Compression or Expansion? Health Surveillance Trends in Cardiovascular and Diabetes Morbidity in the United States

Recent trends from Western countries indicate a stagnation of life expectancy gains, raising questions about the mechanismsthat sustain healthy aging and morbidity compression. In this study, we focus on trends in cardiovascular diseases and diabetesand their determinants, as relevant contributors to potential morbidity compression and, consequently, to increases in healthylife expectancy. Using data from the Behavioral Risk Factor Surveillance System (BRFSS) from 1990 to 2023, we apply apseudo-panel approach to analyze morbidity patterns across birth cohorts. The models account for covariates such as BMI,smoking, ethnicity, gender, income, and education, including relevant nonlinearities and interactions to capture heterogeneityin disease risk. Findings show no clear evidence of morbidity compression, particularly for diabetes, where disease risk atcomparable ages is higher among more recent generations. These results are largely explained by the growing presenceof behavioral and socioeconomic risk factors, such as overweight and low income, which disproportionately affect youngercohorts. Our study contributes to the growing literature documenting worsening population health trajectories in countries withadvanced medical systems and highlights the need for public health strategies that address both behavioral and structuraldeterminants to promote healthy aging.