
Americans Fall Behind In The 'Getting Older' Race - colinprince
http://www.npr.org/blogs/krulwich/2013/10/21/239000940/americans-fall-behind-in-the-getting-older-race
======
jandrewrogers
I am surprised that the article did not really mention why American life
expectancy is relatively low. The answer to this question is well-known and is
a related to a unique negative bias in the American statistics rather than
older Americans dying earlier.

Put simply, Americans have an anomalously high rate of dying when they are
young due to homicide and accidents, particularly vehicular. These are large
statistical outliers compared to the rest of the industrialized world. This
negatively alters the _average_ life expectancy but does not say much about
the life expectancy in the individual case.

If you control for just homicide and vehicular accidents, Americans have among
the highest life expectancy in the world despite issues like obesity, and many
Americans have negligible risk of those causes of premature death. In terms of
deaths due to medical issues (cancer, heart disease, etc), Americans have the
highest life expectancy in the world, which offsets the homicide and accident
death rates among the young.

There used to be a saying by the people that study life expectancy statistics
that the only people on Earth that live longer than Japanese women are
Japanese women living in the US. Which is true and captured an essential point
about the mixture of factors in life expectancy statistics.

~~~
tptacek
As I understand it, life expectancy is also skewed by misreporting of infant
deaths in other countries, which biases infant mortality stats against
countries that reliably report them.

~~~
yummyfajitas
"Misreporting" is a strong term. While I'm sure a few countries (e.g. the
Communist Paradise of Cuba) do misreport their statistics, many other
countries get different answers via reasonable disagreement on definitions.

Consider an 5 month old fetus who completely passed through the vagina, takes
one breath and dies. Is that infant mortality or miscarriage? Now make it 6
months old, but he didn't take any breaths. Or 7 months, the head (but not
body) passed through the vagina, then he dies. Or 7 months, body but not head
passed through vagina. If you want to draw distinctions between miscarriage
and infant mortality you need to draw a more or less arbitrary line. Not every
nation draws the line in the same place and the statistics are therefore
incomparable.

You are right about the effect this has on the statistics. I'm just suggesting
that there are far less nefarious reasons than misreporting stats.

~~~
humanrebar
Calling it misreporting is harsh, but the implication of not counting some
babies is that they weren't really people. I think that's worth thinking
about.

Also, calling a fully-born human being a fetus is both inaccurate and even
more harsh than this use of the word "misreporting".

For the sake of furthering on-topic discussion, let's all agree that infant
mortality is a different problem than longevity and therefore a better measure
than "life expectancy from birth" would be "life expectancy from age 1" or
something along those lines.

------
humanrebar
Before everyone goes on about American healthcare and obesity, consider what
the numbers are actually measuring.

As far as I can tell from the article, these life expectancy numbers do not
compensate for suicide, homicide, premature births (some countries don't count
them as births), and accidental death (as in car accidents).

I would like to see more of the same charts, but instead of just graphing life
expectancy at birth, graph life expectancy from ages 1, 11, 21, 31, 41, and so
on. I would compare the "Life Expectancy from Age X" graph for the U.S.
against the same graphs for other countries. Then I would look at leading
causes of death for each age group in the U.S. Then I would have a much more
quantifiable idea of why citizens in other countries tend to live longer than
U.S. citizens.

Here's an interesting podcasts where a couple of economists discuss this kind
of metric as a measure of longevity and health:
[http://www.econtalk.org/archives/2012/07/scott_atlas_on.html](http://www.econtalk.org/archives/2012/07/scott_atlas_on.html)

EDIT: This is important because counting thousands of premature births and
having a much higher rate of death due to accidents and violence will really
wreck the U.S. average. In that case, talking about how Americans eat too much
red meat is mostly beside the point.

~~~
dragonwriter
> I would like to see more of the same charts, but instead of just graphing
> life expectancy at birth, graph life expectancy from ages 1, 11, 21, 31, 41,
> and so on. I would compare the "Life Expectancy from Age X" graph for the
> U.S. against the same graphs for other countries.

The article itself notes: _In 2011, the National Institutes of Health issued a
report that tried to make sense of it all. Right away, they found our weak
spot. "U.S. women have relatively high mortality rates at the younger older
ages," they said, which means when women hit their 55th birthdays, for the
next almost 20 years, roughly 55 to 75, they will die more often than women in
comparable countries. Americans get more lung disease, more heart disease,
more diabetes. If Americans reach 75, they get competitive again, but that
early old age is where we lose ground. American men showed pretty much the
same weakness at roughly the same times._

And the NIH study [1] _linked_ in the article actually has the kind of charts
that you suggest should be done comparing life expectancy at various ages.

