U.S. Mortality in an International Context: Age Variations

Jessica Y. Ho, University of Pennsylvania
Sam Preston, University of Pennsylvania

Compared to other developed countries, the US ranks poorly in terms of life expectancy at age 50. We seek to shed light on the US’s low life expectancy ranking by comparing the age-specific death rates of 18 developed countries at older ages. A striking pattern emerges: between ages 40 and 75, US all-cause mortality rates are among the poorest in the set of comparison countries. The US position improves dramatically after age 75. We consider four possible explanations: (1) international differences in patterns of smoking; (2) selection processes; (3) health insurance; and (4) age patterns of health care system performance. We find that smoking and health insurance are not plausible sources of this age pattern. While we cannot rule out selection entirely, we present suggestive evidence that the US health care system's unusually vigorous deployment of life-saving technologies at very old ages contributes to the age-pattern of US mortality rankings.