Australia leads life expectancy among English-speaking nations

An analysis of international lifespan data published in the open access journal BMJ opened finds Australians outlive their peers in five high-income English-speaking countries, including the UK and US, by 1 to 4 years.

Most of this benefit occurs between the ages of 45 and 84, with death rates from drug and alcohol abuse, screenable/treatable cancers and cardiovascular and respiratory diseases all lower, the analysis shows .

Although high-income countries have achieved good increases in life expectancy in the 20th century, the researchers note that trends in the 21st century have been much less favorable, even before the COVID-19 pandemic.

Study: Life expectancy and geographic variation in mortality: an observational comparative study of six high-income English-speaking countries. Image credits: CandyRetriever / Shutterstock

The stagnant decline in deaths from cardiovascular disease, along with rising numbers of deaths from drug overdoses, mental illness and neurological disorders, are major contributing factors, they explain. And the significant differences in life expectancy between the richest and the poorest, evident in most of these countries, have widened further in recent decades.

Although high-income English-speaking countries have much in common, they also have notable differences, including inequality in their health care and social security systems, racial and ethnic composition, and immigration history.

So the researchers wanted to know if there were differences in longevity between Australia, Canada, Ireland, New Zealand, the United Kingdom and the United States, which represent some of the richest economies in the world.

They obtained national life tables from the Human Mortality Database (HMD) for men and women in these countries plus, just for context: Austria, Belgium, Denmark, Finland, France, Germany, Italy, Japan, Netherlands, Norway, Portugal, Spain , Sweden and Switzerland between 1990 and 2019.

The World Health Organization’s Mortality Database for all six English-speaking countries provided detailed information on deaths by sex, age and cause of death.

Data analysis shows that Australia has been the best performer in life expectancy at birth since the early 1990s, leading by 1.26 to 3.95 years for women and by 0.97 to 4.88 years for men in 2018.

Specifically, Australia has a 4 to 5 year life expectancy advantage over the US and a 1 to 2.5 year advantage over Canada, New Zealand, Ireland and the United Kingdom.

Canada had the second highest life expectancy for most of the period between 1990 and 2019. Recently, Ireland and New Zealand have equaled Canada.

However, the US has been the worst performer every year since 2001. In the most recent decade, Britain had the second lowest life expectancy overall.

Similar trends are observed for life expectancy at age 65, with Australia generally performing the best and the US the worst, while US life expectancy at age 65 has recently emerged.

The differences in life expectancy at birth between the best and worst performers widened over time. In 1990, Canadian men and women had the highest life expectancies (74 and 80, respectively), while American men and Irish women had the lowest (71 and 77, respectively).

The corresponding differences were 2.38 and 2.91 years. By 2019, these differences between Australia and the US had doubled to 4.75 years for men and increased by 30% for women to 3.80 years.

While women in English-speaking countries were never among the top performers in female life expectancy across all 20 high-income countries between 1990 and 2019, men – with the exception of the US – have generally been in the top half over the past decade.

Of all these countries, Australian men ranked in the top 4 in all but one year between 1990 and 2019. However, American men have the lowest life expectancy since 2005.

The 65 to 84 age group typically contributes the largest percentage of the life expectancy gaps between Australia and the other five English-speaking high-income countries, ranging from 39% in the US to 78% in Ireland among women and from 30% in the US up to 100% in Ireland among men.

Although Australians have lower mortality rates at almost all ages, most of their life expectancy occurs between the ages of 45 and 84.

Ischemic heart disease, other circulatory diseases, cancer, respiratory diseases, mental illness and neurological diseases, especially Alzheimer’s disease and related dementias, contribute significantly to the differences in life expectancy in this age group.

But Australia also tends to have a lower mortality rate from external causes including drugs and alcohol, screenable/treatable cancers, cardiovascular disease and influenza/pneumonia.

In terms of life expectancy within countries, Canada and the US perform the worst, with 13 US states in the lowest category for men and women. On the other hand, all regions in Great Britain and Ireland have a life expectancy of over 81 years for women and 76.5 years for men.

For both men and women, Australia has the lowest inequality within the country, especially among people over 40, followed by Canada. Among women, inequality tends to be greatest in New Zealand, Ireland and the US; among men it is highest in New Zealand, Britain and the US.

The researchers acknowledge that they could not account for differences within local neighborhoods and that there may be differences in the coding of cause of death, especially in old age where different conditions can coexist.

They suggest several possible explanations for Australia’s top position, including the high percentage of people born abroad: almost 30% in 2018.

Low smoking prevalence could be another example. At the same time, public health initiatives around gun control and mental health care and its highly regarded healthcare system could also explain Australia’s position at the top of the life expectancy rankings.

“Australia is performing well but still has room for improvement, especially in reducing inequality among Indigenous people,” and in obesity rates, the researchers say. However, they conclude: “Overall, Australia offers a potential model that underperforming English-speaking countries, such as the US and Britain, can follow to reduce both premature mortality and inequality in life expectancy.”