Progress Stalled? The Uncertain Future of Mortality in High‐Income Countries
Open accessAbstract
Steady and significant improvements in life expectancy have been a bright spot for human progress for the last century or more. Recently, this success has shown signs of faltering in some high‐income countries, where mortality improvements have slowed or even reversed since the early 2010s. Combined with the large mortality shock of the COVID‐19 pandemic, guaranteed forward progress feels less certain. We review mortality trends in high‐income countries since 2000 through the COVID‐19 pandemic. While deteriorating mortality in the United States has received the most attention, countries including the United Kingdom, Canada, the Netherlands, Greece, and Germany are also seeing slowdowns. Before COVID‐19, these slowdowns largely reflected stalling improvements in cardiovascular disease mortality and increases in deaths from external causes in young and midlife for the worst‐performing countries. We discuss prospects for the future of mortality in high‐income countries, including lingering impacts of the COVID‐19 pandemic, challenges and opportunities related to the obesity epidemic, and emerging reasons for both optimism and pessimism. While biological limits to increased life expectancy may eventually dominate long‐term trends, human‐made social factors are currently holding many countries back from already achievable best‐practice life expectancy and will be key to near‐term improvements.
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Continued life expectancy improvements among high-performing populations and the divergence of the United States from other high-income countries suggest that human-made factors are limiting US life expectancy improvement.
“However, continued life expectancy improvements among high-performing populations and the divergence of the United States from other high-income countries suggest that human-made factors are limiting US life expectancy improvement (4).”
From Insights into US life expectancy stagnation from birth cohort mortality dynamics (2026) · cites this paper as [4]
Recent slowdowns in life expectancy improvements have been observed across many high-income countries.
“Recent slowdowns in life expectancy improvements have not been limited to the United States but have been observed across many high-income countries (2–4).”
From Insights into US life expectancy stagnation from birth cohort mortality dynamics (2026) · cites this paper as [4]
The fact that the United States is far from a leader in longevity and continues to fall further behind nearly all other high-income countries indicates that societal factors are operating to hold back life expectancy potential even if biological constraints are at play.
“The fact that the United States is far from a leader in longevity and that it continues to fall further behind nearly all other high-income countries indicates that there are societal factors operating to hold back life expectancy potential even if biological constraints are at play (4).”
From Insights into US life expectancy stagnation from birth cohort mortality dynamics (2026) · cites this paper as [4]
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Pearson‐Stuttard, J., Caul, S., McDonald, S., Whamond, E., & Newton, J. N. (2023) · The Lancet Regional Health - Europe · doi:10.1016/j.lanepe.2023.100802 · Cited by 38 · see citing works
Trends in Causes of Death in Low‐Mortality Countries: Implications for Mortality Projections
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Provisional Life Expectancy Estimates for 2022
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Dynamics of racial disparities in all-cause mortality during the COVID-19 pandemic
Aschmann, H. E., Riley, A. R., Chen, R., Chen, Y., Bibbins-Domingo, K. B., Stokes, A. C., Glymour, M. M., & Kiang, M. V. (2022) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.2210941119 · Cited by 30 · see citing works
The contribution of drug-related deaths to the US disadvantage in mortality
Barbiéri, M. (2018) · International Journal of Epidemiology · doi:10.1093/ije/dyy288 · Cited by 29 · see citing works
Currie, J., & Schwandt, H. (2020) · National Bureau of Economic Research · doi:10.3386/w27544 · Cited by 29 · see citing works
Acosta, E., Mehta, N., Myrskylä, M., & Ebeling, M. (2022) · The Journals of Gerontology: Series B · doi:10.1093/geronb/gbac032 · Cited by 29 · see citing works
The slowdown in mortality improvement rates 2011–2017: a multi-country analysis
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Breton, M. O., & Gray, L. A. (2023) · Obesity · doi:10.1002/oby.23657 · Cited by 28 · see citing works
The US Midlife Mortality Crisis Continues: Excess Cause-Specific Mortality During 2020
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Why Did the Best Prepared Country in the World Fare So Poorly during COVID?
