Americans spend more years being unhealthy than people in any other country

The gap of time between how long Americans live and how much of that time is spent in good health only grew wider in the last two decades, according to a new study published in JAMA Network Open.

The study, which looked at global health data between 2000 and 2019—prior to the COVID-19 pandemic—found the US stood out for its years of suffering. By 2019, Americans had a gap between their lifespan and their healthspan of 12.4 years, the largest gap of any of the 183 countries included in the study. The second largest gap was Australia's, at 12.1 years, followed by New Zealand at 11.8 years and the UK at 11.3 years.

America also stood out for having the largest burden of noncommunicable diseases in the world, as calculated by the years lived with disease or disability per 100,000 people.

The news is perhaps not shocking given the relatively poor quality of health care in the US. An analysis published in January by the Commonwealth Fund found that, compared to other high-income countries, the US has the highest rate of adults with multiple chronic conditions, and the highest rate of obesity. Among just those high-income countries, the US also has the shortest life expectancy at birth, the highest rate of avoidable deaths, the highest rate of newborn deaths, and the highest rate of maternal deaths. That’s all despite the fact that the US spends far more on health care than any other high-income country.

For the new study, researchers at the Mayo Clinic analyzed health statistics collected by the World Health Organization. The resource included data from 183 countries, allowing the researchers to compare countries' life expectancy and healthspans, which are calculated by years of life weighted by health status.

Longer, but not better

Overall, the researchers saw lifespan-healthspan gaps grow around the world, with the average gap rising from 8.5 years in 2000 to 9.6 years in 2019. Global life expectancy rose 6.5 years, to about 73 years, while healthspans only rose 5.4 years in that time, to around 63 years.

But the US was a notable outlier, with its gap growing from 10.9 years to 12.4 years, a 29 percent higher gap than the global mean.

The gap was most notable for women—a trend seen around the world. Between 2000 and 2019, US women saw their life expectancy rise 1.5 years, from 79.2 to 80.7 years, but they saw no change in their healthspans. Women's lifespan-healthspan gap rose from 12.2 years to 13.7 years. For US men, life expectancy rose 2.2 years, from 74.1 to 76.3 years, and their healthspans also increased 0.6 years. Their lifespan-healthspan gap in 2019 was 11.1 years, 2.6 years shorter than women's.

The conditions most responsible for US disease burden included mental and substance use disorders, plus musculoskeletal diseases. For women, the biggest contributors were musculoskeletal, genitourinary, and neurological diseases.

While the US presented the most extreme example, the researchers note that the global trends seem to present a "disease paradox whereby reduced acute mortality exposes survivors to an increased burden of chronic disease."