Multi-Morbidity at Death and the Us Disadvantage in Life Expectancy

Magali Barbieri , Institut National d'Études Démographiques (INED)
Aline Désesquelles, Institut National d'Études Démographiques (INED)
Viviana Egidi, Sapienza Università di Roma
Luisa Frova, Istituto Nazionale di Statistica (ISTAT)
Francesco Grippo, ISTAT
France Meslé, Institut National d'Études Démographiques (INED)
Marilena Pappagallo, Istituto Nazionale di Statistica (ISTAT)
Sergi Trias-Llimós, Centre d'Estudis Demogràfics

The US experiences a significant shortfall in life expectancy compared to peer countries. The literature indicates that a similar disadvantage affects morbidity and, more generally, the prevalence of risk factors for major diseases within the US population. In this study, we assess the impact of multi-morbidity at death on the life expectancy gap between the US and three other high-income countries with comparable data, namely France, Italy and Spain. The study relies on an analysis of the multiple cause-of-death information available on all death certificates for a single year (2017), used to classify morbid processes leading to death into three categories: simple, multi-morbid, and ill-defined. The results show disproportionately high rates of multi-morbid processes among working age adults in the US compared with the other three countries, particularly among men for whom these rates are up to 5 times higher around ages 25-30 years compared with France and Italy, and nearly 25 times higher compared to Spain. Multi-morbid processes contribute 43% of the US gap in life expectancy at birth with Italy, 57% with France, and 64% with Spain. The prevalence of multi-morbid processes in the US indicates that structural factors are most likely at play in this disadvantage in mortality and no magic bullet will easily enable the country to catch up to its peers. The study further demonstrates the value of studying the prevalence of multi-morbidity at the time of death as a complement to the analysis of multi-morbidity within the living population, especially for international comparisons.

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 Presented in Session 51. Flash session Causes of Death and Multi-morbidity at Death