Explaining Divergent Levels of Longevity in High-Income Countries

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Eileen M. Crimmins, Samuel H. Preston, and Barney Cohen, Editors Panel on Understanding Divergent Trends in Longevity in High-Income Countries Committee on Population Division of Behavioral and Social Sciences and Education

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THE NATIONAL ACADEMIES PRESS • 500 Fifth Street, NW • Washington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Govern- ing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. This study was supported by the National Institute on Aging’s Division of Behavioral and Social Research through Contract No. NO1-OD-4-2139, TO#194 between the National Academy of Sciences and the U.S. Department of Health and Human Services. Any opinions, findings, conclusion, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the views of the organization or agencies that provided support for the project. Library of Congress Cataloging-in-Publication Data Explaining divergent levels of longevity in high-income countries / Eileen M. Crimmins, Samuel H. Preston, and Barney Cohen, editors. p. cm. “Panel on Understanding Divergent Trends in Longevity in High-Income Countries, Committee on Population, Division of Behavioral and Social Sciences and Education, National Research Council of the National Academies.” Includes bibliographical references. ISBN 978-0-309-18640-7 (pbk.) — ISBN 978-0-309-18641-4 (pdf) 1. Life expectancy. 2. Longevity. 3. Life expectancy—United States. 4. Longevity— United States. I. Crimmins, Eileen M. II. Preston, Samuel H. III. Cohen, Barney, 1959- IV. National Research Council (U.S.). Panel on Understanding Divergent Trends in Longevity in High-Income Countries. HB1322.3.E97 2011 304.6’45—dc23 2011017452 Additional copies of this report are available from the National Academies Press, 500 Fifth Street, NW, Lockbox 285, Washington, DC 20055; (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area); http://www.nap.edu. Copyright 2011 by the National Academy of Sciences. All rights reserved. Printed in the United States of America Suggested citation: National Research Council. (2011). Explaining Divergent Lev- els of Longevity in High-Income Countries. E.M. Crimmins, S.H. Preston, and B. Cohen, Eds. Panel on Understanding Divergent Trends in Longevity in High-Income Countries. Committee on Population, Division of Behavioral and Social Sciences and Education. Washington, DC: The National Academies Press.

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PANEL ON UNDERSTANDING DIVERGENT TRENDS IN LONGEVITY IN HIGH-INCOME COUNTRIES EILEEN M. CRIMMINS (Cochair), Davis School of Gerontology, University of Southern California SAMUEL H. PRESTON (Cochair), Department of Sociology, University of Pennsylvania JAMES BANKS, Department of Economics, University of Manchester, and Institute for Fiscal Studies, England LISA F. BERKMAN, Department of Society, Human Development, and Health, Harvard University School of Public Health DANA A. GLEI, Center for Population and Health, Georgetown University NOREEN GOLDMAN, Office of Population Research and Woodrow Wilson School, Princeton University ALAN D. LOPEZ, School of Population Health, University of Queensland, Australia JOHAN P. MACKENBACH, Department of Public Health, Erasmus University, Rotterdam, The Netherlands MICHAEL G. MARMOT, Department of Epidemiology and Public Health, University College London, England DAVID MECHANIC, Institute for Health, Health Care Policy, and Aging Research, Rutgers University CHRISTOPHER J.L. MURRAY, School of Public Health, University of Washington JAMES P. SMITH, RAND Corporation, Santa Monica, California JACQUES VALLIN, Institut National d’Études Démographiques, Paris, France JAMES W. VAUPEL, Max Planck Institute for Demographic Research, Rostock, Germany JOHN R. WILMOTH, Department of Demography, University of California, Berkeley BARNEY COHEN, Study Director ROBERT POOL, Consultant JACQUELINE R. SOVDE, Program Associate v

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COMMITTEE ON POPULATION LINDA J. WAITE (Chair), Department of Sociology, University of Chicago CHRISTINE BACHRACH, Social Science Research Institute, Duke University, and School of Behavioral and Social Sciences, University of Maryland EILEEN M. CRIMMINS, Davis School of Gerontology, University of Southern California PETER J. DONALDSON, Population Council, New York, New York BARBARA ENTWISLE, Department of Sociology, University of North Carolina, Chapel Hill JOSHUA R. GOLDSTEIN, Max Planck Institute for Demographic Research, Rostock, Germany CHARLES HIRSCHMAN, Department of Sociology, University of Washington BARTHÉLÉMY KUATE-DEFO, Department of Demography, University of Montreal WOLFGANG LUTZ, World Population Program, International Institute for Applied Systems Analysis, Laxenburg, Austria DUNCAN THOMAS, Economics Department, Duke Global Health Institute, Duke University BARBARA B. TORREY, Independent Consultant, Washington, DC MAXINE WEINSTEIN, Center for Population and Health, Georgetown University BARNEY COHEN, Director vi

