancer and heart disease. But it is relatively small compared to other countries.
For their analysis, researchers from the University of Washington assessed the impacts of hundreds of diseases and other health risks on the US and individual states and compared them to more than 200 other countries.
Their models show that by 2050, several Sub-Saharan African nations like Nigeria, Kenya, and South Africa, as well as war-torn countries like Syria, Afghanistan, and Yemen will see even greater gains than the US will.
Dr Stein Emil Vollset, who led the new study, said: ‘The rapid decline of the US in global rankings from 2022 to 2050 rings the alarm for immediate action.’
Nationwide, America has a life expectancy of 77.5 years, according to the latest estimates from the CDC
Figure A shows the US’ place in the global life expectancy ranking compared to other countries. U.S. life expectancy will rise modestly from 78.3 years in 2022 to 80.4 in 2050, with global rankings falling from 49th to 66th. Figure C shows the global rankings for life expectancy of the highest- and lowest-ranked U.S. states (plus Washington, DC) compared to 203 countries in the Global Burden of Disease Study. CA=California. HI=Hawaii. MA=Massachusetts. MN=Minnesota. MS=Mississippi. NY=New York. WV=West Virginia
He added that the US ‘must change course’ and develop new and more effective health strategies and policies that ‘slow down the decline in future health outcomes.’
Even under scenarios where the best health practices are adopted, and nearly all key health risks vanish entirely in the US, it would still lag behind other countries like Canada, India, and China, even if they change nothing.
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The US leads the world in obesity, a significant risk factor for a laundry list of chronic and deadly conditions from cardiovascular disease and stroke to cancer and kidney disease.
Rising obesity rates will play a critical role in shaping the trajectory of life expectancy in the US over the next three decades and beyond.
Dr Christopher Murray, director of the University of Washington’s Institute for Health Metrics and Evaluation, said: ‘In spite of modest increases in life expectancy overall, our models forecast health improvements slowing down due to rising rates of obesity, which is a serious risk factor to many chronic diseases and forecasted to leap to levels never before seen.
The IHME has projected that 260 million Americans will be overweight or obese by 2050, ‘signaling a public health crisis of unimaginable scale,’ Dr Murray said.
Though life expectancy will climb modestly over time, many Americans will spend those extra years in poor health, ‘with particularly poor outcomes forecasted for females in the USA relative to females in other countries,’ according to the study.
Several states, including Kentucky and West Virginia, are expected to have worse health outcomes in 2050 compared to 1990, with female health expectancy, or the number of years she can be expected to live with good health, projected to decline between 1990 and 2050 in 20 states.
The above graph shows life expectancy in the US by year from 1980 to 2022. There has been a slight rise in the most recent year that data is available, from a study out of the National Vital Statistics System and population estimates from the National Center for Health Statistics
They predicted that West Virginia will have the lowest life expectancy for both men (about 73) and women (about 78) by 2050.
On the other hand, New York is projected to have the highest life expectancy for males (81.0 years), while Hawaii is expected to have the highest for females (85.5 years).
When comparing life and health expectancy in the best- and worst-performing states to other countries and territories, rankings are expected to decline over time.
Hawaii, which was the best-performing state for life expectancy in 2022, will drop in rank from 29th to 41st by 2050, while West Virginia, the worst-performing state, will fall from 102nd to 140th.
The researchers said: ‘Our findings show a concerning trajectory for the future of US health, in which the USA will fail to keep up with health progress around the world unless concerted efforts are made to reduce exposure to key modifiable risk factors’ such as body mass index, high blood pressure, high sodium intake, smoking, and drug use.
The ongoing opioid epidemic is a uniquely American problem stemming from the actions of American pharmaceutical companies. While there are positive signs that the crisis could be turning the corner, the researchers said it poses a ‘monumental challenge’ to addressing public health issues.
The US recorded an 878 percent jump in the national death rate between 1990 and 2021 (from 2.0 deaths to 19.5 deaths per 100,000) due to opioid use disorder, amphetamine use disorder, cocaine use disorder, and a group of other drug use disorders.
The death rate is forecasted to climb another 34 percent between 2022 and 2050. That’s the highest drug use–related mortality rate in the world and more than twice as high as the second-highest country, Canada.
Figure A: The reference scenario projects future health outcomes based on current trends, assuming no significant interventions or efforts to reduce key health risks. It shows life expectancy projections for the USA, its states, and other countries/territories under the reference scenario. Figure B: Life expectancy projections for the USA, its states, and other countries/territories under the combined risk elimination scenario (which includes efforts to eliminate a range of key health risks such as BMI and smoking rates)
This signals to researchers that the progress made since the overdose crisis was declared a public health emergency in 2017 must accelerate significantly in order to make a measurable difference.
Dr Ali Mokdad, an epidemiologist at the IHME and lead author of the study, said: ‘The stark contrast that’s forecasted in the next 30 years comes after a concerted effort by federal, state, and local government agencies and health 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 use are still needed.’
The researchers projected what could happen if the US were to eliminate major health risk factors – high BMI, high fasting plasma glucose, high systolic blood pressure, high sodium intake, and smoking – by 2050.
More than 12 million deaths could be avoided. Death rates due to diabetes, heart disease, and chronic kidney disease could be 85 to 100 percent lower compared to what they would be without making those changes.
But if other countries were to do the same thing, the number of their people’s lives saved would dwarf that of the US, which is already struggling to catch up with them.
The researchers said: ‘The increases in these scenarios would not substantially improve the USA’s global ranking in 2050.’