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Comment by atleastoptimal | Hacker News Reader

What precisely is causing Americans to die so much earlier than Europeans? I know obesity, healthcare access and gun violence play a factor, but is there anything else?

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Americans live on average 2 years less than Europeans. [1]

37% of US adults and 16% of EU adults are obese (2014). [2]

Even moderate obesity reduces life expectancy by 3 years. Severe obesity is 10 years. [3]

Factor in the not-obsese-but-overweight, and you explain basically the entire difference.

[1] https://www.cnn.com/2016/02/09/health/american-life-expectan...

[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7670332/

[3] https://www.ox.ac.uk/news/2009-03-18-moderate-obesity-takes-...

More recent stats

US [1]

Percent of adults aged 20 and over with obesity: 41.9% (2017-March 2020) Percent of adults aged 20 and over with overweight, including obesity: 73.6%

EU [2] [3]

Obese: 16% Percent of adults aged 18 and over with overweight, including obesity: 52.7%

[1] https://www.cdc.gov/nchs/fastats/obesity-overweight.htm [2] https://ec.europa.eu/eurostat/statistics-explained/index.php... [3] https://ec.europa.eu/eurostat/databrowser/view/hlth_ehis_bm1...

It doesn't help that virtually all foods in the US have added sugar. If some day I read about vegetables and livestock being genetically engineered to increase sugar content as well, I would be completely unsurprised.

You should compare with similar economies, so Germany and Spain (France has less industry so the almost 80 yo life expectancy for men is 'easier').

It's the first two - 0.01% of us die to guns, which isn't nothing - but not enough to move averages significantly. Maybe also cars? I assume Americans drive more than most other countries.

Well, maybe like 1% of deaths if you include suicides as "gun violence" (kinda weird, but is often stated), maybe 2% if you focus on only men.

But yea, it's a literal nonfactor in aggregate life expectancy. Amdahl's law applies here too.

According to [1], "homicide, suicide and gun deaths" is the 2nd highest factor in explaining the difference.

[1] https://twitter.com/jburnmurdoch/status/1641799922583326720/...

I can't read the underlying article, but that graph a minimum is not saying "2nd highest factor". It notes both drugs (lowers gap to 2.9) and metabolic diseases (lowers gap to 2.2) as both more of a factor than suicide & homicide (only lowers gap to 3.2).

Which tracks, given that suicide is like 50k per year, homicide is 20k per year (unstated: "gun deaths" that aren't homicide or suicide are orders of magnitude lower), drug deaths are over 100k per year, and metabolic diseases dwarf all of the above.

So, no, what you wrote is wrong.

Oh I've read it the wrong way around! Yes you are correct!

Also it's unclear if there are other factors worth tracking, since the graph only lists a few.

Heart disease, cancer, stroke, respiratory disease (not including covid), accidents (which I suppose includes drug OD), Alzheimer's, and diabetes all have higher death rates that the combination of all suicide+homicide (which again, is sort of strange to join together). The first two alone are 600k+ each.

A bunch of those affect primarily the elderly though, so won't hit the average life expectancy as hard.

If you track homicide separately, it's not even in the top 20 of causes of death. Suicide is not in the top 10.

That’s per annum. The rate decreases by age, but over a lifetime the cumulative odds start to add up to a more significant number.

Also, by killing men in their twenties it affects the average more than something like heart disease that usually kills men over 50.

> it affects the average more than something like heart disease that usually kills men over 50.

If you look at the linked Twitter thing in the other comment chain here, you will note that this is not true.

The numbers are just very different - heart disease (~600k) is like 40x more than all homicide (~15k, varies by year). Even if heart disease only kills people the year or two before they would otherwise die in their 70s (which is not true, it kills a lot of 50-yr-olds too), it would affect the average less than homicide.

This thread (and the accompanying article) are very informative (and damning):

https://twitter.com/jburnmurdoch/status/1641799627128143873?...

Drugs and road accidents are other disproportionate contributors to the US's awful life expectancy.

At the risk of being a wiseass, at least some of this is Americans taking Ben Franklin's aphorism about liberty and safety far too seriously. Sometimes, trading some liberty for safety is entirely sensible.

For those who haven't looked, this analysis is very useful.

Almost all the gap is caused by the higher rate of deaths of under 25yos in the US.

From [1] the largest differences appears to be:

1) Road deaths

2) Homicide, suicide and gun deaths

3) Drug related deaths.

[1] https://twitter.com/jburnmurdoch/status/1641799922583326720/...

Actually I've read this the wrong way around. The biggest difference is actually cardio-matabolic diseases!

"For Americans age 18-45, the leading cause of death is fentanyl overdose."

https://www.getsmartaboutdrugs.gov/media/dea-administrator-r...

