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Comment by whakim | Hacker News Reader

The original article points out that the primary difference between the US and the UK (as well as other peer countries) is that you're much more likely to die young in the US. A 5-year-old in the United States has a 4% chance of dying before age 40, whereas a 5-year-old in Australia, Austria, Canada, England and Wales, France, Germany, the Netherlands, Sweden, or Switzerland has ~1% chance of dying before age 40 (values appear to range from ~0.9% to ~1.25%). This suggests that the US's shorter lifespans aren't primarily caused by poorer healthcare outcomes, but rather social problems like drug overdoses, gun violence, and car accidents.

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As you can see in his chart at [1] from the same thread, drugs, violence, and accidents only explain less than 1/3 of the difference, so the rest would be mainly various disease/lifestyle and care related issues (the overwhelmingly top causes of death in the US [2]). I think those graphs are a easy to misread, the long tail of somewhat poorer results is less dramatic than that younger gap, but actually includes much of the disparity. In [1], you can see that the last cause, cardiovascular, explains more of the difference than drugs, violence, and accidents combined.

[1] https://nitter.moomoo.me/pic/orig/media%2FFsjYUjhWcAEatMo.jp...

[2] "From 2020 to 2021, age-adjusted death rates increased for 8 of the 10 leading causes of death and decreased for 2. The rate increased 3.3% for heart disease (from 168.2 in 2020 to 173.8 in 2021), 1.7% for cancer (144.1 to 146.6), 22.5% for COVID-19 (85.0 to 104.1), 12.3% for unintentional injuries (57.6 to 64.7), 5.9% for stroke (38.8 to 41.1), 2.4% for diabetes (24.8 to 25.4), 9.0% for chronic liver disease and cirrhosis (13.3 to 14.5), and 7.1% for kidney disease (12.7 to 13.6)." https://www.cdc.gov/nchs/products/databriefs/db456.htm

> In [1], you can see that the last cause, cardiovascular, explains more of the difference than drugs, violence, and accidents combined.

This is for overall life expectancy, not 5 to 40 death rates though. I would expect cardio-metabolic disease is a significant driver of "early" deaths (say before 65) in those over 40 in the US compared to other developed countries.

The point is, despite the twitter/article author's (perhaps sensationalist) claims, the numbers don't support the extreme emphasis on the 5-40 age group. The difference in life expectancy, which is what we are talking about, mainly (~2/3) comes from health and healthcare issues, and is in fact spread out throughout Americans' lives, from about 0-79 years of age.

You’d expect correctly; there is non-trivial number of people dying from those diseases between 40 and 65 in the USA, and the number is only increasing.

In the USA and Canada, the probability of death from these diseases is roughly 1 in 3.

As I recall, other developed countries are kind of catching up. Malignant neoplasms and cardiovascular disease are becoming the typical causes of death in the majority of cases in most countries, generally followed by accidental injuries and suicide.

The good news is that if you don’t kill yourself, you exercise, and you eat well, you can likely avoid or significantly delay these events. Accidental injury though, that’s hard to control for.

That's a fair point; I was simply trying to paraphrase the FT article in pointing out the importance of "social factors" (including diet/obesity/etc. leading to cardiovascular disease) in explaining US life expectancy and picked the three examples they used. I hadn't seen the chart you linked.

I still think drugs, guns, and accidents are worth specifically highlighting even if they aren't the single biggest driver of this disparity in life expectancy. I'd wager that most people are aware of America's obesity epidemic, but they might not realize the extent to which these three (big) factors make the US unlike it's peers. I certainly didn't.

They are definitely important issues that I have been aware of for some time, just due to where I have lived over the years. However the author went a bit too far and lost sight of the forest for the trees.

One thing that isn't clear to me (and didn't seem to be addressed in any of the charts) is the percentage of the life expectancy disparity that is explained by the "likelihood of dying before age 40" disparity. To me, this is the key statistic that the author is missing because the original article isn't really about causes - which are only tangentially mentioned.

It doesn't matter that most people die of cancer or heart diseases, as these are old people and these are also prevalent in other countries. When someone dies at 25 from a drug overdose, however, age expectancy is greatly reduced as more expected years are shaved off. The US has WAY more of those than other developed nations.

