Faltering Survival Improvements at Young-Middle Ages in High-Income English-Speaking Countries: Period and Cohort Perspectives

Background: Slowdowns in longevity improvements were seen in a number of high-income countries (HICs) in the period before the Covid-19 pandemic. We provide a systematic analysis of mortality changes across six high-income English-speaking countries (Australia, Canada, Ireland, New Zealand, UK, USA) compared to selected other HICs.Methods: All-cause mortality data from the Human Mortality Database and cause-specific death counts from the WHO Mortality Database were used to estimate longevity measures for each English-speaking country and the average for 14 other HICs for 1970-2020. Cause-of-death contribution was measured using decomposition analysis of differences in life expectancy and life-years lost between Anglophone and other HICs for the pre-pandemic period. The contribution of cohort survival to longevity differences was assessed.Findings: Having improved consistently from the 1970s, life expectancy in all English-speaking countries (except Ireland) stalled in the pre-pandemic decade, mainly due to stagnating or increasing mortality at young-middle ages. Relative to other HICs, those born in Anglophone countries since the 1970s experienced relative mortality disadvantage, largely attributable to injuries, substance-related and cardiovascular mortality. In contrast, advantages were enjoyed by older cohorts for males (except USA) and for females in Australia and Canada.Interpretation: The striking disadvantage of young adults in English-speaking countries relative to other HICs should be seen as an emerging threat to their continued sustainable and equitable development. Population health policies need to be further adapted to meet these new challenges. In addition, post-pandemic life expectancy trends in these countries are unclear and require further monitoring.Funding: Australian Research Council (DP210100401).Declaration of Interest: The authors declare no conflicting interests.