Australia leads life expectancy among English-speaking nations

Reviewed by Lily Ramsey, LLMAug 13 2024

An analysis of international longevity data published in the open-access journal BMJ Open finds that Australians outlive their peers in 5 high-income English-speaking countries, including the UK and the US, by 1 to 4 years.

Most of this advantage accrues between the ages of 45 and 84, with death rates from drug and alcohol misuse, screenable/treatable cancers, and cardiovascular and respiratory diseases all lower, the analysis shows.

While high-income countries achieved good life expectancy gains during the 20th century, the researchers note that the trends have been much less favorable in the 21st century, even before the COVID-19 pandemic. 

Study: Life expectancy and geographic variation in mortality: an observational comparison study of six high-income Anglophone countries. Image Credit: CandyRetriever / Shutterstock

Stalled declines in deaths from cardiovascular disease, along with a rising death toll from drug overdoses, mental illness, and neurological disease, are key contributory factors, they explain. And sizeable gaps in life expectancy between the richest and poorest, evident in most of these countries, have widened further in recent decades.

While English-speaking high-income countries have much in common, they also have notable differences, including inequality in their healthcare and welfare systems, racial and ethnic composition, and immigration history.

Therefore, the researchers wanted to know if there were any lifespan differences among Australia, Canada, Ireland, New Zealand, the UK, and the USA, which represent some of the world's wealthiest economies.

They obtained national life tables from the Human Mortality Database (HMD) for men and women in these countries plus, for context only-Austria, Belgium, Denmark, Finland, France, Germany, Italy, Japan, the Netherlands, Norway, Portugal, Spain, Sweden, and Switzerland between 1990 and 2019. 

The World Health Organization Mortality Database for all 6 English-speaking countries provided detailed information on deaths by sex, age, and cause of death.

Data analysis showed that Australia has been the best performer in life expectancy at birth since the early 1990s, leading its peer countries by 1.26–3.95 years for women and by 0.97–4.88 years for men in 2018.

Specifically, Australia has a 4 to 5-year life expectancy advantage over the USA and a 1 to 2.5-year advantage over Canada, New Zealand, Ireland, and the UK.

Canada had the second-highest life expectancy for most of the period between 1990 and 2019. Most recently, Ireland and New Zealand have matched Canada. 

However, the USA has been the worst performer in every year since 2001. In the most recent decade, the UK generally had the second lowest life expectancy. 

Similar trends are observed for life expectancy at age 65, with Australia generally performing the best and the USA the worst, with the USA's poor life expectancy ranking at age 65 emerging more recently. 

The gaps in life expectancy at birth between the best and worst performers widened over time. In 1990, Canadian men and women had the highest life expectancies - 74 and 80, respectively - while American men and Irish women had the lowest—71 and 77, respectively. 

The corresponding gaps were 2.38 and 2.91 years. By 2019, these gaps had doubled to 4.75 years for men and increased by 30% for women to 3.80 years between Australia and the USA.

While women in English-speaking countries never ranked among the top performers in female life expectancy between 1990 and 2019 in all 20 high-income countries, men - with the exception of the USA - typically have ranked in the top half over the past decade. 

Out of all these countries, Australian men ranked in the top 4 in all but one year between 1990 and 2019. However, American men have had the lowest life expectancy since 2005.

The 65–84 age group typically contributes the single largest percentage to life expectancy gaps between Australia and the other 5 English-speaking high-income countries, ranging from 39% in the USA to 78% in Ireland among women and from 30% in the USA to 100% in Ireland among men.

While Australians have lower rates of death across nearly all ages, most of their life expectancy advantage accrues between ages 45 and 84. 

Ischaemic heart disease, other circulatory diseases, cancers, respiratory diseases, mental illness, and neurological disease, mainly Alzheimer's disease and related dementias, are key contributors to life expectancy gaps in this age group.

But Australia also tends to have a lower death rate from external causes, including drugs and alcohol, screenable/treatable cancers, cardiovascular disease, and flu/pneumonia.

Regarding life expectancies within countries, Canada and the USA perform the worst, with 13 US states in the lowest category for men and women. On the other hand, all regions in the UK and Ireland have life expectancies above 81 for women and 76.5 for men. 

For both men and women, Australia has the lowest within-country inequality, especially at ages above 40, followed by Canada. Among women, inequality tends to be highest in New Zealand, Ireland, and the USA; among men, it is highest in New Zealand, the UK, and the USA.

The researchers acknowledge that they couldn't account for differences within local neighborhoods and that there may be differences in cause of death coding, particularly at older ages where several conditions may co-exist.

They suggest several possible explanations for Australia's top ranking, among which is the country's high proportion of people born overseas - nearly 30% in 2018. 

A low prevalence of smoking might be another. At the same time, public health initiatives around gun ownership and mental health and its highly rated healthcare system might also explain Australia's position at the top of the life expectancy league table.

"Australia performs well, but still has room for improvement, particularly in the area of reducing inequalities among its indigenous populations," and in its rates of obesity, say the researchers. However, they conclude: "Overall, Australia offers a potential model for lower-performing Anglophone countries, such as the USA and UK, to follow to reduce both premature mortality and inequalities in life expectancy."