Date: Jan. 25, 2011




Past Smoking Rates Are a Major Reason For Shorter Lifespans in U.S. Compared to Other High-Income Countries; Obesity Also Appears to be Significant Factor


WASHINGTON -- The nation’s history of heavy smoking is a major reason why lifespans in the U.S. fall short of those in many other high-income nations, and evidence suggests that current obesity levels also play a substantial part, says a new report from the National Research Council. 


Over the last 25 years, life expectancy at age 50 in the U.S. has been rising, but at a slower pace than in many other high-income countries, such as Japan and Australia.  This difference is particularly notable given that the U.S. spends more on health care than any other nation.  Concerned about this divergence, the National Institute on Aging asked the National Research Council to examine evidence on its possible causes.


Three to five decades ago, smoking was much more widespread in the U.S. than in Europe or Japan, and the health consequences are still playing out in today’s mortality rates, the report says.  Smoking appears to be responsible for a good deal of the differences in life expectancy, especially for women.  The habit also has significantly reduced life expectancy in Denmark and the Netherlands, two other countries with lower life expectancy trends than comparable high-income countries.


Because there appears to be a lag of two to three decades between smoking and its peak effects on mortality, one can predict how smoking will affect life expectancy over the next 20 to 30 years.  On this basis, life expectancy for men in the U.S. is likely to improve relatively rapidly in coming decades because of reductions in smoking in the last 20 years, the report says.  For U.S. women, whose smoking behavior peaked later than men’s, declines in mortality are apt to remain slow for the next decade.  Similarly, life expectancy in Japan is expected to improve less rapidly than it otherwise would, because of more-recent high smoking rates. 


Obesity’s contribution to lagging life expectancies in the U.S. also appears to be significant, the report says.  While there is still uncertainty in the literature about the magnitude of the relationship between obesity and mortality, it may account for a fifth to a third of the shortfall in longevity in the U.S. compared to other nations, the report says.  And if the obesity trend in the U.S. continues, it may offset the longevity improvements expected from reductions in smoking.  However, recent data suggest that the prevalence of obesity in the U.S. has leveled off, and some studies indicate that the mortality risk associated with obesity has declined.


Lack of universal access to health care in the U.S. also has increased mortality and reduced life expectancy, the report says, though this is a less significant factor for those over age 65 because of Medicare access.  For the main causes of death at older ages -- cancer and cardiovascular disease -- available indicators do not suggest that the U.S. health care system is failing to prevent deaths that would be averted elsewhere.  In fact, cancer detection and survival appear to be better in the U.S. than in most other high-income nations, and survival rates following a heart attack also are favorable.


Certain risk factors are unlikely to have played a major role in the divergence of life expectancy over the last 25 years, the report adds.  Although a large body of emerging work suggests that there may be important connections between the strength of social ties and mortality, the committee that wrote the report found little compelling data to indicate that differences in social networks among people in high-income countries are related to the differing patterns of life expectancy.  Similarly, little evidence supports the hypothesis that hormone therapy has played a part in the relatively lower longevity for American women.


The study committee also identified many gaps in research.  While lung cancer deaths are a reliable marker of the damage from smoking, no clear-cut marker exists for obesity, physical inactivity, social integration, or other risks considered in this report.  Moreover, evaluation of these risk factors is based on observational studies, which -- unlike randomized controlled trials -- are subject to many biases.  While there is no perfect substitute for randomized controlled trials, studies that take advantage of natural experiments, such as increased cigarette taxes or a dramatic change in the use of hormone therapy, can sometimes serve as valuable supplements to them.


The report was sponsored by the National Institute on Aging’s Division of Behavioral and Social Research.  The National Academy of Sciences, National Academy of Engineering, Institute of Medicine, and National Research Council make up the National Academies.  They are private, nonprofit institutions that provide science, technology, and health policy advice under a congressional charter.  The Research Council is the principal operating agency of the National Academy of Sciences and the National Academy of Engineering.  A committee roster follows.



Copies of Explaining Divergent Levels of Longevity in High-Income Countries are available from the National Academies Press; tel. 202-334-3313 or 1-800-624-6242 or on the Internet at  Reporters may obtain a copy from the Office of News and Public Information (contacts listed below). 


Contacts: Sara Frueh, Media Relations Officer

Christopher White, Media Relations Assistant

Office of News and Public Information

202-334-2138; e-mail <>


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[ This news release and report are available at ]



Division of Behavioral and Social Sciences and Education


Panel on Understanding Divergent Trends in Longevity in High-Income Countries


Eileen M. Crimmins (co-chair)

Associate Dean, Edna M. Jones Chair, and Professor

Davis School of Gerontology

University of Southern California

Los Angeles


Samuel H. Preston1,2 (co-chair)

Fredrick J. Warren Professor of Demography

School of Arts and Sciences

University of Pennsylvania



James Banks


Department of Economics

University of Manchester, and

Deputy Research Director

Institute for Fiscal Studies



Lisa F. Berkman2


Harvard Center for Population and Development Studies, and

Thomas D. Cabot Professor of Public Policy, Epidemiology, and

  Population and International Health

Harvard School of Public Health

Cambridge, Mass.


Dana A. Glei

Senior Research Investigator

Center For Population and Health

Georgetown University

Washington, D.C.


Noreen Goldman

Hughes-Rogers Professor of Demography and Public Affairs

Woodrow Wilson School, and

Acting Director

Office of Population Research

Princeton University

Princeton, N.J.


Alan D. Lopez2

Professor of Medical Statistics and Population Health, and


School of Population Health

University of Queensland

Queensland, Australia


Johan P. Mackenbach

Chair and Professor

Department of Public Health

Erasmus University Rotterdam

Rotterdam, Netherlands


Michael Marmot2


International Institute for Society and Health, and

Professor of Epidemiology and Public Health

University College London



David Mechanic1,2

René Dubos University Professor of Behavioral Sciences, and


Institute for Health, Health Care Policy, and Aging Research

Rutgers University

New Brunswick, N.J.


Christopher J. Murray2

Institute Director

Institute for Health Metrics and Evaluation, and

Professor of Global Health

University of Washington



James P. Smith

RAND Chair in Labor Markets and Demographic Studies

RAND Corp.

Santa Monica, Calif.


Jacques Vallin

Emeritus Research Director

Institut National d’Etudes Demographiques

Paris, France


James W. Vaupel1

Founding and Executive Director

Max Planck Institute for Demographic Research

Rostock, Germany


John R. Wilmoth

Associate Professor

Department of Demography, and


Center on the Economics and Demography of Aging

University of California





Barney Cohen

Staff Officer



1          Member, National Academy of Sciences

2          Member, Institute of Medicine