While this chapter has focused on the United States in comparison with other countries, it should be noted that smoking has been implicated in the poor performance of other countries as well. In a paper commissioned for this study, Christensen and colleagues (2010a) conclude that smoking is the major factor explaining why Denmark’s life expectancy has fallen behind that of neighboring Sweden. Likewise, Juel (2008) used data from 1997-2001 to calculate that nearly all the difference in male life expectancy between Denmark and Sweden and about three-quarters of the difference in female life expectancy could be attributed to smoking- and alcohol-related deaths. Smoking-related deaths, estimated using the Peto/Lopez method, were the more important of the two.

In short, it appears that smoking is responsible for a good deal of the divergence in female life expectancy being examined here. During 1950-2003, gains in life expectancy at age 50 were 2.1 years lower among U.S. women compared with the average of the other nine countries examined in this study (5.7 vs. 7.8 years gained, respectively); Preston and colleagues (2010b) estimate that smoking accounts for 42 percent of this shortfall. In terms of the gap in life expectancy between the United States and other countries in 2003, Preston and colleagues find that differences in the estimated damage caused by smoking account for 78 percent of the 1.6-year gap for women and 41 percent of the 0.8-year gap for men. It appears that smoking has also caused significant reductions in life expectancy in Denmark and the Netherlands, two other countries with relatively poor life expectancy trends. On the other hand, smoking has also had a major negative effect on life expectancy in Canada, where life expectancy trends have been much more favorable. Thus although smoking clearly helps account for the lagging performance of the United States, it is only one of many factors affecting trends in life expectancy.

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