A newly published study by researchers at the University of Texas Medical Branch offers fresh insights into a critical public health concern: why Americans live shorter lives compared to people in other wealthy nations.
Published in the American Journal of Preventive Medicine, the study was led by Dr. Neil Mehta, Professor of Epidemiology and Associate Dean of Research at the School of Public and Population Health, and Dr. Octavio Bramajo, a postdoctoral fellow at UTMB’s Sealy Center on Aging. Their research investigates how deaths from cardiovascular disease (CVD) contribute to the growing life expectancy disparity between the United States and its economic peers between 2008 and 2019.
Their analysis shows that cardiovascular disease accounts for the entire growth in the life expectancy gap between the U.S. and a set of 10 other high-income countries for women, and about half of the growth among men. This puts heart health at the center of one of the most visible indicators of national well-being.
“CVD is largely preventable and treatable, yet it remains a major contributor to the growing gap between the U.S. and other high-income countries,” Mehta said. “The reason for the U.S.'s lagging trend with respect to CVD deaths is highly concerning and the causes of which are poorly understood.”
Systemic Failures Behind Preventable Deaths
The researchers used cause-of-death data from 2000 to 2019 to track mortality trends across countries such as Canada, Germany, Japan, and Sweden. Despite decades of progress in treating cardiovascular conditions, the U.S. is falling behind on key outcomes—particularly among adults under age 80, with the most pronounced stagnation observed in the 50–64 and 65–79 age groups.
“We’re seeing stagnation where there should be continued progress,” Mehta said. “That tells us it's time to re-evaluate our national approach to cardiovascular health—from policy to primary care.”
Despite declining smoking rates and advanced treatments for stroke and heart attacks, the study’s findings imply that other risk factors—obesity, diabetes, poor diet and lack of exercise, limited health care access, and socioeconomic inequality continue undermining progress. The researchers emphasize that these challenges are not simply the result of individual choices, but stem from fundamental differences in how nations approach prevention, diagnosis, and management of chronic disease—differences that can have long-term impacts on population health.
“We can’t close the life expectancy gap without addressing the structural and social conditions that put certain populations at higher cardiovascular risk,” Bramajo said. “Conditions that stem largely from preventable behaviors.”
A Persistent—and Growing—Gap
For two decades, the life expectancy gap between the U.S. and peer nations has widened. In the 1950s and ’60s, Americans lived longer than many in Europe. But by 2019, Americans lived approximately four years less than citizens of comparable nations.
Cardiovascular disease—encompassing heart attacks, strokes, and other blood vessel conditions—remains the leading cause of death in the U.S. While cardiovascular disease mortality fell through the early 2000s, progress has stalled, particularly among middle-aged Americans.
Mehta, who also directs the Center for Health-system Improvement and the NIA-funded TRENDS Network on old-age dementia and disability, noted that the trend is especially troubling given the preventability of cardiovascular disease.
“If we want to meaningfully improve U.S. life expectancy, preventing cardiovascular disease is one place to start,” Mehta said. “The science is there—we need the policies and public will to match.”