11 ms·

Why Americans Die So Much More Than Europeans

31 points by robg 5y ago

xqcgrek2 5y ago
When one corrects for obesity, this usually goes away. Put it another way, American obesity and metabolic disease can almost entirely account for the gap. Regulation prevents market forces from correcting the gap. For example, insurance cannot charge higher premiums based on weight or lifestyle health status.
- frankbreetz 5y ago
  Insurance does charge higher for smokers and that is certainly a "lifestyle health status".
- Arnt 5y ago
  I quote at length: "Infants in the U.S. are considerably more likely to die in the poorest counties than in the richest counties, and this is true for both Black and white babies. Black teenagers in the poorest U.S. areas are roughly twice as likely to die before they turn 20, compared with those in the richest U.S. counties. In Europe, by contrast, the mortality rate for teenagers in the richest and poorest areas is exactly the same—12 deaths per 100,000. In America, the problem is not just that poverty is higher; it’s that the effect of poverty on longevity is greater too." Are you suggesting that obesity makes a difference in the US but not in Europe? Or perhaps that obesity varies in the US but is uniform in Europe?
  - djokkataja 5y ago
    Obesity rates are significantly higher in the United States than in Europe. https://ourworldindata.org/obesity#what-share-of-adults-are-obese https://ourworldindata.org/obesity#what-share-of-adults-are-...
    - Arnt 5y ago
      Yes, but if GP is right (and I understand correctly) then that should lead to a sloped graph for Europe and (significantly higher on the sheet) sheet another sloped graph for the US. Whereas what the report finds is a flat line for Europe and a sloped graph (higher up) for the US.
  - bradknowles 5y ago
    The other factor in Europe is the healthcare system. They have universal healthcare, and we don’t. So, if you don’t have insurance in the US and you’re in a poor neighborhood, then yes — you’re likely to have a lower standard of care. But in Europe, everyone has state-provided insurance, and the quality of healthcare is much more consistent.
    - alkonaut 5y ago
      Most would agree that at least the richest in the US have better care than the lower percentile ms of Europeans. The outcomes according to the article suggests that even the richest don’t reach European longevity. There could be multiple factors overlapping here though I suspect. For all but the richest, public healthcare helps, but for the richest the obesity gap closes any benefit in healthcare (diminishing returns in better care easily overshadowed by even slightly worse lifestyles).
- adonovan 5y ago
  Until recently, insurance companies could refuse entirely to cover a "preexisting condition" such as obesity. Those market forces were good for noone but insurers.
- sprafa 5y ago
  Can you share sources/data? The fact that Americans are so obese it’s draining down their lifespan in a collective way is still something that sounds worthy of study.
- truculent 5y ago
  Those market forces are present in Europe?
- djokkataja 5y ago
  Obesity is a big factor cough but there are others. I found this article (https://ourworldindata.org/us-life-expectancy-low https://ourworldindata.org/us-life-expectancy-low) that shows a number of factors that contribute to the higher American mortality rate. Unfortunately it does not cover ALL causes of death, though if you want, you could independently investigate that[1]. Compared to Western Europe, Americans die at higher rates from smoking, obesity, homicides, opioid overdoses, and road accidents. There are two other graphed factors that don't have an option to compare with "Western Europe", but on those, it's relatively plain that the United States has a significantly higher infant mortality rate and significantly less access to healthcare. And then there are suicide rates, which have increased some in the United States, but which are middle of the road compared to European countries (France is higher, Germany's about the same, Italy, the UK, and Norway are lower... I did not check these exhaustively). You'll have to click the button on the graph to change the country and then add up the rate by each age to get a comparison. I suppose the middle-range American suicide rate didn't fit the narrative of the article, but the author still wanted to highlight it as a concern given that it's been going up in the United States. (Unfortunately, not every graph shows the same set of countries compared to the United States, which makes me think the author chose to cherry pick countries for specific graphs, and I'm not sure why, because it doesn't seem necessary. For example, the graphs in the article allow you to choose additional countries and sometimes regions to add to the graph; if I add "Western Europe" to each graph where it's an available option, the trends that the author is illustrating are completely preserved.) [1] https://ourworldindata.org/causes-of-death https://ourworldindata.org/causes-of-death
