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Injury deaths and life-expectancy gap between US and other high-income countries

The JAMA Network Journals

Andrew Fenelon, Ph.D., of the National Center for Health Statistics, Hyattsville, Md., and colleagues estimated the contribution of 3 causes of injury death to the gap in life expectancy between the United States and 12 comparable countries in 2012. The researchers focused on motor vehicle traffic (MVT) crashes, firearm-related injuries, and drug poisonings, the 3 largest causes of U.S. injury death, responsible for more than 100,000 deaths per year. The study appears in the February 9 issue of JAMA.

The United States experiences lower life expectancy at birth than many other high-income countries. Although research has focused on mortality of the population older than 50 years, much of this life expectancy gap reflects mortality at younger ages, when mortality is dominated by injury deaths, and many decades of expected life are lost. For this study, the researchers used data from the U.S. National Vital Statistics System and the World Health Organization Mortality Database and calculated death rates by age, sex, and cause for the United States and 12 high-income countries that had similar levels of development and quality of vital registration: Austria, Denmark, Finland, Germany, Italy, Japan, the Netherlands, Norway, Portugal, Spain, Sweden, and the United Kingdom.

The researchers found that men in the comparison countries had a life expectancy advantage of 2.2 years over U.S. men (78.6 years vs 76.4 years), as did women (83.4 years vs 81.2 years). The injury causes of death accounted for 48 percent (1.02 years) of the life expectancy gap among men. Firearm-related injuries accounted for 21 percent of the gap, drug poisonings 14 percent, and MVT crashes 13 percent. Among women, these causes accounted for 19 percent (0.42 years) of the gap, with 4 percent from firearm-related injuries, 9 percent from drug poisonings, and 6 percent from MVT crashes. The 3 injury causes accounted for 6 percent of deaths among U.S. men and 3 percent among U.S. women. The U.S. death rates from injuries exceeded those in each comparison country.

"Although the reasons for the gap in life expectancy at birth between the United States and comparable countries are complex, a substantial portion of this gap reflects just 3 causes of injury," the authors write.


(doi:10.1001/jama.2015.15564; Available pre-embargo to the media at

Editor's Note: This study was supported by the U.S. Centers for Disease Control and Prevention. All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.

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