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BLOG: June 2010

U.S. premature adult deaths: falling behind

If you were 15, it would be kind of interesting to know what are your chances to be alive in 45 years (aged 60). Well, you have about as good answer to that question as you could hope for. And not only for the U.S. but pretty much for the whole world. So we can see where do we stand.

Back in May, results of a study funded by Bill & Melinda Gates Foundation were published in the Lancet (Worldwide mortality in men and women aged 15—59 years from 1970 to 2010: a systematic analysis, Rajaratnam J K et al). It presented 15-59y mortality figures for 187 world countries, beginning with 1970. Since dying before age 60, according to study authors, can be considered premature by any standard, with mortality in this particular age span affecting the backbone of any society, the importance of assessing its trends and figures is rather obvious.

The last four decades have seen a positive global trend: premature adult deaths declined by 34 and 19% for women and men, respectively. But two regions witnessed dramatic rise in early mortality: sub-Saharan Africa, mainly due to devastating AIDS epidemics had premature adult death in same areas (southern part, women) nearly tripled since 1988, and eastern Europe had the rates for man up nearly 50% since the late 1980s (political and economic collapse).

Most of the countries with higher premature adult death rates for both, men and women, are in the central and Southern Africa, and eastern Europe.

Unexpectedly, quite a bit of disturbance have taken place among 10 best ranked countries. Only two countries that were making top 10 for male populations in 1970 managed to be there in 2010. The top ten for female populations was much more stable: as many as seven countries was among top 10 in both, 1970 and 2010.

Table below summarizes changes in the rank for the 10 top countries in 1970, as well as for those that are making the top 10 in 2010.








1. Andorra (16)

1. Greece (22)

1. Cyprus (10)

1. Iceland (17)

2. Norway (18)

2. Sweden  (2)

2. South Korea (123)

2. Sweden (2)

3. Greece (4)

3. Cuba (36)

3. Japan (16)

3. Malta (26)

4. Sweden (9)

4. Andorra (20)

4. Greece (3)

4. Netherlands (8)

5. Netherlands (26)

5. Paraguay (70)

5. Italy (9)

5. Switzerland (13)

6. Switzerland (7)

6. Cyprus (14)

6. Spain (7)

6. Australia (44)

7. Spain (6)

7. Norway (7)

7. Switzerland (6)

7. Norway (7)

8. Iceland (10)

8. Netherlands (4)

8. Australia (36)

8. Italy (21)

9. Italy (5)

9. Denmark (28)

9. Sweden (4)

9. Qatar (29)

10. Cyprus (1)

10. Costa Rica (30)

10. Iceland (8)

10. Israel (11)

[1] In brackets: 2010 rank              [2] In brackets: 1970 rank

In four decades, the countries with the largest drop in ranking were Netherlands (5 to 26) and Paraguay (5 to 70) for female and male populations, respectively. In contrast, countries that made largest advance were South Korea for females (123 to 2) and Australia for males (44 to 6).

The researchers are not sure what caused some countries to greatly improve their rankings; not even for South Korea's females unbelievable raise through the ranks.

A for the U.S., there was no dramatic changes, and the overall trend is still positive, but its less than stellar ranking went further down. For females, it went from 34 in 1970 to 49 in 2010, and for males from 41 to 45. It is particularly the trend for female premature adult mortality that becomes worrisome. Plot below shows it with respect to male U.S. trend, as well as for male and female trends for Canada and globally.

While 1970-2010 decline in premature adult deaths globally was faster for female than for male populations (34 vs. 19%, or whooping 79% faster decline rate), in the U.S. it is male population that did better: with 39 vs. 43%, the U.S. female rate decline is lagging 9% behind (the trend lines for U.S. and Canada are drawn based on three data points, for 1970, 1990 and 2010, supplied in the report).

For comparison, Canadian women, with 48% early mortality drop, are also lagging behind Canadian men, but are doing better than either U.S. men or women. If these trends continue, within the next decade Canadian men

will have lower early mortality rate than U.S. women -

an alarming prospect considering that the two countries are fairly similar in their socio-economic structure and status.

Of course, the U.S. women are still doing great when looking at a 15-year old girl in Zambia or Swaziland, who faces

60% (0.60) probability not to be alive by 60.

But their 7.7% probability of dying before 60th birthday is by all measures should be compared to those in Canada (5.2%), UK (5.8%), Australia (4.4%) or western Europe, where most countries are in 4-5% range - some with nearly half the risk of dying for U.S. women.