  - AnimalMuppet 5y ago
    Wait, France has a higher suicide rate than the US? I find that to be quite surprising.
LorenPechtel 5y ago
"Infant mortality" plays a big role in life expectancy. The dividing line between a stillbirth and infant mortality can be a very fine line and varies widely in the developed world. Strangely enough, the combined term (stillbirth + infant mortality) doesn't vary nearly as much. That says there's a big data problem with counting infant mortality, and thus a big data problem with life expectancy.
findalex 5y ago
What a title.
- panny 5y ago
  Same. My initial thought being, "Do Americans die more than once?"
Barrin92 5y ago
Another important factor I think is something that Robert Sapolsky's research has brought to light.[1]. Inequality and poverty itself causes significant health burden. That is to say, even when one accounts for the material disadvantages of the poor, different lifestyle patterns and so on, stratification itself contributes to adverse health outcomes in lower classes. >"Psychologist Nancy Adler has demonstrated that how people rate how they are doing, relative to others, is at least as predictive of health or illness as are any objective measures such as actual income level, and research by epidemiologists Richard Wilkinson and Kate Pickett has shown that by just about every health indicator—infant mortality, overall life expectancy, obesity, you name it— inequality can be even worse than poverty. In the Whitehall studies, Marmot found a fourfold difference in rates of cardiac disease mortality between the lowest and highest rungs of the British Civil Service, despite the fact they were all paid a living wage" All of the outcomes based effects on death in this article are of course real, but it's astonishing that, according to the research of Sapolsky and others, inequality itself can cause stress and inflammation responses that can account for up to half of perceived difference in health outcomes. American society by and large is simply significantly more stressed and it has real impact on the biology of the population. [1]https://newrepublic.com/article/153870/inequality-death-america-life-expectancy-gap https://newrepublic.com/article/153870/inequality-death-amer...
- hdjjhhvvhga 5y ago
  This and other things mentioned in the comments are all connected, especially the inequality aspect. If you don't have enough money, you save on everything, including your health. This means not just immediate health care and simple preventive measures, but also long-term approach such as a healthy life style. One of these is the availability of highly-processed low-quality food everywhere and relative difficulty of getting higher quality food and finding the time to prepare proper meals. The substances used for conservation of foods such as sodium nitrate, sugars, etc. have overall adverse effects on health. Moreover, the "food" industry doesn't stop here. They are trying to push the boundaries, and American institutions supposed to protect the rights of citizens are very weak when confronted with the lobbies. A good example is the infamous pink slime, approved by the FDA in 2001 but banned in the EU. Using these kinds of substances is considered a crime in Europe, and for a good reason.
cheschire 5y ago
>> Americans die more from car accidents, not because our fatality rate per mile driven is unusually high but because we simply drive so much more than people in other countries. This is ridiculous. I've lived over a decade on both continents and it's not the number of miles/kilometers driven that matters, it's how terrible American drivers are. In the USA I see things every 15 minutes on the interstate that in Europe I would have called the police on. American culture seems to have this endless desire to grow, improve, escalate, promote, hustle. It permeates every single aspect of life, from home buying to what is put on the dinner table. Live fast, die young, I guess.
- burnished 5y ago
  I don't know how to tell you this, except to say that how terrible drivers are is summed up in the fatalities/mile statistic, and the number of miles is indeed important here. The way you are responding is completely counter but you don't provide any evidence. If what you said was true then the fatality/miles ratio would be much higher.
