Abstract
INTRODUCTION: Between 2008 and 2019 the gap in life expectancy between the U.S. and other high-income countries grew significantly, with the reasons for the growth remaining unknown. This study measured the contribution of cardiovascular disease mortality in the growth of the gap in life expectancy at age 50 years (LE50) between the U.S. and 10 other high-income countries. METHODS: Cross-sectional observational study in 2008 and 2019, using Human Mortality Database and World Health Organization data for population aged 50 years plus as participants. Actual and counterfactual LE50s were compared to quantify the effect of cardiovascular disease mortality on the growth in the gap. Two counterfactual LE50s were calculated, one based on a cause-deleted method, and another by applying the U.S. trends to other countries. A decomposition was performed to quantify the combined effects of selected death causes and ages. RESULTS: The U.S. was the worst-performing country regarding cardiovascular disease mortality improvements between 2008 and 2019. The LE50 gap between the U.S. and the average of the other high-income countries grew 0.33 years for women, explained entirely by cardiovascular disease mortality, and 0.79 years for men, 50% of which was explained by cardiovascular disease mortality. Cardiovascular disease mortality after age 70 years was responsible for 81% of the growth of the gap among women, while for men cardiovascular disease mortality after age 70 years contributed 36%. CONCLUSIONS: The slow rate of decline of cardiovascular disease mortality in the U.S. was the main driver of the growth of the LE50 gap between the U.S. and other high-income countries, so prevention of those deaths is critical.