US mortality rates outpace peer nations as young adult deaths rise

Research in The Milbank Quarterly reveals that for decades, US mortality rates have exceeded rates in peer countries and have been increasing across many causes of death, especially in young adults and people living in certain regions of the country.

Investigators found that the increase is being driven not only by external causes of death-notably drug overdoses, suicides, and homicides-but also rising mortality from hypertensive, liver, endocrine, and neurologic diseases, among others. COVID-19 added substantially to excess deaths, but non-COVID causes continued to claim lives even as the pandemic waned.

Potential systemic contributors may relate to health care, individuals' behaviors, income inequality, the physical and social environment, and public policies and social values. State-level policies may also explain why certain regions in the United States, such as the Deep South and Appalachia, as well as rural communities, have higher mortality rates than other areas.

We know how to solve this. Other countries that have outperformed the United States for decades have demonstrated that better health outcomes are possible. What we lack in the United States is not solutions but political will."

Steven Woolf, MD, MPH, corresponding author, Virginia Commonwealth University