  - Scoundreller 5y ago
    Here’s evidence: Amongst OECD countries, US is near the bottom. One EU country is slightly worse (Belgium), Czechs are twice as bad, and every other EU country is better, the biggest at least a third less, the best being well under half the US rate of fatalities / km: https://statlinks.oecdcode.org/752017011P1G002.xlsx https://statlinks.oecdcode.org/752017011P1G002.xlsx
    - burnished 5y ago
      Yes, that is shown in the study where the author makes a link for the claim. Figure 2 of [1] even shows this, and by eyeball alone it looks like it is closer to 4X more. The point I'm trying to make is that the people who published this graph, who cited the original study, are saying that the total number of fatalities appears to be more impacted by the total miles driven rather than the rate. I tried to dig up where the comparison of miles driven is made but was unable. In any case, the principle point is that while you are correct that American's have a higher fatality rate, if we are also driving significantly more then that could be a bigger problem. If we have 4X the rate, but 10X the miles, it would seem reasonable to say that the distance is the biggest factor. [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4112220/#SD1 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4112220/#SD1
tropdrop 5y ago
I was surprised to see no examination of the American healthcare system vs. those of the European countries listed anywhere in the article. Doesn't it make sense to see life expectancy fall for every age category when every age category and group have to contend with the same byzantine and terrifying medical industrial complex to get even the most basic care?
- hackeraccount 5y ago
  My understanding is that "healthcare" in the sense of going to the Doctor doesn't impact life expectancy all that much. Public health on the other hand - think drinking/smoking/driving/diet/exercise/suicide - has a bigger hand to play. Somewhere else in this thread there was also mention of the potentially large effect of the way that you measure infant mortality.
asdfge4drg 5y ago
Is there even an elephant in the room? Most of these other countries have effectively free access to health care, whilst millions of sick American's avoid seeking care because of the crippling debt that comes with it. Also, I know how unpopular this opinion is, but as someone who's lived in America, several European countries, and Australia... the average American has a lower standard of living than the average European, and the bottom of society in America tends to fall much lower than the bottom in a European city. Life is more civilized in France, Italy, Spain than in the US. Sorry :D
- vinay427 5y ago
  > Also, I know how unpopular this opinion is I don't think this is unpopular at all, at least here. I've even avoided some nonessential medical care in the European country I live in due to the costs, and those prices would still be lower for nearly anything (with some exceptions) compared to in the US. I think this point is just not brought up here because it's well-enough understood in this audience that it's more useful to discuss other factors that might be more neglected, such as lifestyle, etc.
- mbrodersen 5y ago
  I agree. Having lived, worked, and paid taxes in Denmark, England, Scotland, the US, and Australia. Most Americans have no clue and keep blindly thinking that the US is “better” than all other countries in every possible way. Completely ignoring all the statistics and real data showing that it simply isn’t true. The willingness to ignore reality is jaw dropping.
- fortran77 5y ago
  The elephant in the room is Obesity.
deleted 5y ago
[deleted]
da39a3ee 5y ago
Everyone here knows the answer; it's barely worth an entire article. In the USA there is a poorer segment of society that has much worse healthcare than the equivalent in European countries. This is because they do not have the good health insurance policies that are needed to have good healthcare; even with insurance they can't afford the deductibles. This is largely because richer Americans get their good health insurance from their good jobs. It is also because poorer people's lives are more chaotic because life is harder. In Europe those people's lives are similarly chaotic due to the struggle of living on low income in a low income area, but they have access to good free healthcare in many countries, and fairer insurance schemes in others.