There is literally a graph I linked, and several other in his twitter thread, that show you are not correct. The difference is caused by deaths in all age groups, throughout every age bracket until about 79. Obviously infant mortality rates in the US, which are higher than elsewhere mainly due to poor prenatal care, have the biggest impact on a per-person basis. But we can see that it does not add up to explaining away 74% of all deaths in the US as insignificant (CDC link indicates top 10 causes make up 75% of all deaths), simply because even though the difference is greater in younger age groups, the absolute number of deaths is still too low to completely change the statistics. It certainly has a measurable impact. About 1/3 of the difference, as I said.

I'm sorry but you are the one who doesn't get it. Your data does not show the most important point which is the difference in deaths in people between 5 and 40 years old. In this age range, we are already past the child mortality issue you mention and we are before the other causes of death that are prevalent later. Also, we for this analysis you have to focus on the major differences across countries, not similarities. It doesn't matter that something is causing most deaths, as long as there is another factor, such as drug overdoses, which explains the differences.

You claim this is the most important point, I am saying it is important, but not the most important point. The charts show the difference already, show that this difference is largely related to medical / health reasons (as I said above, cardiovascular alone accounts for more of the difference than all those reasons combined), and don't support your conclusion.

We are talking past each other. You are claiming that cardiovascular diseases and other factors are more important to the US having a lower life expectancy than all these other countries. But not in the age range that is the main thrust of the thread we are in, 5 to 40 years old. The first graph you posted is a bunch of counterfactuals on the aggregate life expectancy, suggesting that the overall impact of these early deaths are almost as significant as cardiovascular diseases, which is astonishing.

I think you are confused about this because you also brought up child mortality. Yes, child mortality is also much higher in the US than other developed countries. But we knew that. The article is focusing on less discussed yet very impactful factors which disproportionally impact young people in the US.

Even the person who started this HN context has agreed I made a good point about these premature deaths not being primarily (their words) from the age range / causes in question, so I am not sure why we need to continue.

You are trying to make the conversation about something it is not, and have changed their point to my point (from primary to important but not primary) to then say I am being unreasonable because I don't understand their point, which is in fact mine. There is no reason I should accept to be shut into your box. Read the twitter thread, and this comment thread again, and it is clear you are the one trying to force the conversation to be about one very specific thing while refusing that it is legitimate to place it into a larger context - the overall causes of lower US life expectancy.

The only reason I care is I don't want a bunch of people running around with the false idea in their head that we just need to deal with the important social issues of our younger generations, and we have solved the bulk of the problem. They are certainly important, even critical issues, but that is not true.

How am I supposed to read your first image? It appears to me that heart related issues, all else constant, have less an effect (2.2 for men) than all the other issues mentioned (2.3-3.3).

When removed, it reduces the actual 3.6 difference to 2.2, the greatest reduction. Lower numbers are indicate bigger effects in those charts.

Woah!

Deaths by billion vehicle miles in UK - 5.2. In US - 12.5. (both have tens of thousands of KSI, but the US has over twice as many per cap. In fact, way, more KSI from car accidents than even gun related homicide in the US. I hadn't realized that!)

Deaths by gun related homicide in UK - 200. In US - 20000. (Both numbers pale in comparison to motor vehicle deaths, but there are a lot more in the US. Probably to be expected as there is stringent firearm control in the UK.)

Deaths by drug overdose and poisoning in UK - ~5000. In US - um, yeah, well over 120000 if you count the poisonings too as the UK does. (I'll just say, I think we found one of our major culprits in this one.)

I'm thinking overdoses is a major contributor. It's the only way to get to millions in less than 10 years. Car accidents, maybe, but honestly it's not that much compared to the number of young people who die every year. Ditto, with gun related homicide, which is even less than car accidents.

I know we may not want to talk about it, but I also noticed major numbers in suicides among young people. (More than vehicle accidents and gun related homicides combined in 2021.) Not sure if that's where the parent comment was going though? So I left that out. It could be a contributor though? The numbers are there, which is what you need to impact averages.

My takeaway? Suicides and drug overdoses. Not to be taken lightly.

