OBJECTIVES : The United States has not realized the same life expectancy improvement as peer nations, and some have attributed this gap to uninsurance in the United States. This analysis examines trends in life expectancy for a population in the United States who are almost universally covered by public insurance; namely, Medicare enrollees at age 68.

METHODS : The study sample consists of a 20% random sample of newly age-eligible fee-for-service Medicare enrollees (n=2,929,852), from 2003 to 2013. Age eligibility starts at age 65, but we examined enrollees with at least two years of continuous enrollment at age 68. Thus, ensuring at least a two-year look back period to identify health status. Health status was measured using validated indicators for 26 conditions, defined algorithmically in Medicare administrative claims data. We examined trends in life expectancy using Kaplan-Meier curves and Cox proportional hazards regressions, controlling for sex, race, and the presence of baseline health conditions.

RESULTS : All-cause mortality for 68-year-old Medicare enrollees declined at a rate of approximately 1% per year from 2003 to 2013 (HR=0.985, p<0.001). However, the gains were not evenly spread across the population. Mortality rates improved the most for patients with chronic kidney disease (HR=0.964, p<0.001), prostate cancer (HR=0.981, p<0.001), glaucoma (HR=0.982, p<0.001), lung cancer (HR=0.983, p<0.001), and breast cancer (HR=0.984, p<0.001). Conversely, mortality increased for other chronic conditions. Patients with heart failure (HR=1.005, p<0.001) and ischemic heart disease (HR=1.005, p<0.001), in particular, saw a slight increase in mortality.

CONCLUSIONS : Overall, Americans aged 68 saw improvements in mortality during the study period. However, this improvement masks important heterogeneity in the population—including troubling increases in mortality for those with cardiovascular conditions. Future research should look at why this heterogeneity exists, particularly for individuals with diseases that have seen an increase in mortality rate.