Causes of Lagging Life Expectancy at Older Ages in the United States

Life expectancy in the United States fares poorly in international comparisons, primarily because of high mortality rates above age 50. This paper evaluates two prominent explanations of its poor performance. One explanation is a poor performance by the health care system. We find that, by standards of OECD countries, the US does well in terms of screening for cancer, survival rates from cancer, survival rates after heart attacks and strokes, and medication of individuals with high levels of blood pressure or cholesterol. We consider in greater depth mortality from prostate cancer and breast cancer, diseases for which effective methods of identification and treatment have been developed and where behavioral factors do not play a dominant role. We conclude that the low longevity ranking of the United States is not likely to be a result of a poorly functioning health care system. In the second part of the paper, we argue that the history of heavy cigarette smoking in the United States is a major factor in its poor ranking. We estimate that male e50 in 2003 would be 2.8 years higher if smoking-attributable deaths were eliminated, while female e50 would grow by 2.6 years. Removing smokingattributable deaths for all countries would improve the e50 ranking of US women from 17 (out of 20) to 7; men’s ranking would improve from 14 to 9.