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Walter, S., Beltrán‐Sánchez, H., Regidor, E., Gómez-Martín, C., del-Barrio, J. L., de Miguel, Á. G., Subramanian, S. V., & Gil-Prieto, R. (2016) · International Journal of Public Health · doi:10.1007/s00038-016-0829-5 · Cited by 26 · see citing works
Gutin, I., Copeland, W., Godwin, J. W., Harris, K. M., Shanahan, L., & Gaydosh, L. M. (2023) · Social Science & Medicine · doi:10.1016/j.socscimed.2023.115764 · Cited by 26 · see citing works
US exceptionalism? International trends in midlife mortality
Dowd, J. B., Doniec, K., Zhang, L., & Tilstra, A. M. (2024) · International Journal of Epidemiology · doi:10.1093/ije/dyae024 · Cited by 24 · see citing works
Self-citationWork–family lifecourses and later-life health in the United Kingdom
Tosi, M., & Grundy, E. M. D. (2019) · Ageing and Society · doi:10.1017/s0144686x19001752 · Cited by 23 · see citing works
Interpreting changes in life expectancy during temporary mortality shocks
Heuveline, P. (2023) · Demographic Research · doi:10.4054/demres.2023.48.1 · Cited by 23 · see citing works
Easterlin, M. C., Crimmins, E. M., & Finch, C. E. (2020) · Journal of Developmental Origins of Health and Disease · doi:10.1017/s204017442000104x · Cited by 21 · see citing works
Santos, C. A. D., de Paula, A. P., Filho, G. G. D. F., Alves, M. D. M., Nery, A. F., Pontes, M. G. A., de Macedo, E. Y. L., Oliveira, R. M., Freitas, S. M., Lima, S., et al. (2023) · International Journal of Infectious Diseases · doi:10.1016/j.ijid.2023.12.001 · Cited by 21 · see citing works
The “double jeopardy” of midlife and old age mortality trends in the United States
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What have we learned about mortality patterns over the past 25 years?
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Sources and severity of bias in estimates of the BMI–mortality association
Masters, R. K. (2023) · Population Studies · doi:10.1080/00324728.2023.2168035 · Cited by 18 · see citing works
Beyond Ozempic: brand-new obesity drugs will be cheaper and more effective
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Vaccination, immunity, and the changing impact of COVID-19 on infant health
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Mehta, N. K. (2023) · Milbank Quarterly · doi:10.1111/1468-0009.12635 · Cited by 16 · see citing works
A Unified Model of Cohort Mortality
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Older Adults in the United States Have Worse Cardiometabolic Health Compared to England
Pongiglione, B., Ploubidis, G. B., & Dowd, J. B. (2022) · The Journals of Gerontology Series B · doi:10.1093/geronb/gbac023 · Cited by 13 · see citing works
Self-citationWhat is driving excess deaths in England and Wales?
Raleigh, V. S. (2022) · BMJ · doi:10.1136/bmj.o2524 · Cited by 13 · see citing works
Johnson, W., Norris, T., & Hamer, M. (2020) · European Journal of Clinical Nutrition · doi:10.1038/s41430-020-00758-5 · Cited by 12 · see citing works
Impacts of the 1918 flu on survivors' nutritional status: A double quasi-natural experiment
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Slowdown in Mortality Improvement in the Past Decade: A US/UK Comparison
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Yousaf, A. R., Mak, J., Gwynn, L. A., Bloodworth, R. F., Rai, R. P., Jeddy, Z., LeClair, L. B., Edwards, L., Olsho, L. E. W., Newes‐Adeyi, G., et al. (2023) · Open Forum Infectious Diseases · doi:10.1093/ofid/ofad500.2466 · Cited by 12 · see citing works
Polizzi, A., & Dowd, J. B. (2024) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.2318276121 · Cited by 12 · see citing works
Self-citationSimon, D. H., & Masters, R. K. (2024) · Journal of Health and Social Behavior · doi:10.1177/00221465231223723 · Cited by 12 · see citing works
Life Expectancy Reversals in Low‐Mortality Populations
Goldstein, J. R., & Lee, R. D. (2024) · Population and Development Review · doi:10.1111/padr.12619 · Cited by 12 · see citing works
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The Long-run Effect of Air Pollution on Survival
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Zeno’s Paradox and the Faith that Technological Game-Changers Are Impossible
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The impact of early death on birth counts in the United States, 1950 to 2019
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Self-citationSurface Plots of Rates of Mortality Improvement
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Why is life expectancy in England and Wales falling behind? A cause-of-death decomposition approach.Preprint
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Self-citationAn Introduction to the Supplemental Issue on Why Does Health in the US Continue to Lag Behind
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Cause-Specific Excess Mortality in the US During the COVID-19 PandemicPreprint
Degtiareva, E., Tilstra, A. M., Schöley, J., Kashyap, R., & Dowd, J. B. (2024) · medRxiv · doi:10.1101/2024.03.05.24303783 · Cited by 3 · see citing works
Self-citationGenerational differences in physical health and disability in the United States and EuropePreprint
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Flagged first, then by citations
Research works printed but not linked: 2
- Alley, Dawn E., Jennifer Lloyd, and Michelle Shardell. 2010. "Can Obesity Account for Cross- National Differences in Life-Expectancy Trends?" In International Differences in Mortality at Older Ages: Dimensions and Sources, edited by Eileen M. Crimmins, Samuel H. Preston, and Barney Cohen. Washington, DC: National Academies Press.
