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Multi-Morbidity at Death and the US Disadvantage in Mortality.

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The US has higher mortality due to multi-morbidity, where multiple diseases contribute to death. This significantly widens the life expectancy gap with countries like Italy, Spain, and France.

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Area of Science:

  • Public Health
  • Epidemiology
  • Gerontology

Background:

  • The United States exhibits higher mortality rates compared to peer nations.
  • Existing literature suggests a parallel disadvantage in morbidity and disease risk factors within the US population.

Purpose of the Study:

  • To evaluate the influence of multi-morbidity at death on the mortality gap between the US and France, Italy, and Spain.
  • To analyze the contribution of multi-morbid processes to excess US mortality.

Main Methods:

  • Analysis of multiple cause-of-death data from US death certificates in 2017.
  • Classification of morbid processes leading to death into simple, multi-morbid, and ill-defined categories.

Main Results:

  • The US demonstrates disproportionately high rates of multi-morbid processes compared to France, Italy, and Spain.
  • Multi-morbid processes account for a substantial portion of the US life expectancy gap: 51% with Italy, 73% with Spain, and 75% with France.
  • This impact is particularly concentrated in the age group of 20-85 years.

Conclusions:

  • The high prevalence of multi-morbidity in the US supports the hypothesis that multiple factors, not a single cause, drive the US mortality disadvantage.
  • Multi-morbidity may partially explain the exceptionally high healthcare costs in the United States.