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Acknowledgments In 2008, at the request of the National Institute on Aging, the Com- mittee on Population of the National Research Council (NRC) established a Panel on Understanding Divergent Trends in Longevity in High-Income Countries to examine trends in life expectancy at older ages, to identify possible lessons about modifiable risk factors, and to discern implications for the future trajectory of mortality at advanced ages. This document represents the final report of the panel and is the collective product of all panel members and staff. This report would not have been possible without the help of numerous people and organizations. We would especially like to thank the report’s sponsor, the National Institute on Aging, and in particular to acknowl- edge the contributions of Dr. Richard Suzman, director of the Division of Behavioral and Social Research and Dr. John Haaga, deputy director of the Division. The support, encouragement, and intellectual energy that they brought to the panel helped us produce a stronger report. In addressing its charge, the panel was faced with a large and burgeon- ing theoretical and empirical literature with contributions from many dif- ferent fields within the social and health sciences. Consequently, as a first step, the panel decided to commission a set of background papers, each one dealing with a topic relevant to the panel’s work. These papers have been published by the National Academies Press in a companion volume titled International Differences in Mortality at Older Ages: Dimensions and Sources. These papers served as a valuable resource for the report, and each one was reviewed and debated at length. Members of the panel were heavily involved in the preparation of these papers, and many others contributed vii

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viii ACKNOWLEDGMENTS as well. The contributors included Dawn Alley, University of Maryland; Mauricio Avendano, Harvard University; Magali Barbieri, Institut National d’Études Démographiques; Carl Boe, University of California, Berkeley; Kaare Christensen, University of Southern Denmark; Michael Davidsen, University of Southern Denmark; Krista Garcia, University of South- ern California; Joop Garssen, University of Groningen; Maria Glymour, Harvard University; Jessica Ho, University of Pennsylvania; Knud Juel, University of Copenhagen; Ichiro Kawachi, Harvard University; Jung Ki Kim, University of Southern California; Renske Kok, Erasmus Medical Center; Anton Kunst, University of Amsterdam; Jennifer Lloyd, University of Maryland; France Meslé, Institut National d’Études Démographiques; Laust Mortensen, University of Southern Denmark; Fred Pampel, Univer- sity of Colorado, Boulder; Roland Rau, University of Rostock; Michelle Shardell, University of Maryland School of Medicine; Andrew Steptoe, University College London; and Anna Wilkman, University College London. In addition, the panel drew on the expertise of several other experts. As part of this project, the panel organized two public meetings. In December 2008, the panel benefited greatly from the expertise and insights provided by Toni Antonucci, University of Michigan; Steve Blair, University of South Carolina; Virginia Chang, University of Pennsylvania; Jim Harter, The Gallup Organization; Frank Hu, Harvard University; Richard Saltman, Emory University; and Jonathon Skinner, Dartmouth College. In March 2009, the panel benefited from presentations and detailed discussion with Dawn Alley, University of Maryland; Kaare Christensen, University of Southern Denmark; Shiro Horiuchi, Hunter College; Knud Juel, University of Southern Denmark; and Andrew Steptoe, University College London. Several members of the staff of the National Academies made significant contributions to the report. The panel was established under the auspices of the Committee on Population. Particular thanks are due to Barney Cohen, who was an exceptionally effective study director, as well as to Robert Pool for research and writing assistance, Benjamin Galick for excellent research assistance, Jacqui Sovde for logistical support, Kirsten Sampson Snyder for help guiding the report through review, Rona Briere for skillful editing, and Yvonne Wise for managing the production process. This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with pro- cedures approved by the NRC’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process.

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ix ACKNOWLEDGMENTS We wish to thank the following individuals for their review of this report: Barbara A. Anderson, Ronald Freedman collegiate professor of soci- ology and population studies, University of Michigan; Mauricio Avendano, Harvard Center for Population and Development Studies, Harvard Univer- sity; John Bongaarts, Policy Research Division, The Population Council; David Burns, School of Medicine, University of California, San Diego; John Cawley, Department of Policy Analysis and Management, College of Human Ecology, Cornell University; Kaare Christiansen, professor of epide- miology, College of Human Ecology, University of Southern Denmark, and senior research scientist, Sanford Institute of Public Policy, Duke University; James S. House, Angus Campbell distinguished university professor survey research, public policy, and sociology, Gerald R. Ford School of Public Policy, University of Michigan; Michael A. Stoto, professor of health sys- tems administration and population health, Georgetown University School of Nursing and Health Studies; and Klaas R. Westerterp, professor of human energetics, Department of Human Biology, Maastricht University, The Netherlands. Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations nor did they see the final draft of the report before its release. The review of this report was overseen by Jane Menken, University of Colorado, Boulder. Appointed by the NRC, she was responsible for mak- ing certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring panel and the institution. Finally, we would like to express our great appreciation to our fellow panel members. This report results from the exceptional efforts of the members of the panel, all of whom had many other responsibilities but who nonetheless generously gave much of their time and their expertise to the project. Eileen M. Crimmins and Samuel H. Preston, Cochairs Panel on Understanding Divergent Trends in Longevity in High-Income Countries

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Contents Summary 1 1 Difference Between Life Expectancy in the United States and Other High-Income Countries 7 2 Causes of Death, Health Indicators, and Divergence in Life Expectancy 26 3 The Role of Obesity 43 4 The Role of Physical Activity 56 5 The Role of Smoking 69 6 The Role of Social Networks and Social Integration 83 7 The Role of Health Care 96 8 The Role of Hormone Therapy 112 9 The Role of Inequality 117 10 Conclusions 142 References 154 Biographical Sketches of Committee Members and Staff 176 xi

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