Between 2022 and 2023, there were 1.5 million “missing Americans” according to new research. That figure refers to excess deaths – people who would be alive had the US had a mortality rate on par with similar countries. While excess deaths had been steadily increasing for decades, the numbers have failed to fully recover from the peaks seen at the height of the COVID-19 pandemic, prompting questions about what could be driving this.
COVID-19 hit the US harder than other high-income countries, causing bigger spikes in mortality rates in 2020 and 2021. In a pandemic that has claimed the lives of over 7 million people worldwide to date, according to World Health Organization data, over 1 million of those have been in the United States.
But the new study was specifically concerned with excess deaths – deaths that would not have occurred had the mortality rate in the US been the same as in other high-income countries. That statistic had been trending in a concerning direction for years before COVID came on the scene.
“The US has been in a protracted health crisis for decades, with health outcomes far worse than other high-income countries,” said study lead Dr Jacob Bor, associate professor of global health and epidemiology at Boston University School of Public Health (BUSPH), in a statement.
“This longer-run tragedy continued to unfold in the shadows of the COVID-19 pandemic.”
Between 1980 and 2023, the country saw an estimated 14.7 million excess deaths in total. By 2023, excess deaths accounted for almost 23 percent of all deaths in the US. The peak of the pandemic in 2021 saw a high of almost 1.1 million excess deaths in that year alone; 2023’s figure of 705,331 may sound like a step in the right direction, but that’s still tens of thousands above the 2019 number.
Younger, working-age Americans appear to be disproportionately affected. The study found that 46 percent of all US deaths in under-65s would not have occurred if the age-group-specific mortality rates had matched those of other countries.
(A) Trends in mortality rates in the US and other high-income countries between 1980 and 2023; (B) age-specific mortality rates in the US vs. the average of other high-income countries; (C) excess deaths attributable to the US mortality disadvantage; and (D) the trend in excess deaths during and post-pandemic extrapolated out from pre-pandemic levels.
Image credit: Boston University School of Public Health
Even with a pandemic, a huge increase in excess deaths was not a foregone conclusion. Recent research from the Organization for Economic Cooperation and Development (OECD) found that nine countries, including New Zealand, Norway, and Ireland, actually registered no excess deaths during the worst years of the pandemic, 2020-22.
The study compared the US data with 21 other high-income countries, including the UK, Canada, and Japan. Senior author Dr Andrew Stokes, also at BUSPH, highlighted the policy gap between the US and its wealthy peer nations, things like universal healthcare and broader social welfare systems.
“These deaths reflect not individual choices, but policy neglect and deep-rooted social and health system failures,” said Stokes.
“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,” said co-author Dr Elizabeth Wrigley-Field of the University of Minnesota, who also offered some suggestions as to the causes. “These deaths are driven by long-running crises in drug overdose, gun violence, car collisions, and preventable cardiometabolic deaths.”
The authors agree that further research is needed to fully understand the driving factors behind excess mortality, but suggest looking to other nations for inspiration on successful social programs would be a good start.
However, recent policy decisions by the Trump administration have Bor concerned for the future.
“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.”
“Imagine the lives saved, the grief and trauma averted, if the US simply performed at the average of our peers,” Bor added. “One out of every two US deaths under 65 years is likely avoidable. Our failure to address this is a national scandal.”
The study is published in the journal JAMA Health Forum.
Source Link: “Missing Americans”: US Excess Deaths Still Above Pre-COVID Levels, Upwards Of 1 Million
