Causes of Lagging Life
Expectancy at Older Ages in the
United States
Samuel H. Preston
University of Pennsylvania
Population Studies Center
Presented to the 11th Annual Joint Conference of the
Retirement Research Consortium
August 10-11, 2009
Washington, D.C.
Life Expectancy at Age 50 in 2006
35.0
34.0
e50
33.0
32.0
31.0
30.0
29.0
United
States
United
Germany
Kingdom
Norway
Sweden
Canada
Spain
France
Italy
Japan
Compared to OECD countries and
composites, the US does well in
• Screening for cancer
• Survival rates from cancer
• Survival rates after heart attacks
• Survival rates after strokes
• Medication for high blood pressure
• Medication for high cholesterol
• Vaccination against influenza
• Mortality from influenza and pneumonia
Five-Year Relative Survival Rates for Cancer of Different Sites, US and
European Cancer Registries
United States
Europe
Five-Year Relative Survival Rate (%)
100
80
60
40
20
Source: Verdecchia et al. 2007
en
om
Al
lw
en
Al
lm
ng
ac
m
St
o
ly
m
N
-H
Cancer Site
Lu
h
a
ph
o
m
um
C
ol
or
ut
pu
s
ec
t
er
i
t
Br
e
as
C
or
Sk
in
m
Pr
o
st
a
el
an
om
te
a
0
Analysis of Prostate Cancer and Breast Cancer
• Effective methods of screening for these diseases
have recently developed;
• These diagnostic methods have been deployed
earlier and more widely in the US than in
comparison countries;
• Effective methods are being used to treat these
diseases; and
• The US has had a significantly faster decline in
mortality from these diseases than comparison
countries
Percentage of Women Aged 50-64 Receiving a Mammogram in
Previous Two Years in 1994
80
70
% Screened
60
50
40
30
20
10
Source: Preston and Ho (2009)
Country
st
ria
Au
ai
n
Sp
um
lg
i
Be
C
an
a
da
ia
st
ra
l
Au
et
h
N
U
ni
te
d
St
a
er
la
nd
te
s
s
0
5-year Relative Survival Rate,
Prostate and Breast Cancer, US
Prostate Cancer
Breast Cancer
100
95
90
Percent
85
80
75
70
65
60
55
19
75
19
77
19
79
19
81
19
83
19
85
19
87
19
89
19
91
19
93
19
95
19
97
19
99
20
01
50
Year of Diagnosis
Source: Surveillance Epidemiology and End Results (SEER)
Age-Standardized Death Rates From Prostate Cancer,
1980-2005
United States
Average for 15 countries
18.0
17.0
Death Rate (p. 100,000)
16.0
15.0
14.0
13.0
12.0
11.0
Year
Source: Preston and Ho (2009)
04
20
02
20
00
20
98
19
96
19
94
19
92
19
90
19
88
19
86
19
84
19
82
19
19
80
10.0
Age-Standardized Death Rates From Breast Cancer,
1980-2005
United States
Average for 15 Countries
24.0
22.0
Death Rate (p. 100,000)
20.0
18.0
16.0
14.0
12.0
10.0
19
80
19
82
19
84
19
86
19
88
19
90
19
92
Year
Source: Preston and Ho (2009)
19
94
19
96
19
98
20
00
20
02
20
04
Austria
Switzerland
Belgium
Years
19
85
-1
98
9
19
90
-1
99
4
19
95
-1
99
9
20
00
-2
00
4
United States
19
50
-1
95
4
19
55
-1
95
9
19
60
-1
96
4
19
65
-1
96
9
19
70
-1
97
4
19
75
-1
97
9
19
80
-1
98
4
19
35
-1
93
9
19
40
-1
94
4
19
45
-1
94
9
Manufactured Cigarette Consumption
(number per adult per day)
Per Capita Consumption of Manufactured Cigarettes
