Photographer: Rick

Guns, Drugs, and Car Crashes: Why Americans Die Younger

Three paths to death explain much of the life expectancy gap between the U.S. and other wealthy nations.

The average American will die as many as two years sooner than if they lived in Western Europe or Japan. This can be attributed, in part, to three of the darker elements of life in the U.S.: gun violence, drug overdoses, and death on the road.

More than 100,000 people in the U.S. lose their lives as a result of these causes every year. For each of the categories, the death rate is far higher in America than in other wealthy countries, according to research published Tuesday in the Journal of the American Medical Association.  

The disparity is evident in comparisons with each of the 12 developed countries that have comparable mortality data available. These include Austria, Denmark, Finland, Germany, Italy, Japan, the Netherlands, Norway, Portugal, Spain, Sweden, and the United Kingdom.

The U.S. could narrow the gap, but "as a country, we have chosen not to by not investing the resources in injury prevention that would be needed," said Rebecca Cunningham, an emergency physician and director of the Injury Research Center at the University of Michigan. She wasn't involved in the JAMA report, which was written by researchers at the U.S. government's National Center for Health Statistics and Johns Hopkins Bloomberg School of Public Health.

Cunningham pointed to policies that other countries use to reduce premature traffic deaths. In most European nations, the blood alcohol limit for driving is lower than the U.S. standard of .08 percent. Also, infrastructure changes such as roundabouts or dividers widely used outside the U.S. prevent head-on crashes and make collisions less lethal.

When it comes to gun violence, political realities make bridging the chasm between European and U.S. laws unlikely. However, some American firearm deaths could be avoided by encouraging safer gun storage. "Gun ownership could stay the same in the country, but we could have gun deaths among our children go down," Cunningham said. 

Even debate over this issue has been fraught. Research into better firearm safety has been hamstrung by a longtime Congressional ban on federal grants for such studies. Cunningham points out that the National Institutes of Health didn't fund a single study on childhood gun injuries from 2005 to 2014, despite the fact that firearms are the second-leading cause of death for Americans aged one to 19, after car crashes.

As with drunk-driving and gun ownership, drug deaths, too, may be affected by looser U.S. practices in prescribing opioids, according to the JAMA report. Data from the Pain & Policies Studies Group at the University of Wisconsin show per capita opioid painkiller consumption in the U.S. exceeded the equivalent of 700 milligrams of morphine in 2013. The figure for the U.K. was 241 mg. In Japan, it was 26 mg.

The pattern of premature death by gun, drug, and automobile is somewhat different for women. But differences among these three causes still account for 19 percent of the life expectancy gap between the U.S. and other countries measured. If American women experienced these three causes of death at the same rates as women in other countries, they would live, on average, five months longer.

The death tallies, drawn from the U.S. National Vital Statistics System and the World Health Organization Mortality Database, count both accidental and intentional deaths. They include, for example, gun suicides and intentional overdoses. Drug-related death totals include the effects of both illicit and legal drugs.

These injuries explain only part of the mortality differential between the U.S. and other countries, and the authors noted that "the fundamental reasons for high U.S. injury mortality remain unclear." Here's a look at the overall difference between the U.S. and the comparison countries:

Cunningham said the JAMA report highlights some of the biggest opportunities to reduce the number of Americans killed by major injuries each year. "I think the general public knows vaguely, perhaps, that we’re not investing as much in injury prevention as other countries are," she said. "This really brings that home."