A. Traits in US mortality charges, mortality charges of different HICs, and common mortality charges in different HICs standardized to the US age distribution in every year (1980–2023). B. Age-specific mortality price ratios evaluating US mortality charges to the common of different HICs (2014–2023). C. Extra deaths attributable to the US mortality drawback (1980–2023). D. Linear extrapolation of the prepandemic development in extra deaths over the interval from 2020 to 2023. Credit score: Boston College Faculty of Public Well being
There have been over 1.5 million “missing Americans” in 2022 and 2023, deaths that will have been averted if US mortality charges matched these of peer international locations. Extra US deaths have been rising for many years, with working-age adults disproportionately affected, and this development continued throughout and after the pandemic.
In 2022 and 2023, greater than 1.5 million deaths would have been averted if america had mortality charges just like different high-income international locations, in response to a brand new research led by Boston College Faculty of Public Well being (BUSPH) researchers.
Printed in JAMA Well being Discussion board, the research refers to those extra deaths as “missing Americans” as a result of these deaths mirror individuals who would nonetheless be alive if US mortality charges have been equal to the common mortality price in different high-income international locations.
The findings reveal a unbroken and worrying development in worsening US mortality in comparison with different rich nations during the last 4 many years.
Whereas extra deaths per yr peaked on the peak of the COVID-19 pandemic in 2021, extra deaths in 2023 nonetheless far exceeded prepandemic ranges in 2019 and intently matched the rising pre-pandemic development.
After rising steadily since 1980, extra US deaths reached 1,098,808 in 2021, earlier than dropping to 820,396 in 2022 and 705,331 in 2023, after the acute section of the pandemic. Nonetheless, the 2023 determine was nonetheless tens of 1000’s of deaths greater than the 2019 whole of 631,247 lacking People.
“The US has been in a protracted health crisis for decades, with health outcomes far worse than other high-income countries,” says research lead and corresponding creator Dr. Jacob Bor, affiliate professor of world well being and epidemiology at BUSPH. “This longer-run tragedy continued to unfold in the shadows of the COVID-19 pandemic.”
Extra mortality is a nationwide drawback, however the research revealed one other staggering, but persistent, statistic about youthful and working-age People: 46% of all US deaths amongst individuals beneath 65 years outdated wouldn’t have occurred if the US had the age-specific loss of life charges of its friends.
This age-related disparity was evident earlier than, throughout, and after the pandemic, and the 2023 extra loss of life price was solely barely decrease than it was in 2021, at 50%, a discovering detailed in a earlier research by the researchers.
“Imagine the lives saved, the grief and trauma averted, if the US simply performed at the average of our peers,” Dr. Bor says. “One out of every two US deaths under 65 years is likely avoidable. Our failure to address this is a national scandal.”
For the research, Dr. Bor and colleagues from BUSPH, the College of Minnesota, Hunter School, Metropolis College of New York, and the Cambridge Well being Alliance analyzed developments in US deaths from 1980 to 2021 after which in contrast these developments with age-specific mortality charges within the US and 21 different high-income international locations, equivalent to Australia, Canada, France, Japan, and the UK.
The evaluation included 107,586,398 deaths within the US and 230,208,265 deaths within the different 21 international locations. Between 1980 and 2023, there have been roughly 14.7 million extra US deaths relative to what would have been noticed if the US had the mortality charges of its friends. In 2023, extra deaths accounted for almost 23% of all deaths within the US.
The COVID-19 pandemic sharply exacerbated the rise in US deaths in 2020 and 2021, extra so than in different international locations, and with long-lasting penalties that proceed to be realized. However the persistent disparity in US mortality compared to its friends is essentially pushed by crises that started lengthy earlier than the pandemic.
“The 700,000 excess American deaths in 2023 is exactly what you’d predict based on prior rising trends, even if there had never been a pandemic,” mentioned research co-author Dr. Elizabeth Wrigley-Discipline, affiliate professor of sociology on the College of Minnesota.
“These deaths are driven by long-running crises in drug overdose, gun violence, car collisions, and preventable cardiometabolic deaths.”
“These deaths reflect not individual choices, but policy neglect and deep-rooted social and health system failures,” says senior creator Dr. Andrew Stokes, affiliate professor of world well being at BUSPH. “The COVID-19 pandemic exposed structural weaknesses—including gaps in health care access and social supports—that have continued to fuel premature deaths even after the acute phase of the pandemic ended.”
Dr. Stokes co-authored a separate research that discovered that drug-related deaths have been the one largest reason for mortality amongst adults aged 25–44.
Future analysis is required to pinpoint particular causes of the US’ disparity in mortality charges, however the researchers say the nation ought to look to the insurance policies of its peer international locations for perception into decreasing well being inequities and enhancing inhabitants well being outcomes.
“Other countries show that investing in universal health care, strong safety nets, and evidence-based public health policies leads to longer, healthier lives,” says Dr. Stokes. “Unfortunately, the US faces unique challenges; public distrust of government and growing political polarization have made it harder to implement policies that have proven successful elsewhere.”
The whirlwind of government actions and insurance policies enacted beneath the second Trump administration additionally threaten to stymie the potential for these developments, Dr. Bor says.
“Deep cuts to public health, scientific research, safety net programs, environmental regulations, and federal health data could lead to a further widening of health disparities between the US and other wealthy nations, and growing numbers of excess—and utterly preventable—deaths to Americans.”
Extra data:
Extra Deaths Earlier than, Throughout, and After the COVID-19 Pandemic, JAMA Well being Discussion board (2025). DOI: 10.1001/jamahealthforum.2025.1118
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Boston College
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US extra deaths proceed to rise even after the COVID-19 pandemic, research finds (2025, Might 23)
retrieved 24 Might 2025
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