Why life expectancy has stalled in Europe - and how some countries stayed ahead

Why life expectancy has stalled in Europe - and how some countries stayed ahead

New research shows why life expectancy gains have slowed across Europe - and how proactive policies in some countries have helped them weather the Covid-19 crisis better than others.

In a recently published study inThe Lancet Public HealthResearchers compared trends in risk factors, causes of mortality and life expectancy in European countries before and during the coronavirus disease 2019 (Covid-19) pandemic.

Life expectancy is a key measure of population health and has increased in high-income countries since the 1900s. This increase could be attributed to progressive and sustained improvements in nutrition, child mortality, infectious disease control and living standards. However, the increase in life expectancy has slowed since 2011 in all countries except Norway, and in some cases the slowdown has been more pronounced. The slowdown was further exacerbated in 2020 due to the Covid-19 pandemic.

Covid-19 led to high mortality rates and reduced life expectancy in many countries. These reductions have not yet recovered, and excess deaths still occurred in some regions after 2021. However, not all countries saw equal declines - although most saw declines, some, such as Ireland, Iceland, Sweden, Norway and Denmark, showed marginal improvement or stability in life expectancy. The Covid-19 pandemic may continue to impact life expectancy from healthcare disruptions and post-Covid-19 conditions.

About the study

Countries with the largest slowdowns in life expectancy after 2011 were also hit hardest by Covid-19, suggesting weaker health trends before the pandemic made populations more vulnerable.

In the present study, researchers compared trends in risk factors, life expectancy and causes of death in European countries before and during the Covid-19 pandemic. They used data from the Global Last of Diseases Study (GBD) 2021. Life expectancy, summary exposure values ​​(SEVs) for risk factors, and deaths attributable to specific risk factors were estimated for the 16 founding European Economic Area (EEA) and four Great Britain (UK) nations.

The researchers compared three time periods: 1990-2011, 2011-19 and 2019-21. They estimated average annual life expectancy changes for these periods. Life expectancy was estimated at birth, overall, and at decomposition by cause of death. Life expectancy at birth was the average number of years that newborns could expect if they endured life exposed to prevailing age- and sex-specific mortality rates.

Joinpoint regression models were used to estimate the year of an overall slowdown in life expectancy. Cause-specific mortality rates for 288 causes were calculated using a GBD-developed tool. Changes in life expectancy were attributed to changes in causes of mortality for each period to determine the contribution of changes in specific causes of death to slowing life expectancy gains.

In addition, life expectancy by attrition by cause of death was used to estimate contributions from specific causes. GBD 2021 generated epidemiological estimates for 88 risk factors, and SEVs were estimated for each risk factor. SEV was the risk-weighted prevalence of exposure. Average age-standardized mortality rates attributable to key risk factors were calculated.

Life expectancy at birth for both sexes combined from 1990 to 2021 by country, ordered from 2019 life expectancy

Results

Improvement in high blood pressure and cholesterol levels stalled in many countries after 2011, or vice versa, even though medical advances should have kept progress stable.

The researchers observed steady life expectancies for at least two decades until 2011, when there was a significant change for all countries except Norway. All countries achieved an average annual life expectancy increase in life expectancy from 1990 to 2011 and 2011-19, but there was significant heterogeneity across countries. The rate of life expectancy gains in 2011-19 was lower than before in all countries except Norway. England showed the highest reduction in the rate of improvement between these two periods, while Iceland recorded the smallest decline.

In 2019-2011, life expectancy declined in most countries, but some (Ireland, Iceland, Sweden, Norway and Denmark) experienced marginal improvement or no change. The highest reductions in life expectancy were observed in Greece, England and the other British nations. The causes of death for the highest life expectancy between 1990 and 2011 were neoplasms and cardiovascular diseases (CVDs).

Countries where life expectancy gains from these causes were similar from 1990 to 2011 to 2011-19 were also the countries with the best improvements between these periods: Sweden, Iceland, Belgium, Norway and Denmark. In addition, these countries have seen life expectancy improve or slightly in 2019-21. In contrast, the British nations Italy and Greece, which had the biggest slowdowns in life expectancy before Covid-19, saw the biggest declines in 2019-21.

During this time, the reduction in life expectancy countries was due to deaths from respiratory infections and Covid-199 outcomes. However, in Ireland and Sweden, despite a high number of deaths from respiratory infections, life expectancy improved due to fewer deaths from neoplasms and CVDs.

The top specific risk factors for CVDs in 2019 were elevated systolic blood pressure (SBP), elevated low-density lipoprotein cholesterol (LDL), and diet risks. For neoplasms, the top risk factors were nutritional risks, occupational risks and tobacco smoking. Significant risk factors for both neoplasms and CVDs included dietary risks, smoking, high fasting plasma glucose (FPG), high body mass index (BMI), low physical activity, air pollution, and other environmental risks.

However, these risk factors showed different trends:

• Die Raucherraten gingen in allen Ländern stetig zurück.
• Der BMI nahm während des Untersuchungszeitraums in allen Nationen stetig zu.
• Verbesserungen bei hohem SBP- und LDL -Cholesterinspiegel standen nach 2011 in vielen Ländern zum Stillstand oder sogar um.
• Ernährungsrisiken und niedrige körperliche Aktivität blieben anhaltend hoch.

Changes in life expectancy at birth of both sexes combined, by country and cause of death from 2019 to 2021, ordered up to 2019, which have life expectancy up to 2019. The solid vertical black bars show life expectancy in 2019 for each country, and the dashed vertical black bars show life expectancy in 2021. All colored bars to the left of the 2019 line represent years of deterioration in life expectancy attributable to specific causes of death between 2019 and 2021. Bars on the outside of the solid and dashed lines represent the same number of years.

Conclusions

Norway, Belgium and Sweden have made strategic policy moves, including better access to cancer treatment and long-term nutritional interventions, that have helped ensure life expectancy while others have struggled.

Overall, all countries except Norway experienced a reduction in life expectancy after 2011. Improvements in deaths from CVDs and neoplasms as well as improvements in high SBP and LDL cholesterol slowed significantly after 2011. In contrast, high BMI rose steadily over the three decades, and other risks remained elevated in most nations.

Iceland, Norway, Sweden and Denmark showed significant international differences in life expectancies after 2011 and during the pandemic. These countries have implemented policies that have helped reduce mortality from CVDs and neoplasms and potentially mitigate the impact of Covid-19.

Life expectancy trends are associated with long-term policy interventions, suggesting that governments can influence longevity through policy decisions, such as: For example, Norway has a long history of fiscal measures to reduce sugar consumption, and the national cancer plan in Belgium emphasized prevention and early treatment, thereby maintaining life expectancy. Conversely, public health funding in the UK after 2010 likely contributed to stagnant improvements in life expectancy.

The study highlights the importance of proactive public health policies for not only improving life expectancy, but also for building resilience to future health crises.

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