It would maybe help if instead of reciting canned arguments based assumptions
generated by the _title_ , people would actually read the linked articles.

[1]
[http://www.ncbi.nlm.nih.gov/books/NBK62373/](http://www.ncbi.nlm.nih.gov/books/NBK62373/)

~~~
humanrebar
My comment was to push back at already-posted assumptions about the U.S.
healthcare system in general and obesity in particular. I have gone through
the original study, but the NPR article said:

"The NIH report says that in 2002, 2003 and 2004, life expectancy in France
increased by 10 months, which is a crazy pace (and I'm guessing it hasn't
stayed that way)."

The likeliest explanation for a jump that large is a change in methodology,
but there could be other factors (climate? there was a big heat wave in 2003).
The U.S. does have a different culture and climate than these other countries.

I'm very happy to read an article that discusses the complexity of comparing
life expectancies between countries, but the NPR article wasn't it and the HN
comment section is just now getting to the point where people are discussing
what the numbers really mean.

The podcast I linked is more along those lines as well, but it also goes into
other popular measurements of national health as well, if I recall correctly.

~~~
PeterisP
If you're doing longevity studies in Europe, then you should get huge
differences between cohorts separated by a few years due to WW2 - there are
significant long-term effects (such as changes in metabolism gene expression)
caused by, say, near-starvation during pregnancy or infanthood; and current
longevity studies all include people who were essentially born on a
battlefield as well as those who weren't due to small differences of age or
location.

------
Theodores
I believe that American diet may have a hand in this. I don't know when it
happened exactly, maybe it was when the new Coke formula came in, however,
since then an increasing amount of Americans have been 'corn fed'. The meat is
corn fed, the breakfast cereal is made of corn, the milk is from corn fed
cows, the sugar is made from corn and everything else is made from corn give
or take a soy bean here or there.

[http://www.youtube.com/watch?v=dBnniua6-oM](http://www.youtube.com/watch?v=dBnniua6-oM)

Robert Lustig is the man to explain all this. He blames fructose (i.e. corn
stuff) and fully expects this generation of Americans to have a shorter
lifespan than previous generations could expect.

~~~
bluedino
We just eat too damn much. Any chain restaurant has 1,4000 calorie 'salads'
and you get served 2+ lbs in a pasta dish. That doesn't even count the
appetizer or dessert that cram down your throat for the $12.99 3-course meal

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scotch_drinker
"To my surprise, they found our health disadvantage 'could not be explained
simply by reference to problems associated with an inefficient health care
system, the lack of universal health care coverage, or large racial and
socioeconomic disparities in the United States.'"

That doesn't seem to address the fact that as a nation, the US seems to be
growing more and more obese with worse nutrition and less exercise. I assume
the authors of the paper did some analysis based on things other than the
inefficient health care system.

~~~
sp332
I'm not sure that would explain a drop specifically in 55-to-75 year old
people, even though we're competitive in other areas?

~~~
scotch_drinker
It might if the reasons we were dying between 55-75 were related to poor
nutrition and low activity levels. My assumption (always dangerous) is that
the things that kill us in those age ranges are diabetes, heart disease and
stroke which are all manageable in some fashion through moderation in diet as
well as exercise. Once you make it past 75, you've probably been either lucky
genetically or you've been living well or some combination of the two.

------
BetaCygni
> "these levels represent increases in average life spans of almost five
> months for women and four months for men compared to the previous year."

Let's get it up to twelve months per year!

~~~
sp332
As far as I can tell, these graphs only show the average age of people who are
dying in a given year. If someone survives, they won't count as an
improvement! So to inflate the graphs, we just have to kill off all the really
old people :)

------
michael_nielsen
A little research (sources at end) shows that the many commenters pointing to
vehicular accidents, homicide, infant mortality, and suicide as the "reason"
for lower US life expectancy are flat-out wrong:

Each year the chance of someone dying in a vehicular accident is about 1 in
10,000 in the US. Over 80 years that means a citizen has roughly a 1 / 125
chance of dying in a vehicular accident. The total reduction in life
expectancy from vehicular accidents is thus well under 1.0 years. Assume, for
example that such an accident cuts an average of 60 years off a person's life
-- they would have lived to 80, say, but their life was cut short at just 20
years old. That works out as a 0.5 year reduction in life expectancy due to
accidents.

