Why Do Some People Live Longer Than Others?

Trying to find the answer to one of life's biggest questions.

By

Debra Whitman

 
Published September 05, 2024
gif illustration of various hourglasses varying in time
Inma Hortas

In the summer of 2017, my husband was hiking alone in the mountains of Colorado. He was fit and trim, a lifelong athlete, but as Glenn ascended the trail, he felt an unfamiliar tightness in his chest. A high school history teacher who gets CPR training each year, Glenn knew the signs of a heart attack. Surely it couldn’t be that? He was only forty- six and had zero history of heart problems.

He pushed on, hoping the sensation in his chest would go away. But it persisted.

At some point, two other hikers appeared on the trail, a father and daughter. It wasn’t like Glenn to ask for help, but for once, he did. They immediately sat him down and called 911. Soon six members of Boulder Mountain Rescue, an elite group of volunteers who perform alpine search and rescue, came sprinting up the mountain. They strapped Glenn to a gurney and raced him down to a waiting ambulance.

I got a phone call from one of the helpful hikers while I was out running errands at home in Maryland. He was a little vague at first, but eventually, I understood that things were serious, and I was soon speeding to the airport to catch a flight to Denver. I couldn’t believe this was happening. The vow Glenn and I had exchanged at our wedding in 1999 was “I will love you until I am 103.”

We come from different faiths, so we wrote our own ceremony and found saying “103” funnier than “forever.” As the years passed, the line had become a running joke between us. It might seem strange that we assumed we could live that long. But the odds were in our favor. We were healthy, well-educated, and financially secure — all factors that boost life expectancy.

Not only had we promised to love each other beyond the age of one hundred, we had used that horizon to calculate how long we’d need to work and how much we would need to save for our retirement. Suddenly, I realized that all our planning, all our optimistic assumptions, might be for nothing.

In the end, we were incredibly lucky: Glenn’s heart didn’t stop on that mountain. He reached the emergency room before he flatlined. The hospital staff flew into action and started chest compressions, breaking several ribs in the process. The cardiologist diagnosed a blockage in Glenn’s left anterior descending artery. I didn’t know it at the time, thankfully, but this vital blood vessel is known as the “widow-maker.”

When this kind of heart attack occurs outside a hospital or advanced care center, the survival rate is only 12 percent. Until the 1980s, even patients who were hospitalized fared little better. But then coronary stents were developed. These tiny metal structures hold the artery open to prevent it from narrowing again and can save a patient even in the middle of a heart attack. In a matter of minutes, Glenn’s brilliant cardiologist had placed four stents in three arteries near Glenn’s heart. My flight was about to take off when the doctor called to say the procedure had gone well. Glenn was already recovering in the ICU.

By the time I arrived, my husband was out of danger. Glenn’s general fitness and healthy habits have supported his recovery. His doctors say that, with the stents and proper medications, he can expect many more fully active years. He is now back to hiking regularly.

But my own heart beats faster retelling the story here. I had a glimpse into the true complexity of this thing called longevity, and I was shocked to discover just how much I didn’t know. Until Glenn’s heart attack, he and I had assumed we held the most important pieces of the puzzle. Yet no one had ever detected that heart condition. Nor had we given much thought to the critical roles that geography, government, and community might play. So much of Glenn’s survival had come down to luck. We were lucky that those other hikers had come along and that they had cell phones and reception.

We were lucky he’d had a heart attack in a county with a well-equipped rescue team, and that they’d been able to get him to the hospital so quickly. We were lucky that stents existed, that a qualified cardiologist was available, and that we had the health insurance to cover everything. In a literal heartbeat, my husband’s fate had depended on people, programs, policies, and circumstances that I’d never imagined would factor into his life expectancy. And I work in the field of aging!

Glenn’s heart attack forced me to confront the fact that even when the odds are in our favor, longevity is an uncertain business. We may live to 103, or we may not make it past fifty. There are no guarantees. The close call didn’t turn me into a fatalist, though. Instead, it set me on a mission. I wanted to know what determines how long we live, and why some of us live much longer and healthier lives than others. How much of a role do genes play? What factors are within our control, and which ones are beyond it? And how do governmental priorities, like the support for health care in Colorado that helped save Glenn’s life, shrink or extend life expectancy? Might there be a way to ensure that we all live to 103?

