US exceptionalism? International trends in midlife mortality

Area of Science:

• Public Health
• Demography
• Epidemiology

Background:

• Rising midlife mortality in the USA is linked to "deaths of despair" (drug, alcohol, suicide).
• Life expectancy is stalling in other high-income countries, including the UK.
• Trends in midlife mortality outside the USA require further investigation.

Purpose of the Study:

• To synthesize cause-specific mortality trends in midlife (ages 25-64) for the USA and UK.
• To compare these trends with other high-income and Central and Eastern European (CEE) countries.
• To analyze mortality trends from 1990 to 2019.

Main Methods:

• Utilized annual mortality data from the World Health Organization Mortality Database.
• Analyzed sex- and age-specific (25-44, 45-54, 55-64 years) age-standardized death rates.
• Examined 15 major cause-of-death categories across the USA, UK, 13 high-income countries, and seven CEE countries.

Main Results:

• US midlife mortality worsened for drug, alcohol, suicide, metabolic, nervous system, respiratory, and infectious diseases since 1990.
• While some causes like homicide and cardiovascular diseases declined, recent increases or stalled improvements were observed.
• Midlife mortality increased in the UK (45-54 years) and in Canada, Poland, and Sweden (25-44 years).

Conclusions:

• The USA is lagging behind high-income and even some CEE countries in midlife mortality.
• Despite lower overall midlife mortality than the USA, the UK shows signs of worsening trends relative to Western Europe.
• These findings highlight concerning shifts in midlife health across developed nations.