Two Major Studies Reveal Deteriorating US Mortality Trends
A convergence of research shows that the United States has experienced a steady rise in excess deaths since 1999, a sharp reversal in cardiovascular gains, and a generational shift toward worsening health.
Excess Deaths in the US Compared to Peer Nations (1999-2022)
A study published in JAMA Network Open analyzed the causes of excess deaths in the United States compared to 17 other high-income countries from 1999 to 2022. Using a repeated cross-sectional design, researchers drew data from the World Health Organization Mortality Database and the Human Mortality Database. The analysis covered 63.5 million US deaths, of which 12,675,646 were identified as excess.
Key Findings
Overall Trend
Annual excess deaths increased steadily before the COVID-19 pandemic, surged in 2020 and 2021, and remained high in 2022. Annual excess deaths rose from 346,166 in 1999 to 905,159 in 2022.
Circulatory Diseases
This was the leading cause of excess deaths every year except 2010. Excess deaths from circulatory diseases declined by an average of 7,809 per year from 1999 to 2009, then increased by an average of 15,474 annually from 2009 to 2019. In 2022, circulatory death rates were 1.63 times higher in the US than in peer countries.
Deaths attributed to drug poisonings, alcohol, and suicide rose from -5,762 in 1999 to 131,151 in 2022.
Deaths of Despair
Deaths attributed to drug poisonings, alcohol, and suicide contributed increasingly to the excess. In 2022, drug poisoning deaths were 7.48 times higher in the US than the peer average.
Other Drivers
- Metabolic conditions: 2.25 times the peer average
- Homicide: 14.25 times the peer average
- HIV/AIDS: 6.16 times the peer average
COVID-19 accounted for 19% of excess deaths in 2020, 23% in 2021, and 10% in 2022. Excess deaths from other causes also increased during the pandemic period.
Mortality Burden
The cumulative burden over the 24-year period was estimated at 314,307,151 excess years of life lost.
Limitations included potential differences between countries in death certification, coding practices, diagnostic patterns, data completeness, imputation assumptions, and pandemic-era reporting.
US Life Expectancy Stagnation and Cohort Trends (1979-2023)
A second study, published in the Proceedings of the National Academy of Sciences, analyzed changes in US mortality from 1979 to 2019, with additional data extending to 2023. The research examined how cardiovascular deaths, external causes, and generational health patterns relate to US life expectancy trends.
Life Expectancy Trends
The US experienced a slowdown in life expectancy gains, with an improvement of only 0.26 years between 2010 and 2019. This compares to an average gain of 1.78 years per decade over the preceding five decades. While a slowdown is present in other high-income countries, the US trend is more pronounced.
Previous studies attributed the stagnation to suicides, alcohol-related deaths, drug overdoses, and a plateau in the decline of cardiovascular disease (CVD) deaths.
Methodology
Researchers used Lexis diagrams and regression models to analyze mortality data by year, age, and cause of death. Data sources included the National Vital Statistics System and the Human Mortality Database. The study included cohorts born between the 1890s and the 1980s and evaluated all-cause mortality, cancer deaths, CVD mortality, and deaths from external causes.
Key Cohort Findings
1950s Birth Cohorts
These cohorts displayed higher overall mortality rates compared to preceding generations at nearly all adult ages. Females in these cohorts showed elevated CVD mortality.
Mortality Deterioration Post-2010
A broad worsening of mortality began around 2010, affecting most adults alive at that time, primarily driven by changes in CVD mortality.
The 1950s birth cohort represents a transitional period, shifting from generally improving mortality to worsening trends.
Younger Cohorts (1970-1980s)
Mortality increases were observed for individuals aged 30 to 45 years in the 2010s.
Cancer Mortality
While overall cancer mortality improved for many cohorts, the 1950-1959 cohorts exhibited higher or stagnant mortality declines, especially among females. Cohorts born between 1970 and 1985 also showed adverse cancer patterns at younger adult ages.
External Causes of Death
Deaths from external causes (including drug overdoses, suicides, traffic accidents, and homicides) declined from 1980 to 1995 but increased afterward. The 1950-1959 cohorts showed higher rates at ages 40-69, with progressively higher rates noted in cohorts born between 1970 and 1989. Drug overdose deaths rose sharply from the late 1990s. Suicide mortality among females worsened from 2000, affecting all cohorts by 2010.
Impact of COVID-19 Pandemic
The years affected by the COVID-19 pandemic (2019-2023) saw an increase in mortality from all causes, external causes, cancer, and CVD across most cohorts analyzed. CVD mortality increased from 2019 to 2022 before showing some recovery by 2023.
Conclusion
The study concludes that the 1950s birth cohort represents a transitional period, shifting from generally improving mortality in earlier cohorts to worsening trends in later ones. The broad mortality deterioration observed around 2010, largely due to CVD mortality, indicates a complex and multifaceted situation. The authors suggest this may signal a risk of prolonged stagnation or further declines if current cohort trends persist.