Why Are So Many Americans Still Dying Young?

It’s no secret that life expectancy in the United States hasn’t kept up with that in other wealthy countries, generally trailing around four years behind countries like France and Canada, and nearly 7 years behind Japan. 

It’s easy to look at these numbers and picture Americans dying at 79 while residents in other countries die at 83 or later. However, it’s important to realise that life expectancy is an average – a large part of why life expectancy is lower in the US is that many Americans die young and bring down that average substantially. There are all kinds of reasons for this including higher rates of obesity, drug abuse, homicide and infant mortality (which drags the average down more than anything else), all compounded by poor healthcare access.

To make matters worse, life expectancy dropped sharply during the COVID-19 pandemic, which hit the US especially hard. COVID-19 is most dangerous for the elderly, but also significantly increases mortality among younger adults. Now, a new study published in The Journal of the American Medical Association (JAMA) has further investigated the impact of the pandemic on early adult mortality, and shows how COVID-19 is far from the only reason early adult mortality has increased.

The graph above shows excess deaths among US adults aged 25-44, broken down by cause. ‘Excess deaths’ refers to the number of deaths that exceed what would be expected based on historical trends – in this case researchers used data from 1999 to 2010 as a baseline, analysing nearly 3,4 million deaths between 1999 and 2023. Unsurprisingly, excess deaths increased substantially during the pandemic years with COVID-19 itself being the largest cause of the increase, though most other causes of excess death also rose substantially, which may be mostly explained by strain placed on healthcare systems.

What happened in 2023 might come as more of a surprise: despite the substantial reduction in excess deaths from COVID-19, non-covid excess deaths did not decrease much. Overall, excess deaths in 2023 were 70% higher than predicted by pre-2011 trends. Some causes of death, like cancer and transport related deaths, even continued to increase relative to expected mortality.

So, why were excess deaths in 2023 so much higher than pre-pandemic levels? Healthcare disruptions continued even after the pandemic ended due to backlogs. Also, it’s important to keep in mind that people whose treatment was delayed due to the pandemic won’t necessarily die during the pandemic. Someone whose cancer was not detected early enough due to the pandemic might still live with cancer for another 5 years, so the impact of the pandemic on mortality from other diseases is going to last a long time. Some people might also have avoided going to the doctor during the pandemic due to fear of infection, leading to treatable problems going undetected. Some researchers are concerned that long-term effects of Covid (AKA ‘long Covid’) may also be driving up the risk of other diseases like cardiovascular disease. Other causes of death like drug poisoning, alcohol, suicide and homicide might be explained by the direct and indirect economic and social impacts of the pandemic.

It should also be noted that excess deaths were already on the rise before the pandemic began (largely due to opioid and alcohol use but also a steady rise in excess cancer deaths) and probably would have continued to rise even had the pandemic not occurred.

All that said, it’s still somewhat surprising how high excess mortality in younger US adults remained after the pandemic ended, especially compared to other developed countries in which life expectancy rebounded more (though still not returning to pre-pandemic levels). Previous studies have also noted how mortality among young people in the United states seems to have been disproportionately impacted by the pandemic compared to other developed countries. It is probable that factors like economic and social inequality and a lack of healthcare access significantly worsened the indirect impacts of COVID-19, which otherwise should not have harmed this age group as much.

We spend a lot of time thinking about the biological systems behind the ageing process and how we can harness them to improve health and life expectancy. We should not forget that societal structures and inequality have severe consequences for longevity in ways that might not be immediately apparent, especially during times of crisis.