It didn’t take long to realize that it’s complicated. For all the factors that push life expectancy upward, including incredible medical and technological advances, our society also faces a lot of challenges that can press life expectancy downward. And these upward and downward pressures are different for different people. Typical lifespans in the United States vary widely among different income and racial groups, from county to county, and even within individual cities. The life expectancy of Asian Americans, the longest-living group in the United States, is eighteen years longer than that of Native Americans, who have the shortest lives. This is a shocking gap. It is also an average across a population. When we talk about “life expectancy,” we mean a prediction of the age at which a person is expected to die. Very few of us will die precisely at the age indicated by our life expectancy. Some of us will die sooner, and some will live much longer. I can’t reveal exactly the age at which you will die, but I can tell you what we know about how long, on average, people in your demographic live.

Over the last century, U.S. life expectancy at birth has increased dramatically, from forty-eight years in 1900 to 77.3 years by 2020. We owe a lot

of the progress to scientific advances that have reduced death in early life. Before 1900, it was tragically common for women and babies to die during childbirth, and diseases such as diphtheria, cholera, typhus, and polio carried off thousands of children every year. But increases in life expectancy have also resulted from public health research and policy changes. Clean drinking water, antibiotics, and vaccines have extended millions of lives around the world. Improved access to maternal and child health care caused the infant mortality rate to plummet. Medications to fight hypertension and blood glucose made dramatic gains on conditions such as heart disease and diabetes.

By the end of the twentieth century, previously unthinkable lifesaving procedures like kidney, liver, heart, and lung transplants were being performed by the tens of thousands. Meanwhile, U.S. agencies such as the Food and Drug Administration, the Environmental Protection Agency, and the Occupational Safety and Health Administration have helped to ensure that the air we breathe is cleaner, our food and medications are safer, and we are less likely to get injured on the job. With improved automotive safety and emergency medical technology, as well as changes in driving laws and driver behaviors, the motor vehicle death rate has fallen almost 60 percent since its peak in 1937.

The remarkable increase in the number of years Americans can expect to live is wonderful news. The not-so-good news is that for the last couple of decades, the United States has lagged behind most other high-income countries in boosting life expectancy. Countries with the highest life expectancies added almost two and a half years of life each decade, roughly six hours per day, while here it rose at half that rate. By the late 2010s, life expectancy was 78.8 years in the United States, while in Japan it was 84.4 years. By 2019, the United States ranked fortieth in the world on this measure, below Turkey and just ahead of Ecuador.

Even more troubling is the fact that since the mid-2010s, well before the dip caused by the Covid-19 pandemic, life expectancy in the United States had begun to fall for the first time since 1918 — when World War I was still dragging on and a global influenza pandemic was raging. Between 2014 and 2016, it dropped from 78.8 years to 78.5 years. The decline didn’t hold true for all Americans. In certain groups, it is still rising, but many more people, especially those who had dropped out of high school, were dying at younger ages than in the previous decade.

One big reason was a spike in deaths from suicide, alcoholism, and drug overdoses, especially among people in their late forties and early fifties who were without a bachelor’s degree. People in this group were four times more likely than college graduates to die by suicide or from substance abuse. Economists Anne Case and Angus Deaton coined the term deaths of despair to describe these losses. They counted 158,000 such deaths in 2017 alone, attributing many to America’s opioid epidemic and, for those without a college degree, to the “long-term drip of

losing opportunities and losing meaning and structure in life.”

Then in 2020, the pandemic hit, worsening social isolation and the physical, mental, and financial health of many people; the pandemic made it harder for people to access support and compounded the tragedy of deaths of despair. In 2021, more than 107,000 people died from drug overdoses, up almost 15 percent from the previous year. The combination of lethal overdoses and over one million deaths from Covid-19 sent life expectancy spiraling downward. By 2021, Americans could expect to live for 76.1 years — a nearly three-year drop from 2015 that erased a generation’s worth of gains.

The pandemic shone a light on weaknesses in our public health system and on the powerful connections between economic status, education, race and ethnicity, geography, and health. Counties that had the highest household incomes had fewer Covid-19 deaths than lower-income counties. People who never graduated from high school had significantly higher death rates than did graduates. Deaths varied significantly from state to state, with Arizona having a death rate three and a half times that of Hawaii, which had the lowest rate. People of color had the highest rates of infection, hospitalization, and death, far out of proportion to their numbers in the general population, while infection and death rates on reservations across the country were much greater than in nearby non-native communities. Even the horrific death toll in nursing homes was highest among Black and Hispanic residents. Some of the causes for these disparities echo the reasons for longevity discrepancies generally.

What do YOU think is the biggest factor when it comes to why some people live longer than others? Let us know in the comments below.

Debra Whitman is an economist and chief public policy officer for AARP, where she leads a team that works to improve the lives of older Americans and their families.