Youth suicide has always been pretty bad in the US and it's getting worse https://www.pbs.org/newshour/health/youth-suicide-rates-are-...

That's from 2019, numbers for the last 3 years are a little harder get but like attempts went up but deaths went down at least in most places but in a couple places deaths shot up a lot?

https://www.nichd.nih.gov/newsroom/news/042722-COVID-adolesc...

https://www.nbcnews.com/news/us-news/youth-suicide-attempts-...

I was floored when I met some students from NYU who explained they've installed nets in the library because there have been so many suicides from people jumping.

Yikes.

Not exactly how I remember it.. but yeah. https://www.huffpost.com/entry/nyu-bobst-library-suicides-al...

NYU is also more vertical than most universities in the US. How many university buildings in the US are 12 floors or higher?

I don't care if the building 100 floors - the problem is not the height of the building. The problem is that young people in the US who are clearly privileged enough to attend a very prestigious university are driven to suicide.

Tall structures everywhere are suicide magnets because they are fairly accessible and the means of death is easy and (seems) fairly certain. It’s why you can’t build a large bridge with a pedestrian walkway without some kind of safety netting, and that’s globally.

Countries by suicides per 100,000 population:

US: 14.5 UK: 6.9 Germany: 8.3

The problem IS NOT tall structures. The problem is something about US society.

https://en.wikipedia.org/wiki/List_of_countries_by_suicide_r...

> the problem is not tall structures

https://www.skyscrapercenter.com/countries

The data shows that the USA has way more tall buildings than most of Europe, by more than an order of magnitude.

Disclaimer: I don’t agree they’re a leading cause, rather an accessory to a suicide premeditated by various health/societal factors.

I remember when the exact same thing was used to berate Apple for working with Foxconn.

Looking at the date of the article, they were almost contemporary.

Youth suicide in the US has been in the press a lot lately but it's not really one of those things that's really bad or getting worse. It's less frequent than it was years ago, and less frequent than in many OECD countries. That sets it apart from the overall picture which shows the US to be worse than all other advanced countries and rapidly getting worse.

For anyone else not hip with the lingo, KSI seemingly refers to 'Killed or Serious Injury'

> I hadn't realized that!

That's because the media only reports on unusual deaths.

For example, sometimes I'll see the emergency crews pulling a body out of Lake Washington. It never makes the news. Drowning deaths are too common.

Many drownings could have been prevented but it's still a relatively niche cause of death. Unintentional drowning is ten times less frequent than either of falling or motor vehicle crashes, which are about the same frequency. The main way that drownings could be prevented among adults is by enforcing alcohol rules, or having some in the first place, but that goes against the entire theme of American water recreation. Which is sort of the point of the article: dying unnecessarily is part of the culture of America.

> Many drownings could have been prevented but it's still a relatively niche cause of death.

I read somewhere that drownings were the 2nd leading cause of death for children. Cars were #1.

People drown mainly because they underestimate the risk of it.

I know parents who had their toddler drown. The grief and devastation of that never stops, decade after decade. They had camped near a river bank, and the kid wandered off into the water.

In the youngest age group, drowning beats cars even. https://wisqars.cdc.gov/data/lcd/drill-down?causeLabel=Unint...

Basically the #1 causes of unintentional death in age order are drowning (<5), cars (5-20) then drugs (20+).

> Deaths by billion vehicle miles in UK

UK driving test is difficult, and I suspect drunk driving is much lower because distances are lesser and public transport is better.

> suicides

Much easier when you have a gun around

And DUI is treated much more seriously in the UK, consequences are stricter (for example, no "oh you need a car to get to work so you can carry on driving but only too and from work" loophole) and there is greater social opprobrium to drink driving.

Yes, it's fairly common to go to prison for drink-driving here.

The problem with drug overdoses can be directly tied to the War on Drugs. The entire campaign criminalized addiction vs focusing on rehabilitation, it removed outlets from relief in many states and it has only made illicit drug quality significantly worse (versus removing access to them).