European Countries (Group 1) and the United States
Netherlands
France
Germany
12
10
8
6
4
2
0
Years
Japan
19
95
-1
99
9
20
00
-2
00
4
Canada
19
85
-1
98
9
19
90
-1
99
4
United Kingdom
19
75
-1
97
9
19
80
-1
98
4
19
65
-1
96
9
19
70
-1
97
4
United States
19
55
-1
95
9
19
60
-1
96
4
19
45
-1
94
9
19
50
-1
95
4
19
35
-1
93
9
19
40
-1
94
4
Manufactured Cigarette Consumption
(number per adult per day)
Per Capita Consumption of Manufactured Cigarettes
Non-European Countries
Australia
12
10
8
6
4
2
0
Daily Cigarettes Per Capita and Lung Cancer
Mortality in the US
12
2.5
10
8
1.5
6
1
4
0.5
2
Daily cigarettes per adult
Lung cancer
0
1920
0
1930
1940
1950
1960
1970
1980
1990
2000
rate (per 1,000)
cigs per day
2
The Model
ln M0   a X a   t X t   c X c   ct (T  X c )   LML   tL (ML  T )   aL (ML  X a )
M0 is the death rate from causes other than lung cancer in a particular
age/sex/period country category;
Xa is a set of dummy variables for each age group;
Xt is a set of dummy variables for each calendar year;
Xc is a set of dummy variables for each country;
(T x Xc) is a set of interactions between calendar year (linear) and each
country dummy;
ML is the death rate from lung cancer;
(ML x T) is an interaction between ML and year;
(ML x Xa) is an interaction between ML and the age dummies
Life expectancy at age 50 in 2003*
before/after removal smoking deaths, Males
34
32
30
28
26
24
22
e50 (with smoking)
Increase in e50 (without smoking)
* 1997 for Belgium; 2001 for Denmark.
SWE
PRT
ISL
CHE
NOR
AUS
NZL
FIN
AUT
ENW
JPN
FRA
DNK
ESP
ITA
CAN
USA
NLD
BEL
HUN
20
Life expectancy at age 50 in 2003*
before/after removal smoking deaths, Females
40
38
36
34
32
30
28
e50 (with smoking)
Increase in e50 (without smoking)
* 1997 for Belgium; 2001 for Denmark.
ESP
PRT
FRA
ITA
FIN
BEL
CHE
AUT
SWE
NOR
JPN
AUS
NLD
NZL
HUN
ENW
ISL
DNK
CAN
USA
26
Effect of removing smoking-attributable deaths on
ranking of e50 in 2003*
Males
Country
Rank (before) Rank (after)
Australia
2
4
Austria
13
16
Belgium*
19
13
Canada
6
2
Denmark*
18
18
England & Wales
12
14
Finland
16
17
France
11
10
Hungary
20
20
Iceland
1
3
Italy
8
5
Japan
3
1
Netherlands
15
11
New Zealand
7
8
Norway
9
12
Portugal
17
19
Spain
10
7
Sweden
5
15
Switzerland
4
6
United States
14
9
* 1997 for Belgium; 2001 for Denmark.
Females
Rank (before) Rank (after)
2
3
13
14
15
18
7
2
19
17
17
13
12
15
3
6
20
20
9
4
6
9
1
1
14
16
11
8
10
12
16
19
5
11
8
10
4
5
18
7
35
30
25
20
e50 (in years)
FIGURE 1 U.S. trends in observed e50 and estimated e50 without smoking by sex.
1950
1960
1970
Observed (Females)
Observed (Males)
Source: Preston, Glei, and Wilmoth (2009)
1980
1990
2000
Without Smoking (Females)
Without Smoking (Males)
3
4
5
6
FIGURE 2 U.S. trends in the observed sex difference in e50 and the estimated sex difference without smoking.
1950
1960
1970
Observed
Source: Preston, Glei, and Wilmoth (2009)
1980
1990
Without Smoking
2000
Source: Preston and Ho (2009)