Projected Life Expectancy in the U.S. Likely to Stagnate by 2050, Health Decline Threatens Global Standing

The United States appears to be lagging behind many other countries regarding overall health, as indicated by a comprehensive evaluation involving all 50 states and Washington, D.C., published in The Lancet. Researchers from the Institute for Health Metrics and Evaluation (IHME) have projected health outcomes, such as life expectancy and disease-related mortality rates, analyzing data from over 350 diseases and injuries and 68 risk factors spanning from 1990 to 2050.

Declining Life Expectancy and Global Standing

Life expectancy in the U.S. is anticipated to rise from 78.3 years in 2022 to 79.9 years by 2035, reaching 80.4 years by 2050 for all populations combined. Despite this slight increase, the nation’s position in global rankings is expected to decline from 49^th in 2022 to 66^th in 2050 among the 204 nations assessed in the most recent Global Burden of Disease (GBD) study.

Overall, mortality rates in the U.S. decreased from 1990 to 2021 for many significant causes of death, including ischemic heart disease, cancer, and stroke, which has positively influenced life expectancy. Nevertheless, despite advancements made over the past thirty years, the U.S. is projected to rank lower compared to other nations regarding healthy life expectancy, falling from 80^th in 2022 to 108^th by 2050.

Women’s health is deteriorating more rapidly than men’s in the U.S. By 2050, female health-adjusted life expectancy (HALE) is anticipated to drop in 20 states, including Ohio, Tennessee, and Indiana. Only three states are expected to see no change: Arizona, Idaho, and North Dakota. The disparity between male and female health metrics stems primarily from the stagnation or minimal growth in female life expectancy and HALE, rather than significant advances for males.

Furthermore, projections indicate that the U.S. ranking for female life expectancy will fall to 74^th globally by 2050, down from 19^th in 1990 and 51^st in 2022. Similarly, male life expectancy rankings are expected to drop to 65^th in 2050, down from 35^th in 1990 and 51^st in 2022. Such declines position the U.S. below most high-income and some middle-income countries.

Comparing U.S. states reveals worsening global rankings. If Hawaii were a nation, its life expectancy of 1990 would have placed it fourth globally, being the highest in the U.S. However, its ranking fell to 29^th by 2022 and is expected to drop to 43^rd by 2050. While New York is projected to have the highest life expectancy by 2050, ranking 41^st worldwide, this represents a decline from its previous position of 33^rd in both 1990 and 2022.

The anticipated slight increase in U.S. life expectancy is attributed to declining mortality in specific areas, notably a 49.4% drop in ischemic heart disease rates, a 40.5% reduction in stroke rates, and a 35.7% decrease in diabetes mortality.

“Despite slight improvements in overall life expectancy, our models indicate a slowdown in health advancements due to rising obesity rates, a critical risk factor for chronic diseases, forecasted to reach unprecedented levels,” commented co-senior author Professor Christopher J.L. Murray, Director of IHME. “The growing obesity epidemic, projected to affect over 260 million individuals by 2050, signifies a monumental public health crisis.”

Concerning Trends in U.S. Mortality and Death Causes

The U.S. is also grappling with other distressing trends. From 1990 to 2021, the mortality rate related to drug use disorders surged by 878%, escalating from 2.0 to 19.5 deaths per 100,000 population. This rate is expected to increase by another 34% from 2022 to 2050, reaching approximately 26.7 deaths per 100,000, making it the highest drug-use mortality rate globally, more than double that of the next highest country, Canada.

“The projected stark contrast over the next three decades comes after a unified effort by governmental and health organizations initiated following the opioid crisis declaration in 2017. The opioid epidemic is not over, necessitating enhanced and expanded prevention and treatment programs,” stated lead author Professor Ali Mokdad from IHME.

Key Projected Factors for Mortality and Morbidity in the U.S.

IHME has developed various scenarios examining how to mitigate health outcomes in the U.S. Eliminating significant risk factors such as obesity, high blood sugar, and high blood pressure could potentially prevent 12.4 million deaths by 2050. However, even with these risk factors eliminated on a global scale, the U.S. would still trail some peer nations. Countries like Canada are so advanced that American life expectancy would only align with that of Canada if these risks were solely addressed in the U.S.

Nonetheless, our scenarios suggest that addressing individual risk factors can save millions of lives. For instance, lowering smoking rates to match the lowest levels could prevent 2.1 million deaths in the U.S. by 2050. Additionally, reducing high body mass index and blood sugar levels could avert 1.4 million fatalities over the same timeframe.

“The significant decline of the U.S. in global health standings from 2022 to 2050 is a wake-up call for immediate reforms. It is crucial for the U.S. to chart a new path, implementing improved health strategies and policies to reverse the downturn in future health outcomes,” remarked co-senior author Dr. Stein Emil Vollset, an Affiliate Professor at IHME.

Recommendations from IHME

IHME aims to share these findings with policymakers, healthcare professionals, and the community to collectively foster a healthier and more robust nation. Leaders across all sectors can leverage these forecasts to anticipate potential economic repercussions.

“Poor health adversely affects the economy due to a diminished workforce, reduced productivity, and increased healthcare costs for businesses and their employees, ultimately lowering GDP and allowing other nations with stronger economies to surpass the U.S., producing widespread financial and geopolitical effects,” Dr. Murray emphasized.

The IHME’s scientific investigations have consistently highlighted the importance of enhancing access to preventive healthcare for early detection and management of diseases. Prompt interventions can also mitigate complications and reduce healthcare expenses.

“All Americans should have access to high-quality healthcare through universal health coverage to safeguard against illness, maintain health, and protect against financial strains, irrespective of their income,” asserted Dr. Mokdad.

Previous IHME studies have also indicated that increased educational levels correlate with lower mortality risks, as more education leads to fewer risk-laden behaviors and more informed decision-making. Nevertheless, local leaders must prioritize investments in community health to effectively address disparities through tailored care and community-specific initiatives.

About GBD

This research constitutes the most thorough modeling examination of the health status of the U.S. population, forecasting a variety of determinants such as disease drivers, demographic trends, and risk factors. Furthermore, future scenarios and their possible implications for American health are modeled.

The GBD 2021 study (https://www.healthdata.org/research-analysis/gbd) and all GBD visualization resources including GBD Foresight (https://vizhub.healthdata.org/gbd-foresight/), GBD Results (https://vizhub.healthdata.org/gbd-results/), and GBD Compare (https://vizhub.healthdata.org/gbd-compare/) are accessible online.

Notes:

1. The mortality statistics are age-adjusted per 100,000 inhabitants.
2. Twenty states projected to witness a decline in female HALE by 2050 include: Alabama, Arkansas, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Mississippi, Missouri, Montana, Nebraska, New Mexico, Ohio, Oklahoma, Tennessee, Utah, South Dakota, West Virginia, and Wyoming.

Further details can be found in The Lancet online at: https://www.thelancet.com/issue/S0140-6736(24)X0050-1