- k2562. · DOI · Paper page
Cited by
Sorted by citations
Cohort mortality forecasts indicate signs of deceleration in life expectancy gains
Andrade, J., Camarda, C. G., & Arolas, H. P. I. (2025) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.2519179122 · Cited by 8 · see citing works
Potential and challenges for sustainable progress in human longevity
Bonnet, F., Alliger, I., Camarda, C. G., Klüsener, S., Meslé, F., Mühlichen, M., Thuilliez, J., & Grigoriev, P. (2026) · Nature Communications · doi:10.1038/s41467-026-68828-z · Cited by 6 · see citing works
Insights into US life expectancy stagnation from birth cohort mortality dynamics
Abrams, L., Bramajo, O., van Raalte, A., Myrskylä, M., & Mehta, N. K. (2026) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.2519356123 · Cited by 6 · see citing works
“However, continued life expectancy improvements among high - performing populations and the divergence of the United States from other high - income countries suggest that human - made factors are limiting US life expectancy improvement (4).”
Assessment of Demographic Profile of European Union Countries
Ginevičius, R., Neverauskienė, L. O., Trishch, R., Andriušaitienė, D., & Stasytytė, V. (2025) · Amfiteatru Economic · doi:10.24818/ea/2025/70/1109 · Cited by 3 · see citing works
Temporary Shock or Lasting Scar? Life Expectancy Trajectories Since COVID-19Preprint
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Potential and challenges for sustainable progress in human longevity.Preprint
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Pérez‐Reche, F. J., Summers, J. A., Jones, G. T., & Macfarlane, G. J. (2026) · medRxiv · doi:10.64898/2026.06.01.26354619
Faibles progrès de l’espérance de vie et contrastes marqués entre types de départements
Barbiéri, M. (2026) · Population · doi:10.3917/popu.2503.0417
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Why is life expectancy in England & Wales falling behind? A cause-of-death decomposition approach
Polizzi, A., Tilstra, A. M., Zhang, L., & Dowd, J. B. (2026) · Population Studies · doi:10.1080/00324728.2026.2682462
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Mortality Dynamics in Low-Mortality Countries: An Introduction to the Special Issue
Trias‐Llimós, S. (2026) · European Journal of Population / Revue européenne de Démographie · doi:10.1007/s10680-026-09780-y
Successes in Reducing Cause-Specific Mortality, United States, 2000-2019
Rust, G. S., Dark, T., Eke, R., Levine, R. S., & Harman, J. S. (2026) · Public Health Reports · doi:10.1177/00333549261477725
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Sicker at all ages? Two decades of changing disease histories and mortality in the United States
Ebeling, M., Mehta, N. K., Abrams, L. R., & Myrskylä, M. (2026) · International Journal of Epidemiology · doi:10.1093/ije/dyag217
- Authors
- Dowd, J. B., Polizzi, A., & Tilstra, A. M.
- Affiliations
- University of Oxford (GB)
- Corresponding author
- Dowd, Jennifer Beam
- Venue
- Population and Development Review
- Publisher
- Wiley
- Published
- 2024-11-04
- Volume
- 51
- Issue
- 1
- Pages
- 257-293
- ISSN
- 0098-7921 (ISSN-L)
- 1728-4457
- OpenAlex
- W4404086071
- Cited by
- 21
- References
- 146
- Citations by year
- 2026: 17 · 2025: 4
- FWCI
- 17.98
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Population and Development Review (publishedVersion, cc-by)
- Funders
- Leverhulme Trust (RC‐2018‐003)
- European Research Council (ERC‐2021‐CoG‐101002587)
- UK Research and Innovation (EP/X027678/1)
- Topics
- Social Sciences › Demography › Insurance, Mortality, Demography, Risk Management
- Health Sciences › Medicine › Epidemiology › Healthcare Systems and Public Health
- Health Sciences › Health Professions › General Health Professions › Global Health Care Issues
- Keywords
- mortality trends, life expectancy, cardiovascular mortality, external causes of death, obesity epidemic, social determinants of mortality, high-income countries
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