Even as Americans live longer, they spend more of their years in poor health than any other country, a new study shows.

People in the U.S. live with illness for 12.4 years on average — up from 10.9 years in 2000, according to a study published by the American Medical Association Wednesday.

The U.S. offers the starkest illustration of a so-called healthspan-lifespan gap that is widening around the world, as chronic illnesses take up larger portions of people’s lives. While life expectancy has long been a standard measure of public health, researchers are increasingly focused on health-adjusted life expectancy, which tracks the number of years people live in good health.