injuries, discussed above, which together account for a majority of the excess in U.S. male mortality before age 50.


Vital statistics paint a definitive and vivid portrait of the relative position of the United States in cross-national health comparisons. On nearly all indicators of mortality, survival, and life expectancy, the United States ranks at or near the bottom among high-income countries. Its poor performance pertains to both sexes, to all ages below 75, to white non-Hispanics as well as to the population as a whole, and to the most important causes of death.

Although the poor ranking of U.S. life expectancy at birth is partly attributable to relatively higher mortality rates after age 50, that is not the entire story: the United States compares unfavorably on mortality rates up to age 75. U.S. performance is particularly poor from birth to age 50, ranking near the bottom among peer countries. These findings and those from previous research, including the prior National Research Council (2011) report, suggest that throughout the life course people living in the United States fare worse than their peers, except at the oldest ages.

The data reported here highlight specific threats to health early in life, beginning in infancy: the United States has the lowest life expectancy at birth of the 17 peer countries the panel examined. Accidents (unintentional injuries), many of which involve adolescents and young adults, claim about 30 percent of the years lost before age 50, and suicides and violence also contribute to deaths in this age group. Noncommunicable diseases become more of a factor after age 30.

In summary, there is a growing mortality gap between the United States and comparable high-income countries. If the United States experienced the same rates of mortality due to unintentional injuries and noncommunicable diseases as do other peer countries, then almost two-thirds of the excess losses in years of life lost before age 50 would be eliminated (Palloni and Yonker, 2012). To add to the analysis in this chapter, which focuses on life expectancy, the next chapter examines how the United States compares with other countries in terms of quality of life, specifically, health status, the prevalence of disease, and the incidence of injuries.

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