This is one of those metrics that really makes US federalism apparent and shows the drastic difference in outcomes from the two major parties. By reviewing the per state metrics[1], you can see that states that take a much lighter hand to drug criminalization and that offer state sponsored relief (California, for instance) have a much lower death rate to ones that take a heavy hand (southern states, New Mexico, etc).

1 - https://www.cdc.gov/nchs/pressroom/sosmap/drug_poisoning_mor...

Your map tells no such story. In particular, California's low rate cannot be attributed to California's policies, as California's rate is matched by Utah, Idaho, Texas, Mississippi, Alabama, etc.

You say Southern States have a higher death rate, yet Mississippi (typically considered archetypical of the deep south) a lower per-capita drug overdose rate.

Texas, which is a state dominated by the party that does not rule California has an overdose rate about 75% that of California.

There's a lot more going on than your analysis would suggest.

Your drug and gun deaths are totals right? That makes the US look worse than it really is due to the large population difference. If that’s the case then you can divide the US number by about 5 to make it actually comparable (and still terrible).

The road deaths surprise me the most , as most American roads are big and straight and most British roads are small and squiggly!

I can guess a few reasons:

* Cars tend to be bigger i.e. more dangerous in the US

* Drink driving seems to be more acceptable in the USA.

* The driving test in the UK is much tougher than even the toughest us state

* Most of the US don't have mandatory annual vehicle inspections to check they're safe and roadworthy

Big and straight allows higher speeds and less need to pay attention. Lane width is a major contributor to the actual speed driven.

It's counterintuitive, but broad and straight roads are often more dangerous, as they invite faster driving.

Faster *inattentive* driving.

I'm always kind of surprised how terrified Americans visiting the UK are, when they see the kind of speeds people drive at here.

If you're coming here on holiday from the US and you're planning your route using Google Maps, double the time estimate. You won't like the speeds it expects you to drive at.

> roads are big and straight

To accommodate big cars.

Re: Vehicle miles. In the UK a license proves you are competent to drive. In the US a license proves you are not incompetent. The US driving test is set so that over 90% pass, deliberately. Because driving is seen as necessary.

Has that changed? Is the UK license standard as high as it once was?

> In fact, way, more KSI from car accidents than even gun related homicide in the US. I hadn't realized that!

Guns get an outsized portion of air time on most media. Especially crimes committed by legal weapons against white people. If all gun crimes were covered equally you would hears a lot more about gang violence and illegal weapons.

> Deaths by gun related homicide in UK - 200. In US - 20000. (Both numbers pale in comparison to motor vehicle deaths, but there are a lot more in the US. Probably to be expected as there is stringent firearm control in the UK.)

I'd be curious to see the difference between gun homicides and homicides. The UK has a huge knife crime problem.

> I'm thinking overdoses is a major contributor. It's the only way to get to millions in less than 10 years. Car accidents, maybe, but honestly it's not that much compared to the number of young people who die every year. Ditto, with gun related homicide, which is even less than car accidents.

Overdoses and drug related deaths. Drug addiction will shorten a person's lifespan by decades.

Yes, there has been a huge increase in the number of accidental fentanyl poisonings. I think this is now the leading cause of accidental death among young people, surpassing even vehicle crashes. Mexican drug cartels have been manufacturing counterfeit prescription painkillers and replacing active ingredients with fentanyl. They have bad quality control and sometimes just put in too much. Fentanyl is so potent that there is only a tiny difference between a recreational dose and a lethal dose, even for opioid addicts who have built up a tolerance.

https://peterattiamd.com/anthonyhipolito/

That's why punishing Big Pharma for making opioid pills has the perverse effect of causing more opioid deaths due to no quality control on the illegal versions.

I mean one could use the money from settlements to you know .... Help?

> but rather social problems like drug overdoses, gun violence, and car accidents.

I think you could make a reasonable argument that much of these actually are healthcare problems. But either way, investment in looking after people is the solution, what that looks like is probably more controversial.

I don't think you have enough information to say this?

Certainly that Americans die young, but that could be because American healthcare does worse for people between 5 and 40.

Eg. You'd prefer to be in a car crash in Canada, because it's more likely that the healthcare will take better care of you

I'm not a doctor so I don't know the answer but could poorer lifestyle choices in mothers/to-be cause an increase in infant mortality?

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