select search filters
briefings
roundups & rapid reactions
Fiona fox's blog
A study published in The Lancet Public Health looks at life expectancy changes across 20 European countries from 1990-2020.
Prof Jennifer Dowd, Professor of Demography and Population Health, University of Oxford, said:
Does the press release accurately reflect the science?
“While accurate overall, the press release at times oversimplifies and overstates the conclusions of the paper, including the press release title: “We are no longer living longer.” The paper looks at mortality trends from 1990-2021 and finds slowing improvements in life expectancy in the decade prior to COVID–but improvements still mean we are living longer. Life expectancy declined due to COVID-19 in 2020 and 2021, but this is likely a temporary shock and doesn’t mean we will die sooner than our parents and grandparents, as implied. The press release also states that food, physical activity, and obesity are largely to blame for these trends, but this overstates what we can confidently say about these causes.”
Is this good quality research? Are the conclusions backed up by solid data?
“This is good quality research, especially in the standard estimation of life expectancy trends and the causes of death contributing to these trends. The part of the analysis that tries to attribute slower mortality improvements to specific risk factors such as cholesterol, hypertension, and “dietary risks” is on shakier ground. The estimates used for this part of the analysis were based on different data and analysis that are not discussed in detail here. The estimation of how risk factors such as diet causally impact mortality is methodologically very challenging, and there is a lot of uncertainty about any single estimate. In addition, the population-representative data on the prevalence and trends of these risk factors across all the countries is not readily available. Putting these two sources of uncertainty together means it is very difficult to attribute country-level life expectancy trends to specific risk factors with high confidence. The “under the hood” part of how these estimates are produced is largely glossed over in the paper, but they are presented as established facts.”
How does this work fit with the existing evidence?
“The analysis of trends in life expectancy is consistent with previous work that has shown similar trends and slowdowns in improvements in the decade prior to COVID. For example, see a recent review “Progress Stalled? The Uncertain Future of Mortality in High-Income Countries””
Have the authors accounted for confounders? Are there important limitations to be aware of?
“The portion of the paper attributing life expectancy changes to specific risk factors like diet and physical activity is based on other analyses that are highly vulnerable to bias due to confounding. The conclusions for this portion of the analysis should be tempered.”
What are the implications in the real world? Is there any overspeculation?
“We are seeing slowdowns in life expectancy improvements after decades of often rapid gains. But even slow improvements mean we are living longer on average. Slowing improvements may be a warning sign of things to come, so we need to continue tracking these trends. This paper makes strong statements about the specific risk factors responsible for slowing life expectancy improvements, including obesity, high cholesterol, and “occupational risks.” While these risk factors are no doubt important for health, we can’t say with certainty how each one contributes to these trends.”
How confident can we be as to the causes of the decline in life expectancy in England?
“The reported decline in life expectancy in England was only during COVID. Prior to that there were slower improvements in life expectancy compared to the previous period and compared to other countries. There is not broad agreement on the cause of these slowdowns, as it is difficult to directly test mechanisms such as austerity cuts. We have good evidence that the slower improvements were largely attributable to slowing improvements in cardiovascular disease, as well as some increases in external cause mortality such as drug deaths at younger ages and midlife. For more thorough examinations, please see paper here and here.”
Could these trends be potentially linked to current state of NHS/ waiting lists? Also could the use of weight-loss drugs potentially help reverse this trend if they tackle rising obesity rates?
“Challenges with the NHS are one potential contributor to mortality trends in England, but the size of their contribution is not well established. These trends likely reflect much longer-term trends in risk factors such as obesity that accumulate over time. Since the obesity epidemic is now many decades old, more people are entering midlife and older age having been obese for a long time, which could be contributing to these trends. There is cautious optimism that the new GLP-1 class of diabetes and weight-loss drugs could be a game-changer for treating obesity have some long-term benefits for life expectancy, though more evidence is needed to confirm this.”
Dr Yize Wan, NIHR Clinical Lecturer in Intensive Care Medicine & Anaesthesia, William Harvey Research Institute (WHRI), Queen Mary University London (QMUL), said:
“The reasons for these findings are complex and likely to be a combination of both individual risk factors from health behaviours and the need to improve access and delivery of healthcare systems. This study has highlighted the importance of addressing modifiable risk factors and preventing and not just treating long-term disease. It would be important to see if these trends are seen across the whole population or whether people from more socioeconomically deprived or different ethnic backgrounds are disproportionally affected. Particularly as we know that socioeconomically and ethnically disadvantaged population groups are more likely to be exposed to common risk factors such as poor diet and low physical activity as well as have more limited access to healthcare.”
Prof Tom Sanders, Professor emeritus of Nutrition and Dietetics, King’s College London (KCL), said:
“This is a useful analysis of changes in life expectancy across Europe since 2011 compared with the period 1990-2011. Prior to this life expectancy had increased by about 11 years compared with 1960s for a variety of reasons particularly better control of high blood pressure, blood pressure and immunisation against flu as well as lifestyle changes (smoking cessation and better diet) including increased prosperity. This study shows overall across the 20 countries there was an improvement in life expectancy increased from 1990 up to 2011 by on average 0.23 years but this rate of improvement slowed to 0.15 years between 2011 and 2019. The UK, France and Germany showed bigger declines in life-expectancy compared to the Nordic countries.
“It is important to recognise that the demographics of the European population have changed markedly in some countries such as the UK, France and Germany because of increased migration compared to Nordic countries. In the UK, the population growth had been due to migration often from countries where life expectancy is much lower.
“The authors attribute the small decline in life-expectancy to increasing prevalence of obesity particularly in younger and middle-aged adults. While, obesity is likely to contribute to decreased life expectancy in future generations, the prevalence was not particularly high in the older generation, who accounted for most of the deaths in the period 2011-2019.”
‘Changing life expectancy in European countries 1990–2021: a subanalysis of causes and risk factors from the Global Burden of Disease Study 2021’ by Nicholas Steel et al. was published in The Lancet Public Health at 23:30 UK time Tuesday 18th February 2025.
DOI: 10.1016/S2468-2667(25)00009-X
Declared interests
Dr Yize Wan: I have no declarations of interest.
Prof Jennifer Dowd: No conflicts.
For all other experts, no reply to our request for DOIs was received.