Temporal trends in cardiovascular disease and diabetes prevalence in the United States: assessing compression versus expansion

Recent trends from Western countries indicate a stagnation of life expectancy gains, raising questions about the mechanisms that sustain healthy aging and morbidity compression. In this study, we focus on trends in cardiovascular diseases and diabetes and their determinants in the United States, as relevant contributors to potential morbidity compression and, consequently, to increases in healthy life expectancy. Using data from the Behavioral Risk Factor Surveillance System from 1990 to 2023, we apply a pseudo-panel approach to analyze morbidity patterns across birth cohorts in the United States. The models account for covariates such as BMI, smoking, ethnicity, gender, income, and education, including relevant nonlinearities and interactions to capture heterogeneity in disease risk. Findings show that, at comparable ages, more recent cohorts exhibit higher disease risk, for diabetes, a pattern that is not consistent with morbidity compression. These results are largely explained by the growing presence of behavioral and socioeconomic risk factors, such as overweight and low income, which disproportionately affect younger cohorts. Our study contributes to the growing literature documenting worsening population health trajectories in countries with advanced medical systems and highlights the need for public health strategies that address both behavioral and structural determinants to promote healthy aging.