Despite spending $4.5trn a year – or $13,400 a person on healthcare – US life expectancy at birth is 77.6 years, one of the lowest among 38 member states of the Organisation of Economically Developed Nations, according to Narrowing the Gap: The Burden of Alcohol, Drugs, and Firearms on U.S. Life Expectancy, a new paper from The Research and Action Institute at the AAMC (Association of American Medical Colleges).
The OECD average life expectancy in 2022 is 80.6, and the US figures are over six years below Japan (84.1). In all, more than 27 OECD member states have a life expectancy at birth greater than 80 years and the handful of countries behind the US include Hungary, the Slovak Republic, and Latvia.
Kendal Ogera was lead researcher on the paper, which reported that not only was the US performing worse than its peer group of advanced economy states, but the gap has also widened over the last two years.
The paper said that in 2022, there were more than 48,000 firearm-related deaths (more than half were recorded as suicides, according to a soon to be published analysis by the AAMC), close to 108,000 drug-related deaths; and more than 51,000 alcohol-induced deaths.
“While these numbers made up a small fraction of the nearly 3.3 million deaths in 2022 in the United States, they disproportionately affected children and younger adults — and, as a result, lowered the U.S. life expectancy at birth. If these deaths were eliminated (and other causes of death remained the same), life expectancy at birth would increase by 1.6 years,” the paper said.
The AAMC paper said that alcohol, drugs, and firearms deaths in the US were far higher than other countries, and it consistently led the world for the highest level of gun-related deaths in children and teenagers, which were over 9.5 times the rate of Canada in 2021.
The paper says that the issue of firearm related deaths in the US appears to be worsening and is now the leading cause of mortality among people aged one to 19 – previously it was unintentional injuries, a category which includes incidents such as car accidents.
The US has also had a long term issue with prescription drug use – in 2017 the opioid crisis was classified as a public health emergency by the US government, a status that remains in place.
The AAMC research said drug use – including opioids – was the leading cause of death for Americans aged one to 44 years old. According to the latest data from the World Health Authority drug deaths stood at 31.8 per 100,000 in the US.
This figure was significantly higher than neighbouring Canada (19.2) and over 15 times higher than Spain which recorded just 2.1 deaths per 100,000. Despite Scotland recording the highest level of drug deaths in Europe in 2023, the figure for the UK as a whole was 8.4 per 100,00.
According to the paper, drug-related deaths were the single biggest factor in reducing US life expectancy at birth figures. The think tank said that if no drug deaths had occurred the average American could expect to live nearly a year longer.
“The United States would add an average of 0.4 years and 0.3 years of life expectancy if firearm-related and alcohol-induced deaths, respectively, were eliminated. Younger Americans would see the greatest opportunity for gaining potential years of life if these causes of death were eliminated, though each age group would be impacted to some degree if deaths due to alcohol, drugs, or firearms were eliminated or reduced,” the paper said.
There is a wide disparity in drug deaths across the US with the AAMC research indicating that an elimination of substance-linked mortality could spark an even bigger increase in life expectancy in certain jurisdictions.
West Virginia, Delaware and Washington DC would each see a 1.4 year jump in life expectancy if drug deaths were eliminated whereas in New Mexico, Alaska, and South Dakota, eliminating alcohol deaths would result in the greatest increase in life expectancy.
“In Louisiana, Mississippi, and New Mexico, residents would see the largest gains in life expectancy by eliminating deaths due to firearms,” said the paper. “Overall, 10 states and the District of Columbia would see a jump of at least two years in life expectancy if deaths due to alcohol, drugs, and firearms did not occur, ranging from 2.0 years in South Carolina to 3.0 years in New Mexico.”
There was also a significant disparity between ethnic groups. Taking the US as a whole, American Indian, Alaska Native, Black, White, and Hispanic populations would see the largest increases in life expectancy if alcohol, drug, and firearm-related deaths were eliminated.
It would only have a minimal impact on Asian populations and there would be no difference to the life expectancy of Native Hawaiian and other Pacific Islander populations would not see any impact on life expectancy.
The study did not look at socioeconomic causes for the differences in life expectancy.
The AARC report said that while it was impossible to eliminate deaths linked to drugs, alcohol, and firearms, relatively limited progress would have a material impact on increasing the US life expectancy at birth figures.
“Federal and state policies can help decrease these deaths and improve life expectancy for all. Reducing causes of death that disproportionately impact children, and young people is particularly important, since youth death rates have the greatest impact on the nation’s average life expectancy. Even a slight reduction in deaths due to the three causes listed above would bring the United States’ life expectancy at birth closer to the OECD average.”
