Mortality rates for young American adults have jumped 71% in just over a decade

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Study analyzes what’s behind the silent crisis that’s killing Americans in their prime

Mortality rates for Americans aged 25 to 44 have jumped 71.2% in just eleven years, from about 140 deaths per 100,000 people in 2010 to 239 per 100,000 in 2021. No other age group is as close to this increase. Overdoses, suicides, car accidents and chronic illnesses appearing at younger and younger ages are now killing people in the prime of their lives.

Steven H. Woolf, a physician and researcher at Virginia Commonwealth University School of Medicine, published the analysis in The quarterly Milbank. It combined data from the United Nations, the CDC, the Organization for Economic Cooperation and Development and a U.S. mortality database to show how far American life expectancy has fallen behind the rest of the developed world and, increasingly, much of the developing world as well.

In 2023, life expectancy in the United States ranked 38th among countries with more than 1 million people, behind not only Western Europe, Canada, Japan, and Australia, but also Chile, Costa Rica, Slovenia, Israel, South Korea, and several Persian Gulf countries. Sixty countries had a lower risk of death before age 40 than the United States. This gap did not widen overnight. It has expanded since the 1990s, and accelerated significantly after 2010.

How researchers tracked rising death rates

Woolf constructed this analysis by comparing decades of death records rather than conducting a new clinical trial or investigation. It pulled data from the United Nations Department of Economic and Social Affairs, the U.S. Mortality Database, the CDC’s death database known as WONDER, and OECD data covering 16 other wealthy countries, including Canada, Japan, France, Germany, and the United Kingdom. It tracked age-specific death rates from 1999 to 2023, categorized into five groups: infants, youth ages 1 to 24, young adults ages 25 to 44, middle-aged adults ages 45 to 64, and adults ages 65 and older.

A separate part of the study looked at all 50 states starting in 1941, comparing life expectancy data each year to the political party of the sitting governor to see whether state policy choices matched health outcomes over time.

What explains the rising death rates among young Americans

Drug overdoses top the list. Among adults ages 25 to 44, the overdose death rate increased sevenfold after 1999, from about 7.7 per 100,000 to more than 54 per 100,000, and surpassed circulatory diseases (such as heart disease and stroke) in 2015 to become the leading cause of death in this age group. Suicide rates in this same group are higher than in any other age group and have climbed more than 40% between 2000 and 2023. Homicides increased 75.5% between 2014 and 2021, and deaths from car and other transportation accidents increased 43.5% during the same period.

What has surprised even the closest followers of these trends is the extent of the damage that now comes from illness rather than injury. Deaths from diabetes and other metabolic and hormonal diseases increased by almost a quarter between 2010 and 2019 among young adults. Deaths linked to liver damage due to alcohol consumption more than doubled between 2010 and 2023. Deaths due to alcohol-related mental health disorders more than tripled during the same period. Even high blood pressure, historically a problem later in adulthood, saw its mortality rate more than double among 25- to 44-year-olds between 2000 and 2023.

Middle-aged adults, ages 45 to 64, have experienced many of the same trends: an increase in deaths from drug overdoses, liver damage from alcohol use, and diseases of the brain and nervous system, as well as a death rate from COVID-19 that nearly doubled between 2020 and 2021, even after vaccines became available. Older people have largely avoided these sharp increases, although deaths from brain and nerve diseases doubled between 2000 and 2023, and deaths from endocrine disorders and suicide also increased.

Where life expectancy in the United States has fallen the most

National averages hide brutal local realities. Comparing each state to countries with similar life expectancies, Woolf found that Hawaii, the best-performing state, matched the life expectancy of Western European countries like Sweden and Ireland. Mississippi, on the other hand, resembled Libya, Venezuela, Belarus and Syria in 2019. Conditions deteriorated after the COVID-19 pandemic. In 2021, life expectancy in West Virginia and Mississippi was comparable to that of Bulgaria, Bangladesh, and Iraq, and was lower than that of North Korea and Syria. Life expectancy was higher in Palestine and Iran than in nine U.S. states, including Oklahoma, Tennessee, Kentucky, Alabama and Mississippi.

Woolf’s review of state data dating back to 1941 found that states led by Republican governors tended to see life expectancy stagnate or decline, a trend that became particularly visible after 2010 and turned into what Woolf calls a “natural experiment” during the COVID-19 pandemic. States’ vastly different decisions on masking, business closures and vaccinations, he writes, could be measured in the number of deaths within weeks. Red states, the analysis notes, suffered the largest declines in life expectancy in the COVID era, a trend that held even after researchers took into account other factors such as poverty rates and existing health problems.

Other researchers cited in the review, who looked at generational patterns rather than state policy, found that Americans born after 1970 had higher mortality rates from heart disease, cancer and injuries than previous generations. They concluded that the current blockage in life expectancy in the United States stems from “social, biological, and generational forces at multiple levels.”

Why US death rates continue to climb

Woolf’s analysis identifies five broad categories behind America’s health disadvantage: a health care system without universal coverage, riskier individual behaviors like higher calorie consumption and gun ownership, greater income inequality and greater poverty, a built environment that favors driving over walking and green space, and public policies that place less emphasis on collective well-being than do peer countries. None of these explanations are new, but the article argues that treating overdoses, suicides and chronic illnesses as separate problems ignores the bigger picture: They are symptoms of the same underlying neglect.

This is the most pointed point in the document, and probably the one worth addressing. Other rich countries have not managed to extend life by chance. They implemented universal health coverage, stronger safety nets, and stronger consumer and environmental protections decades ago, and it shows up in their citizens’ death certificates today. America’s problem has never been a lack of ideas to solve this problem. There is a lack of political will to act, and until that changes, the gap between the lifespans of Americans and the lifespans of people in dozens of other countries seems likely to continue to widen.

Disclaimer: This article summarizes a single peer-reviewed analysis published in The Milbank Quarterly and reflects the results and conclusions of its author, Steven H. Woolf. The study is a narrative analysis of existing mortality data rather than a controlled experiment. It can therefore show associations between state leadership, policy, and health outcomes, but cannot alone prove that a specific policy caused a specific number of deaths. The author notes that factors such as poverty, education, smoking and obesity can also contribute. Interpretations of politics and political leadership belong to the author. This content is for informational purposes only and does not constitute medical, health, or political advice.