This is without taking into account the vehicular fatality rates in other
countries. When you do that for, e.g., Japan (1 in 20,000 per year), the
difference in life expectancy is likely around 0.25 years.

The homicide rate in the US is about 1 in 20,000 people per year, or about
half the vehicular fatality rate, so perhaps a further 0.25 year reduction,
without factoring in homicides in other countries.

For infant mortality, the chance of dying at birth is a little over 1 in 200
in the US. That translates to a reduction in life expectancy of about 0.4
years, without factoring in infant mortality in other countries.

A similar analysis shows suicide rates are probably not a factor -- in fact,
in some countries, such as Japan, the rate is higher than in the US, while in
countries such as the UK it is comparable to the US.

So the contributions from all four of these sources is very unlikely to be
more than a 1 year difference in life expectancy. It's probably quite a bit
less, since I've ignored (e.g.) infant mortality in other countries.
Certainly, the contribution from all four of these is nowhere near the
dominant effect to explain differences in life expectancy.

A caveat: some people pointing to infant mortality are claiming that what's
going on is that a large number of stillbirths simply aren't being reported in
some countries outside the US, and this is skewing the results. That
possibility isn't accounted for in my analysis above. I doubt it's true - in
my many years living in Canada and Australia I've known quite a few people who
died in car accidents, and none of whom had a stillbirth (to my knowledge).
But while this suggests to me that this effect isn't large, it's of course
only anecdotal evidence.

Sources for rates:

[http://en.wikipedia.org/wiki/List_of_countries_by_intentiona...](http://en.wikipedia.org/wiki/List_of_countries_by_intentional_homicide_rate)

[http://en.wikipedia.org/wiki/List_of_countries_by_traffic-
re...](http://en.wikipedia.org/wiki/List_of_countries_by_traffic-
related_death_rate)

[http://en.wikipedia.org/wiki/List_of_countries_by_infant_mor...](http://en.wikipedia.org/wiki/List_of_countries_by_infant_mortality_rate)

And if you want to look at the details of the suicide statistics:

[http://en.wikipedia.org/wiki/List_of_countries_by_suicide_ra...](http://en.wikipedia.org/wiki/List_of_countries_by_suicide_rate)

~~~
penguindev
I think you mean 1/1250 in 80 years... thanks for scaring me. Edit: Uh, no, it
is 1/125\. Ouch. That seems awfully high.

I can only hope that's some bad statistics whereas your chances are
disproportionally high while you're a teenager but if you make it past that,
you're ok...

~~~
michael_nielsen
No, I mean 1/125\. Yes, it is awfully high.

~~~
simplemath
That humans continue to operate motor vehicles is a serious bug, not a
feature.

I have kids who will be driving age in 10 years. If there is a self driving
car widely available by then, and I suspect there will be, I will look to the
heavens and praise Science.

------
EGreg
I think life expectancy is increasing across the board in the world, but race
plays a difference.

America is home to a lot of different races. Look at the races of the
population over 80 and how it changed since 1950s.

~~~
drjesusphd
A lot has changed since the 1950s. Correlation != causation.

Besides, race and poverty are so closely linked in the US that, even if this
were true, it still doesn't say anything about the intrinsic properties of
different races. Implying that it does is a racist statement.

~~~
EGreg
Saying that members of some races are shorter on aberage than others may be
"racist" in some sense, but it's also informative. Same with life expectancy.

Now how much of it is genetic vs lifestyle and cultural is a different story.
It's not easy to tease apart genotype vs phenotype arguments or nature vs
nurture. But I don't think I would take offense to ACTUALLY 90% TRUE
generalizations about MY race and ethnicity, and I don't think others should,
either.

That's different than saying POTENTIALY UNTRUE things based on anecdotal
evidence, such as that Mexicans are usually bad at physics, that women bad at
programming or that Jews are averse to taking low paid menial jobs.
Disclaimer: I am Jewish. But I have no issue discussing things dispassionately
like that. However I _am_ sensitive to how they are presented, and MORE
imporyantly careful ny to perpetuate harmful stereotypes that are possibly
untrue or may cause people to actually suffer as a result.

------
16s
Reminds me of an answer my old boss gave to a terminally ill patient...

 __ _" How long does it take to die?"_ __

 __ _" A lifetime."_ __

