Early Death Crisis In America

Their findings indicate that in America over one million annual deaths could be avoided if the nation had mortality rates that were similar to other high-income peer countries, which includes many young working-age adults. The study refers to these excess deaths as “Missing Americans” because these deaths represent people who would otherwise still be alive with rates equal to peer countries. 

“The number of Missing Americans in recent years is unprecedented in modern times,” says Dr. Jacob Bor, the study’s lead and corresponding author and associate professor of global health and epidemiology at BUSPH.

For example, in 2021, 1.1 million deaths could have been averted if the country's mortality rates were in line with other wealthy nations. The researchers report that the level of excess deaths among working-age adults was particularly high, during 2020 and 2021 close to 50% of all Missing Americans died before reaching the age of 65 years old. 

“Think of people you know who have passed away before reaching age 65. Statistically, half of them would still be alive if the U.S. had the mortality rates of our peers,” Dr. Bor said. “The U.S. is experiencing a crisis of early death that is unique among wealthy nations.”

The recent pandemic contributed to the increase in mortality, even with the lockdowns, more so than other countries, including Sweden which did not impose lockdowns. However, the findings indicate that the number of excess deaths in America has been steadily increasing over the past 40 years. 

The researchers analyzed mortality trends from 1933-2021 in America which included the impact of the recent pandemic, and then compared their results with age-specific mortality rates from peer nations which included Australia, Canada, Japan, and 18 European Nations. Findings revealed that during WWII America had lower mortality rates than peer nations, and during the 1960s and 70s the mortality rates were similar to peer nations. But this really began to change in the 1980s, increasing year by year reaching 622,534 annual excess deaths by 2019. This climbed to 1,009,467 in 2020 and 1,090,103 in 2021. 

“By using an international benchmark, we show that Americans of all races and ethnicities are adversely affected by the US policy environment,” said Jacob Bor, Associate Professor of Global Health and Epidemiology. 

The researchers noted that the mortality crisis is a multiracial phenomenon, and it is not specific to any single group of people including minority groups. But, during early adulthood from ages 15-44 years old, the mortality rates among Black and Native Americans were five and eight times higher than the average of other wealthy peer nations. However, two-thirds of the Missing Americans are White, and the death rates among White Americans are significantly higher than in other wealthy peer nations. 

"Living in the US is a risk factor for early death that is common across many US racial and ethnic groups. Whereas most health disparities studies assess differences between US racial/ethnic groups, such an approach renders the poor health of Whites invisible and grossly underestimates the health shortfall of minoritized groups," Dr. Bor says. "By using an international benchmark, we show that Americans of all races and ethnicities are adversely affected by the US policy environment, which places a low priority on public health and social protections, particularly for low-income people."

Dating back to 1980 there has been an alarming 13.1 million Missing Americans, according to the researchers. In terms of future years of life lost due to premature death, the researchers estimate that their findings represent a translated excess mortality of 26.4 million years of life lost during 2021 relative to the mortality rates of other wealthy peer nations. The researchers connect the massive excess mortality burden to the astounding failure of US policy to adequately address major public health issues such as the opioid epidemic, the obesity epidemic, economic inequality, food insecurity, workplace safety, mental health, access to healthcare, and environmental pollution. 

"We waste hundreds of billions each year on health insurers' profits and paperwork, while tens of millions can't afford medical care, healthy food, or a decent place to live," says study senior author Dr. Steffie Woolhandler, Distinguished Professor at the School of Urban Public Health at Hunter College, City University of New York. "Americans die younger than their counterparts elsewhere because when corporate profits conflict with health, our politicians side with the corporations."

The researchers are not very optimistic that the mortality rates will reverse in the near future. However, they are interested in exploring a number of questions that arose from this study that will be critical to address to help level out the excess deaths such as which geographic areas are disproportionately responsible for the Missing Americans, what were their causes of death, and how might they have been avoided? 

“The U.S. was already experiencing more than 600,000 Missing Americans annually before the pandemic began, and that number was increasing each year. There have been no significant policy changes since then to change this trajectory,” Dr. Bor adds.

“While COVID-19 brought new attention to public health, the backlash unleashed during the pandemic has undermined trust in government and support for expansive policies to improve population health,” Bor concludes. “This could be the most harmful long-term impact of the pandemic, because expansion of public policy to support health is exactly how our peer countries have attained higher life expectancy and better health outcomes.”