That is a sad situation, but giving up more liberty won't save those people. Freedom is more important than safety and I have no interest in living under an authoritarian police state.

Agreed on fentanyl, but there are other areas where nanny-stating saves lives.

The evidence on higher tobacco and alcohol taxes, for instance, is pretty irrefutable.

Or, moving up the implausibility scale in the American context, drastic reductions in the availability of handguns including the mass forfeiture of existing weapons (which has been done in a number of other developed countries).

You may not like any of these, particularly the last, but the fact is that they would increase life expectancy significantly.

It's always interesting to me when people bring up Franklin in this context because the aphorism is usually completely misunderstood.

The audience and context was the colony of Pennsylvania deciding to accept an offer from the Penn family to provide a one-off detachment of mercenaries to patrol the colony's western border in exchange for a perpetual ban on taxing the Penn landholdings.

The safety was border defense. The liberty was the colonial government's authority to pass law. In context, Franklin is saying "The government that cedes its taxation authority over the citizens for a temporary boon from its richest citizens deserves neither the boon nor the authority."

Thank you, that is fascinating!

Despair.

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

https://jamanetwork.com/journals/jamapsychiatry/fullarticle/...

The "deaths of despair" narrative has been found really wanting: https://www.slowboring.com/p/the-deaths-of-despair-narrative... and it's probably time to throw it out entirely. The tl;dr is that most of the effect disappears when you use age-adjusted death rates instead of arbitrary buckets (whose average age goes up over time) and adjust for things like obesity, gun violence, and car accidents.

Well 20 years ago the US drinking culture and driving culture made car accidents a main driver especially in distorting the lower age demograpics. But in the past few years opiods is basically the top cause of death of adults before 45 which then is mostly heart disease. So the recent drop is almost entirely opiods. https://www.reddit.com/r/Damnthatsinteresting/comments/16umz...

Car culture is a big one. No pedestrian collision safety regulation at all, extremely low driving standards (and pervasive illegal driving without a license even so), and long car commutes as standard.

If you want actual analysis of this, I'd suggest:

- https://www.slowboring.com/p/tackling-americas-weirdly-short...

- https://www.noahpinion.blog/p/americans-are-coping-ourselves...

> Tackling America's weirdly short life expectancy

Shows US higher than Poland.

Okay.

I don't understand your complaint, isn't that accurate?

> Indeed, life expectancy in the United States is so bad that the relevant comparison class is a set of much poorer countries like Chile and Poland — countries that are richer than the world average but aren’t even close to the top.

Fentanyl, a male suicide crisis and a strong cultural taboo around male mental health, bad responses to COVID-19, poor medical system, and social attitudes strongly attack tackling health care issues for men as somehow oppressive to women. (Compare and contrast funding for prostate cancer and breast cancer in the USA).

Add in drug abuse, those are pretty huge (though gun violence isn't a real influencer here, just doesn't put up the numbers heart disease does).

Gun violence is a major influencer of life expectancy in America. The average American would live a couple of years longer without gun deaths (including suicide and accidents).

https://time.com/5471069/guns-life-expectancy/

The reason that it has such an outsized effect is because it tends to happen early in life.

Oh right, suicide. But wouldn't at least a portion of those suicides still be suicides without guns?

Not successful ones. The issue with not having an available loaded gun is that you have to plan your death.

Obtaining a gun is planning in the exact same way walking to the top of a roof or grabbing a fist full of pills is planning.

Raking a fistful of pill fail often, with little consequences (unlike a bullet, who might fail but consequences are painful).

Jumping is rare, the only case I know of was someone with bone cancer who suffered a lot (I'm kinda remember her but I was very young when she died). Bullets are a common way to go for people with hunting background. There is a reason why 'revolving credits' were called 'revolver credits' in my area before they were basically outlawed (I'm from the countryside).

People do kill themselves with guns, nobody was debating that...

https://www.stlouisfed.org/on-the-economy/2022/january/evolu...

Preventative health care on average.

Europe might not be always great, but at least people aren't afraid to go to doctor early before things become too major.

And it can really add years to life for lot of people.

Suicide and overdoses

All work and no fun

Drug abuse.

Covid.

Drug overdoses.

Vacation time.

Lest someone assume the parent is a snide comment, Europeans tend to have significantly longer vacations.

Plastics.

Trash food

Stress

Fear

Black and Native American life expectancy drag it down a fair bit. A median European dropped in US only loses a few years. In fact this goes for lots of stuff; drop someone from Norway in America and their chance of dying by gun doesn't change much either.

On the other side, Japanese-Americans are basically the longest lived people on the planet. Medical outcomes are generally excellent in the US, so when they intersect with healthy, safe lifestyles the results are good. Poor and dangerous lifestyles do a lot of heavy lifting in the US when it comes to life expectancy.

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