Why is life expectancy in England and Wales falling behind? A cause-of-death decomposition approach.

Life expectancy in England and Wales has diverged from its high-income peers since 2011, raising concerns that England and Wales may become an international life expectancy laggard like the United States of America (USA). Using the contour decomposition method, we decompose gaps in male and female life expectancy between England and Wales and 20 individual high-income countries in 2019 into: (a) pre-existing differences in age- and cause-specific death rates in 2011; and (b) diverging trends in these rates in 2011–19. Focusing on mortality trends, we find that external causes at young-to-middle ages, cardiometabolic mortality at middle-to-older ages, and dementia mortality at older ages contributed most to life expectancy gaps. Although there are parallels to the USA, England and Wales is experiencing distinct mortality trends. Whether we are entering a period of more generalized life expectancy stagnation in high-income countries will be an important question to monitor.