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Major Causes of Injury Death and the Life Expectancy Gap Between the United States and Other High-Income Countries

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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,1 when mortality is dominated by injury deaths, and many decades of expected life are lost. This study estimated the contribution of 3 causes of injury death to the gap in life expectancy at birth between the United States and 12 comparable countries in 2012. We focused on motor vehicle traffic (MVT) crashes, firearm-related injuries, and drug poisonings, the 3 largest causes of US injury death responsible for more than 100 000 deaths per year.2

Andrew Fenelon, PhD1; Li-Hui Chen, PhD1; Susan P. Baker, MPH2

Using data from the US National Vital Statistics System2 and the World Health Organization Mortality Database,3 we 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. We used death rates to calculate life expectancy at birth for the United States and the comparison countries. We calculated the difference in life expectancy using death rates observed and after removing deaths from the 3 causes of injury.1The International Classification of Diseases, Tenth Revision, codes were used to capture the 3 injury causes, which included intentional and unintentional deaths and drug poisonings from illicit and nonillicit drugs. We used Stata (StataCorp), version 13.1, for all analyses.

In 2012, the all-cause, age-adjusted death rate per 100 000 population was 865.1 among US men vs 772.0 among men in the comparison countries (Table 1), and 624.7 among US women and 494.3 among women in the comparison countries. Men in the comparison countries had a life expectancy advantage of 2.2 years over US 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% (1.02 years) of the life expectancy gap among men. Firearm-related injuries accounted for 21% of the gap, drug poisonings 14%, and MVT crashes 13%. Among women, these causes accounted for 19% (0.42 years) of the gap, with 4% from firearm-related injuries, 9% from drug poisonings, and 6% from MVT crashes. The 3 injury causes accounted for 6% of deaths among US men and 3% among US women.

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