31 points by robg 5y ago

When one corrects for obesity, this usually goes away. Put it another way, American obesity and metabolic disease can almost entirely account for the gap. Regulation prevents market forces from correcting the gap. For example, insurance cannot charge higher premiums based on weight or lifestyle health status.

frankbreetz 5y ago
Insurance does charge higher for smokers and that is certainly a "lifestyle health status".
Arnt 5y ago
I quote at length: "Infants in the U.S. are considerably more likely to die in the poorest counties than in the richest counties, and this is true for both Black and white babies. Black teenagers in the poorest U.S. areas are roughly twice as likely to die before they turn 20, compared with those in the richest U.S. counties. In Europe, by contrast, the mortality rate for teenagers in the richest and poorest areas is exactly the same—12 deaths per 100,000. In America, the problem is not just that poverty is higher; it’s that the effect of poverty on longevity is greater too." Are you suggesting that obesity makes a difference in the US but not in Europe? Or perhaps that obesity varies in the US but is uniform in Europe?
- djokkataja 5y ago
  Obesity rates are significantly higher in the United States than in Europe. https://ourworldindata.org/obesity#what-share-of-adults-are-obese https://ourworldindata.org/obesity#what-share-of-adults-are-...
  - Arnt 5y ago
    Yes, but if GP is right (and I understand correctly) then that should lead to a sloped graph for Europe and (significantly higher on the sheet) sheet another sloped graph for the US. Whereas what the report finds is a flat line for Europe and a sloped graph (higher up) for the US.
- bradknowles 5y ago
  The other factor in Europe is the healthcare system. They have universal healthcare, and we don’t. So, if you don’t have insurance in the US and you’re in a poor neighborhood, then yes — you’re likely to have a lower standard of care. But in Europe, everyone has state-provided insurance, and the quality of healthcare is much more consistent.
  - alkonaut 5y ago
    Most would agree that at least the richest in the US have better care than the lower percentile ms of Europeans. The outcomes according to the article suggests that even the richest don’t reach European longevity. There could be multiple factors overlapping here though I suspect. For all but the richest, public healthcare helps, but for the richest the obesity gap closes any benefit in healthcare (diminishing returns in better care easily overshadowed by even slightly worse lifestyles).
adonovan 5y ago
Until recently, insurance companies could refuse entirely to cover a "preexisting condition" such as obesity. Those market forces were good for noone but insurers.
sprafa 5y ago
Can you share sources/data? The fact that Americans are so obese it’s draining down their lifespan in a collective way is still something that sounds worthy of study.
truculent 5y ago
Those market forces are present in Europe?
djokkataja 5y ago
Obesity is a big factor cough but there are others. I found this article (https://ourworldindata.org/us-life-expectancy-low https://ourworldindata.org/us-life-expectancy-low) that shows a number of factors that contribute to the higher American mortality rate. Unfortunately it does not cover ALL causes of death, though if you want, you could independently investigate that[1]. Compared to Western Europe, Americans die at higher rates from smoking, obesity, homicides, opioid overdoses, and road accidents. There are two other graphed factors that don't have an option to compare with "Western Europe", but on those, it's relatively plain that the United States has a significantly higher infant mortality rate and significantly less access to healthcare. And then there are suicide rates, which have increased some in the United States, but which are middle of the road compared to European countries (France is higher, Germany's about the same, Italy, the UK, and Norway are lower... I did not check these exhaustively). You'll have to click the button on the graph to change the country and then add up the rate by each age to get a comparison. I suppose the middle-range American suicide rate didn't fit the narrative of the article, but the author still wanted to highlight it as a concern given that it's been going up in the United States. (Unfortunately, not every graph shows the same set of countries compared to the United States, which makes me think the author chose to cherry pick countries for specific graphs, and I'm not sure why, because it doesn't seem necessary. For example, the graphs in the article allow you to choose additional countries and sometimes regions to add to the graph; if I add "Western Europe" to each graph where it's an available option, the trends that the author is illustrating are completely preserved.) [1] https://ourworldindata.org/causes-of-death https://ourworldindata.org/causes-of-death
- AnimalMuppet 5y ago
  Wait, France has a higher suicide rate than the US? I find that to be quite surprising.

LorenPechtel 5y ago

"Infant mortality" plays a big role in life expectancy. The dividing line between a stillbirth and infant mortality can be a very fine line and varies widely in the developed world. Strangely enough, the combined term (stillbirth + infant mortality) doesn't vary nearly as much. That says there's a big data problem with counting infant mortality, and thus a big data problem with life expectancy.

findalex 5y ago

What a title.

panny 5y ago
Same. My initial thought being, "Do Americans die more than once?"

Barrin92 5y ago

Another important factor I think is something that Robert Sapolsky's research has brought to light.[1]. Inequality and poverty itself causes significant health burden. That is to say, even when one accounts for the material disadvantages of the poor, different lifestyle patterns and so on, stratification itself contributes to adverse health outcomes in lower classes. >"Psychologist Nancy Adler has demonstrated that how people rate how they are doing, relative to others, is at least as predictive of health or illness as are any objective measures such as actual income level, and research by epidemiologists Richard Wilkinson and Kate Pickett has shown that by just about every health indicator—infant mortality, overall life expectancy, obesity, you name it— inequality can be even worse than poverty. In the Whitehall studies, Marmot found a fourfold difference in rates of cardiac disease mortality between the lowest and highest rungs of the British Civil Service, despite the fact they were all paid a living wage" All of the outcomes based effects on death in this article are of course real, but it's astonishing that, according to the research of Sapolsky and others, inequality itself can cause stress and inflammation responses that can account for up to half of perceived difference in health outcomes. American society by and large is simply significantly more stressed and it has real impact on the biology of the population. [1]https://newrepublic.com/article/153870/inequality-death-america-life-expectancy-gap https://newrepublic.com/article/153870/inequality-death-amer...

hdjjhhvvhga 5y ago
This and other things mentioned in the comments are all connected, especially the inequality aspect. If you don't have enough money, you save on everything, including your health. This means not just immediate health care and simple preventive measures, but also long-term approach such as a healthy life style. One of these is the availability of highly-processed low-quality food everywhere and relative difficulty of getting higher quality food and finding the time to prepare proper meals. The substances used for conservation of foods such as sodium nitrate, sugars, etc. have overall adverse effects on health. Moreover, the "food" industry doesn't stop here. They are trying to push the boundaries, and American institutions supposed to protect the rights of citizens are very weak when confronted with the lobbies. A good example is the infamous pink slime, approved by the FDA in 2001 but banned in the EU. Using these kinds of substances is considered a crime in Europe, and for a good reason.

