The United States spends more on health care than any similarly large and wealthy country. However, in 2023, Americans had a life expectancy of 78.4 years, compared to an average of 82.5 among peer countries. This chart collection examines deaths in the U.S. and comparable countries through 2021, by age group and cause, to highlight factors that contribute to this life expectancy gap. The countries included in the comparison are Australia, Austria, Belgium, Canada, France, Germany, Japan, Netherlands, Sweden, Switzerland, and the United Kingdom.
The U.S.’s premature death rate (408 deaths per 100,000 people under age 70) in 2021 was almost twice the average of these similarly large and wealthy countries (228 deaths). About a third (32%) of the difference in premature death between the U.S. and similar countries is due to deaths from cardiovascular diseases, chronic respiratory diseases and chronic kidney diseases (which, combined, caused 105 deaths per 100,000 population under 70 in the U.S. in 2021). Additionally, in 2021, COVID-19 made up 24% of the difference in premature death rates between the U.S. and peer nations, killing 64 Americans out of every 100,000 under 70.
Another 12% of the difference between the U.S. and its peers’ premature death rates is due to substance use, which caused 29 deaths per 100,000 people under age 70 in the U.S. in 2021. For the purposes of this analysis, substance use deaths are defined as deaths occurring as a direct result of consumption of alcohol or illicit drugs, excluding any deaths from chronic diseases and organ damage caused by long-term use.
Deaths at younger ages bring down life expectancy more than deaths among older age groups. In the younger adult age group (15- to 49-year-olds), the difference in death rate between the U.S. and peer countries is largely driven by more deaths due to chronic diseases, COVID-19, and substance use. Among 15 to 49-year-olds, the U.S. death rate was 2.5 times that of comparable countries (192 vs. 76 per 100,000).
The charts below illustrate how among the under-70 population, the U.S. diabetes death rate is about 2.5 times that of comparable countries, the liver disease death rate is 1.6 times as high, and kidney disease death rate is 3.8 times as high. Additionally, the U.S. substance use death rate is four times that of comparable countries in the under-70 population, and the homicide death rate is nearly 8 times the average of peer nations.
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Delusions of Adequacy 