Falling Behind: The Growing Gap in Life Expectancy Between the United States and Other Countries, 1933–2021
Open accessAbstract
Objectives. To document the evolution of the US life expectancy disadvantage and regional variation across the US states. Methods. I obtained life expectancy estimates in 2022 from the United Nations, the Human Mortality Database, and the US Mortality Database, and calculated changes in growth rates, US global position (rank), and state-level trends. Results. Increases in US life expectancy slowed from 1950 to 1954 (0.21 years/annum) and 1955 to 1973 (0.10 years/annum), accelerated from 1974 to 1982 (0.34 years/annum), and progressively deteriorated from 1983 to 2009 (0.15 years/annum), 2010 to 2019 (0.06 years/annum), and 2020 to 2021 (–0.97 years/annum). Other countries experienced faster growth in each phase except 1974 to 1982. During 1933 to 2021, 56 countries on 6 continents surpassed US life expectancy. Growth in US life expectancy was slowest in Midwest and South Central states. Conclusions. The US life expectancy disadvantage began in the 1950s and has steadily worsened over the past 4 decades. Dozens of globally diverse countries have outperformed the United States. Causal factors appear to have been concentrated in the Midwest and South. Public Health Implications. Policies that differentiate the United States from other countries and circumstances associated with the Midwest and South may have contributed. (Am J Public Health. 2023;113(9):970–980. https://doi.org/10.2105/AJPH.2023.307310 )
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In 1983 to 2009, the median pace of life expectancy improvement in peer nations was 0.18/year compared to 0.06 in the United States.
“In that period, the median pace of life expectancy improvement in peer nations was 0.18/year compared to 0.06 in the United States (8).”
From Insights into US life expectancy stagnation from birth cohort mortality dynamics (2026) · cites this paper as [8]
Table 1 (Public Health Implications; page unavailable) reports 0.23 years per annum for the median of populous countries and 0.15 for the United States in 1983–2009. The claimed figures, 0.18 and 0.06, are the table’s values for 2010–2019, not 1983–2009; the paper also describes its comparison group as populous countries rather than peer nations. (LLM, conf=0.93)
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Experimental — accuracy not yet measuredCompared to a set of 22 peer nations, the gap in life expectancy at birth between the United States and the top performer rose from 2.6 y to 4.7 y between 1983 and 2009.
“Compared to a set of 22 peer nations, the gap in life expectancy at birth between the United States and the top performer rose from 2.6 y to 4.7 y between 1983 and 2009 (8).”
From Insights into US life expectancy stagnation from birth cohort mortality dynamics (2026) · cites this paper as [8]
Figure 1 (page not provided) tracks the gap between US life expectancy and the highest-performing populous country and identifies 1983–2009 as a study phase. The paper supports a widening US disadvantage, but our copy does not give the claimed 2.6- and 4.7-year endpoints or define this comparison as one against a set of 22 peer nations; its Methods instead use countries with populations over 500,000. (LLM, conf=0.85)
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References 21 · Cited by 78
Research works printed but not linked: 2
- Woolf SH, Aron LY, eds. US Health in International Perspective: Shorter Lives, Poorer Health. Washing- ton, DC: National Academies Press; 2013.
- Crimmins EM, Preston SH, Cohen B, eds. Explain- ing Divergent Levels of Longevity in High-Income Countries. Washington, DC: National Academies Press; 2011.
- Authors
- Woolf, S. H.
- Affiliations
- Virginia Commonwealth University (US)
- Corresponding author
- Woolf, Steven H.
- ORCID
- Woolf, Steven H.
- Venue
- American Journal of Public Health
- Publisher
- American Public Health Association
- Published
- 2023-09
- Volume
- 113
- Issue
- 9
- Pages
- 970-980
- ISSN
- 0090-0036 (ISSN-L)
- 1541-0048
- PMC
- PMC10413748
- OpenAlex
- W4379094757
- Cited by
- 78
- References
- 21
- Citations by year
- 2026: 17 · 2025: 24 · 2024: 29 · 2023: 8
- FWCI
- 45.41
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- American Journal of Public Health (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (UM1TR004360)
- National Center for Advancing Translational Sciences
- Topics
- Social Sciences › Demography › Insurance, Mortality, Demography, Risk Management
- Social Sciences › Health › Health disparities and outcomes
- Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
- Keywords
- life expectancy, life expectancy gap, United States, cross-national comparison, regional variation, United States states, Midwestern United States, South Central United States, mortality trends, public health policy
- MeSH terms
- Humans, Life Expectancy, Mortality, United States, Policy
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