cheschire 5y ago

>> Americans die more from car accidents, not because our fatality rate per mile driven is unusually high but because we simply drive so much more than people in other countries. This is ridiculous. I've lived over a decade on both continents and it's not the number of miles/kilometers driven that matters, it's how terrible American drivers are. In the USA I see things every 15 minutes on the interstate that in Europe I would have called the police on. American culture seems to have this endless desire to grow, improve, escalate, promote, hustle. It permeates every single aspect of life, from home buying to what is put on the dinner table. Live fast, die young, I guess.

burnished 5y ago
I don't know how to tell you this, except to say that how terrible drivers are is summed up in the fatalities/mile statistic, and the number of miles is indeed important here. The way you are responding is completely counter but you don't provide any evidence. If what you said was true then the fatality/miles ratio would be much higher.
- Scoundreller 5y ago
  Here’s evidence: Amongst OECD countries, US is near the bottom. One EU country is slightly worse (Belgium), Czechs are twice as bad, and every other EU country is better, the biggest at least a third less, the best being well under half the US rate of fatalities / km: https://statlinks.oecdcode.org/752017011P1G002.xlsx https://statlinks.oecdcode.org/752017011P1G002.xlsx
  - burnished 5y ago
    Yes, that is shown in the study where the author makes a link for the claim. Figure 2 of [1] even shows this, and by eyeball alone it looks like it is closer to 4X more. The point I'm trying to make is that the people who published this graph, who cited the original study, are saying that the total number of fatalities appears to be more impacted by the total miles driven rather than the rate. I tried to dig up where the comparison of miles driven is made but was unable. In any case, the principle point is that while you are correct that American's have a higher fatality rate, if we are also driving significantly more then that could be a bigger problem. If we have 4X the rate, but 10X the miles, it would seem reasonable to say that the distance is the biggest factor. [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4112220/#SD1 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4112220/#SD1

tropdrop 5y ago

I was surprised to see no examination of the American healthcare system vs. those of the European countries listed anywhere in the article. Doesn't it make sense to see life expectancy fall for every age category when every age category and group have to contend with the same byzantine and terrifying medical industrial complex to get even the most basic care?

hackeraccount 5y ago
My understanding is that "healthcare" in the sense of going to the Doctor doesn't impact life expectancy all that much. Public health on the other hand - think drinking/smoking/driving/diet/exercise/suicide - has a bigger hand to play. Somewhere else in this thread there was also mention of the potentially large effect of the way that you measure infant mortality.

asdfge4drg 5y ago

Is there even an elephant in the room? Most of these other countries have effectively free access to health care, whilst millions of sick American's avoid seeking care because of the crippling debt that comes with it. Also, I know how unpopular this opinion is, but as someone who's lived in America, several European countries, and Australia... the average American has a lower standard of living than the average European, and the bottom of society in America tends to fall much lower than the bottom in a European city. Life is more civilized in France, Italy, Spain than in the US. Sorry :D

vinay427 5y ago
> Also, I know how unpopular this opinion is I don't think this is unpopular at all, at least here. I've even avoided some nonessential medical care in the European country I live in due to the costs, and those prices would still be lower for nearly anything (with some exceptions) compared to in the US. I think this point is just not brought up here because it's well-enough understood in this audience that it's more useful to discuss other factors that might be more neglected, such as lifestyle, etc.
mbrodersen 5y ago
I agree. Having lived, worked, and paid taxes in Denmark, England, Scotland, the US, and Australia. Most Americans have no clue and keep blindly thinking that the US is “better” than all other countries in every possible way. Completely ignoring all the statistics and real data showing that it simply isn’t true. The willingness to ignore reality is jaw dropping.
fortran77 5y ago
The elephant in the room is Obesity.

deleted 5y ago

[deleted]

da39a3ee 5y ago

Everyone here knows the answer; it's barely worth an entire article. In the USA there is a poorer segment of society that has much worse healthcare than the equivalent in European countries. This is because they do not have the good health insurance policies that are needed to have good healthcare; even with insurance they can't afford the deductibles. This is largely because richer Americans get their good health insurance from their good jobs. It is also because poorer people's lives are more chaotic because life is harder. In Europe those people's lives are similarly chaotic due to the struggle of living on low income in a low income area, but they have access to good free healthcare in many countries, and fairer insurance schemes in others.