Faltering mortality improvements at young-middle ages in high-income English-speaking countries

Background Before the COVID-19 pandemic, stagnating life expectancy trends were reported in some high-income countries (HICs). Despite previous evidence from country-specific studies, there is a lack of comparative research that provides a broader perspective and challenges existing assumptions. This study aims to examine longevity trends and patterns in six English-speaking countries (Australia, Canada, Ireland, New Zealand, UK, USA) by combining period and cohort perspectives and to compare them with other HICs. Methods Using data from the Human Mortality and WHO Mortality Databases, we estimated partial life expectancy, lifespan inequality and cohort survival differences for 1970-2021, as well as the contribution of causes of death to the gap in life expectancy between English-speaking countries and the average for other HICs in 2017-19. Results In the pre-pandemic period, the increase in life expectancy slowed in all English-speaking countries, except Ireland, mainly due to stagnating or rising mortality at young-middle ages. Relative to other HICs, those born in Anglophone countries since the 1970s experienced relative survival disadvantage, largely attributable to injuries (mainly suicides) and substance-related mortality (mainly poisonings). In contrast, older cohorts enjoyed advantages for females in Australia and Canada and for males in all English-speaking countries except the USA. Conclusions Although future gains in life expectancy in wealthy societies will increasingly depend on reducing mortality at older ages, adverse health trends at younger ages are a cause for concern. This emerging and avoidable threat to health equity in English-speaking countries should be the focus of further research and policy action. Key messages The study highlights striking similarities between English-speaking high-income countries in terms of adverse health outcomes at young-middle ages compared to a group of other high-income countries (HICs). Each of the Anglophone populations has experienced a marked mortality disadvantage for cohorts born since the early 1970s relative to the average of other HICs, which contrasts with the generally better performance of the older cohorts in some English-speaking countries, particularly for men. In the most recent pre-pandemic period, i.e. 2017-19, the negative contribution of higher mortality at ages below 50 years to the gap in life expectancy at birth between English-speaking countries (excluding Ireland) and other HICs ranged from 0.15 years for Australian women to 2.06 years for US men.