Last Thursday, Staff Writer Amélie Acevedo attended a virtual seminar on aging, aimed at discussing recent trends in mortality rates in the US and UK over the past decade. In the wake of the COVID-19 pandemic, the once-assumed continuous progress in life expectancy feels increasingly uncertain.

To address the concerning rise in mortality trends in the United States and the United Kingdom, Columbia invited Dr. Jennifer Beam Dowd, a leading expert in Demography and Population Health, to shed light on these troubling trends. She opened the seminar by providing an overview of the unsettling trends of mortality within high-income countries, specifically focusing on the US and the UK. She emphasized that while mortality represents the end stage of life, it also serves as a crucial indicator of the overall health of a population.

Mortality in the United States

Despite the successes in reducing mortality in past decades, the US has been faring poorly compared to other high-income countries. This downward trend began in about 1980, decades before the pandemic occurred. Today, the US life expectancy significantly lags behind other developed nations by several years. While three to four years may not seem like much, this gap reflects a deeper, more concerning issue: a substantial number of Americans are not reaching old age.

Dr. Dowd highlighted that much of the decline in life expectancy is driven by working-age mortality. Working-age Americans, particularly those facing low levels of education, economic challenges, and lower marriage rates, are losing “meaningful lives” due to a lack of economic opportunities. These individuals are increasingly turning to negative coping mechanisms like drugs and alcohol, leading to a rise in substance-related deaths among this demographic. Across various age groups, unhealthy lifestyles are becoming more prevalent, and many Americans are now faring worse health-wise compared to previous generations.

The US stands out among its peers in terms of drug-related deaths, with no other high-income country rivaling its numbers. However, while drug-related deaths, particularly from opioids and fentanyl, are a significant issue, they are not the largest contributing factor to life expectancy stagnation in the US. According to Dr. Dowd, the real driver of stalled life expectancy is slowing progress in cardiovascular disease treatments. Although drug-related deaths often dominate the headlines, it is cardiovascular disease that is quietly becoming a larger threat to US mortality rates. After decades of steady improvements, more people in the US are now suffering from cardiovascular diseases, which is stalling overall life expectancy growth.

Mortality in the United Kingdom

While the US is the clear outlier in terms of poor life expectancy trends, the UK is also showing troubling patterns, particularly since 2010. Both the scientific community and the general public in the UK are grappling with the reasons behind this downturn. Like the US, the UK is seeing a rise in cardiovascular disease among working-age people, particularly those aged 25 to 44. Additionally, dementia mortality is increasing among older populations, further contributing to the country’s stalled life expectancy.

Dr. Dowd warned that we may be entering a new era of mortality pessimism. There is a common misconception that life expectancy will always continue to rise, but this recent stalling trend is challenging that assumption.

The Impact of the COVID-19 Pandemic on Mortality

Dr. Dowd also addressed the impact of the COVID-19 pandemic on mortality rates, particularly in the US and UK. Many high-income countries, including the US, have not yet rebounded to their pre-pandemic mortality rates. However, the US experienced a unique and troubling trend: mortality rates continued to rise in 2021, even after the peak of the pandemic, while countries such as Italy and Spain—despite being severely hit by COVID-19 early on—saw mortality rates decrease post-pandemic.

The US saw 1.3 million excess deaths during the pandemic, surpassing the official COVID-19 death toll. Much of this excess mortality is believed to be due to underreported COVID-19 deaths, as well as an increase in drug-related deaths, particularly involving fentanyl and opioids, from January 2020 to December 2022. The US also experienced a significant number of deaths during the Delta and Omicron waves of COVID-19. Notably, the excess mortality in the US was largely concentrated among younger and working-age populations, unlike most other high-income countries, where deaths were concentrated among older, more vulnerable groups.

Understanding Why the US and UK Performed Poorly

Several factors explain the US’s particularly poor performance in terms of COVID-19 mortality. There is a well-documented health disadvantage among older adults in the US compared to their high-income counterparts, with higher rates of diabetes, obesity, and high cholesterol making them more susceptible to COVID-19’s severe effects.

The UK, on the other hand, experienced early and severe COVID-19 waves but fared better post-vaccine rollout. A significant difference between the two countries lies in their handling of vaccinations. In the UK, the third COVID-19 vaccine dose was made part of the main vaccination sequence, with clear prioritization for older populations. In contrast, in the US, the third dose was positioned as an optional booster, leading many people, particularly Republicans, to opt out. This hesitancy, largely driven by political polarization, contributed to the excess deaths in the US during the winter wave of 2021, especially among those registered as Republicans. 

Optimism Amid the Stagnation

Despite the troubling trends in mortality, Dr. Dowd offered reasons for optimism. One positive development is the increasing use of GLP-1 agonists, such as Ozempic and Mounjaro, to treat diabetes and obesity, which could significantly improve public health outcomes. Additionally, the US and UK can look to other high-performing countries as models for reform, showing that improvements are possible. Bad trends do not last forever, and history shows that recovery is likely.

Dr. Dowd concluded her presentation by emphasizing that while mortality trends may appear pessimistic in the short term, there is still reason for hope. Human ingenuity, along with social and medical improvements, has the potential to reverse these trends and improve life expectancy in both the US and the UK.

This seminar is one part of the Robert N. Butler Columbia Aging Center series directed by Dean Fried. For more information on other seminars, view the Aging Center’s website.

Editor’s note: This post was updated to include more information about the Aging Center.

Image via Bwog Archives